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Weight loss surgery mayhelp with Type 2 diabetes
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CHICAGO — New research gives clear proof that weight-loss surgery can reverse and possibly cure diabetes, and doctors say the operation should be offered sooner to more people with the disease — not just as a last resort.
The two studies, released Monday, are the first to compare stomach-reducing operations to medicines alone for “diabesity” — Type 2 diabetes brought on by obesity. Millions of Americans have this and can’t make enough insulin or use what they do make to process sugar from food.
Both studies found that surgery helped far more patients achieve normal blood-sugar levels than medicines alone did.
The results were dramatic: Some people were able to stop taking insulin as soon as three days after their operations. Cholesterol and other heart risk factors also greatly improved.
Doctors don’t like to say “cure” because they can’t promise a disease will never come back. But in one study, most surgery patients were able to stop all diabetes drugs and have their disease stay in remission for at least two years. None of those treated with medicines alone could do that.
“It is a major advance,” said Dr. John Buse of the University of North Carolina at Chapel Hill, a leading diabetes expert who had no role in the studies. Buse said he often recommends surgery to patients who are obese and can’t control their blood-sugar through medications, but many are leery of it. “This evidence will help convince them that this really is an important therapy to at least consider,” he said.
There were signs that the surgery itself — not just weight loss — helps reverse diabetes. Food makes the gut produce hormones to spur insulin, so trimming away part of it surgically may affect those hormones, doctors believe.
Weight-loss surgery “has proven to be a very appropriate and excellent treatment for diabetes,” said one study co-leader, Dr. Francesco Rubino, chief of diabetes surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center. “The most proper name for the surgery would be diabetes surgery.”
The studies were published online by the New England Journal of Medicine, and the larger one was presented Monday at an American College of Cardiology conference in Chicago.
More than one-third of American adults are obese, and more than 8 percent have diabetes, a major cause of heart disease, strokes and kidney failure. Between 5 million and 10 million are like the people in these studies, with both problems.
For a century, doctors have been treating diabetes with pills and insulin, and encouraging weight loss and exercise with limited success. Few very obese people can drop enough pounds without surgery.
Surgery offers hope for a long-term fix. Gastric bypass is the most common type: Through “keyhole” surgery, doctors reduce the stomach to a small pouch and reconnect it to the small intestine.
One previous study tested stomach banding, a less drastic and reversible procedure for limiting the size of the stomach. This technique lowered blood sugar, but those patients had mild diabetes. The new studies tested permanent weight-loss surgery in people with longtime, severe diabetes.
At the Cleveland Clinic, Dr. Philip Schauer studied 150 people given one of two types of surgery plus standard medicines or a third group given medicines alone. Their A1c levels — the key blood-sugar measure — were over 9 on average at the start. A healthy A1c is 6 or below.
One year after treatment began, only 12 percent of those treated with medicines alone were at that healthy level, versus 42 percent and 37 percent of the two groups given surgery.
Use of medicines for high cholesterol and other heart risks dropped among those in the surgery groups but rose in the group on medicines alone.
“Every single one of the bypass patients who got to 6 or less got there without the need for any diabetes medicines. Almost half of them were on insulin at the start. That’s pretty amazing,” said a study co-leader, Dr. Steven Nissen, the Cleveland Clinic’s cardiovascular chief.

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From the book 'Outliers' comes proof that good health is more than just genetics
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Friends Jim Young, left, Mike Natale, Jeff Natale and Ryan Kiernan were on Greenwich High School football team together and Jim and Mike were captains. Jim, who was the youngest in Sherry Young's family, was welcome in the homes of the other three boys who still had siblings around and grandparents near. - photo by Sherry Young
As I look back on my life and the lives of others, both personally and in the reading I have done, I am convinced of the necessity of positive human contact in our lives. We are doubly blessed when we are able to make good friends or are a part of a family where we are accepted and loved.

Malcolm Gladwell in his book Outliers tells of a time in the 1950s when Dr. Stewart Wolf met a physician who practiced in the area of Roseto, Pennsylvania. Roseto was settled by a group of Italian families from Roseto, Italy, who re-created their life again in America.

This was in the 1950s before drugs and measures to prevent heart disease became important. In their conversation the physician said, You know, Ive been practicing for 17 years. I get patients from all over, and I rarely find anyone from Roseto under the age of 65 with heart disease.

Wolf was surprised by these words as, It was impossible to be a doctor, common sense said, and not see heart disease.

Wolf enlisted the aid of a sociologist and friend John Bruhn to help him. They found, There was no suicide, no alcoholism, no drug addiction, and very little crime. They didnt have anyone on welfare. Then we looked at peptic ulcers. They didnt have any of those either. These people were dying of old age. Thats it.

They checked into diet, genetics and possibilities of something in the foothills of eastern Pennsylvania but nothing made sense.

What they found was that Rosetans visited one another, stopping to chat in Italian on the street, say, or cooking for one another in their backyards. (Researchers) learned about the extended family clans that underlay the towns social structure. They saw how many homes had three generations living under one roof and how much respect grandparents commanded. They went to Mass at Our Lady of Mount Carmel and saw the unifying and calming effect of the church. They counted 22 separate civic organizations in a town of just under 2,000 people. They picked up on the particular egalitarian ethos of the community, which discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.

What they found eventually convinced the medical establishment to look beyond the individual and understand the culture people are part of their friends, families and town they came from. They determined that the people we surround ourselves with and the values of the world we inhabit have a profound effect on who we are.

Likely, this study could have been done with other ethnicities. However, my family's experiences with the Italian families in Connecticut ring true to the study. Our hungry and growing sons, especially our youngest son, Jim, who was left home alone with two beady-eyed parents, all had some memorable experiences being fed and loved in the Cos Cob multigenerational families. Proof of the African proverb, It takes a village to raise a child.

We live in an age when the contact we have with people often is on the internet, and many of us live among strangers. Unless we make the effort to reach out, we will become isolated, especially as we age. The Rosetan study is proof that reaching out and communicating may be good for our health.
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