Surgery not magic answer for diabetes

Special to the Herald-LeaderJanuary 6, 2013 

Over the past year, news headlines have suggested that Type 2 diabetes and obesity can be safely "cured" by bariatric surgery.

Patients who undergo this surgery, which bypasses part or all of the stomach, typically lose weight rapidly and may no longer need diabetes medication when they leave the hospital.

Surgery, however, has its own risks, including a significant number of complications that require re-hospitalization. In addition, follow-up studies demonstrate that many patients regain weight and have a re-emergence of their diabetes.

Although we do not fully understand why blood sugars normalize so rapidly after bariatric surgery, a study presented at the 2012 Obesity Society International compared low-calorie dieting to surgery. The study found equivalent effects on insulin and blood sugar levels, suggesting that a dramatic drop in calorie intake is the initial key.

The focus of diabetes therapy is prevention: Avoid or minimize the impact of damage to the eyes, kidneys, nerves and blood vessels. The usual therapeutic approach is to control blood sugars as much as is safely possible. This usually requires multiple medications and weight gain is a common side effect.

However, most people with Type 2 diabetes are already obese, and further weight gain as a result of well-intentioned therapy can increase psychological and physical distress. Weight gain means higher medication dosages and longer medication lists.

An estimated 70 million Americans have prediabetes, a condition marked by elevated blood sugar that can result eventually in diabetes. More than a decade ago, three landmark studies demonstrated that changes in diet and activity resulting in modest (5-7 percent) weight losses prevented diabetes in nearly 60 percent of those with prediabetes.

Of course, weight loss and maintenance seem to be unreachable goals for many people, especially those with diabetes. However, even modest reductions in calorie intake and increases in physical activity reduce blood sugars, resulting in lower medication requirements. A 20-minute walk after a meal can lower blood sugar by 30 percent compared to prolonged sitting.

Weight loss is the most powerful tool that we have against obesity-related diabetes, but success requires behavioral change that is difficult in our calorie-rich environment. Willpower alone cannot be depended upon. Our primitive ancestors programmed us with a survival gene that tells us: "Eat food within reach or you may starve."

Behavioral change starts with goal-setting and establishing accountability. This usually requires a whole new set of skills, not easily acquired without coaching or professional assistance. Studies now show that participation in a weight-loss program can have long-lasting benefits and is cost-effective.

Those who are successful share some common behaviors: eating breakfast, self-monitoring weight, recording food intake, eating more fruits and vegetables, daily physical activity, and limited screen (computer/TV) time outside of work.

So if you have prediabetes or diabetes, consider making a commitment to embark on a healthier lifestyle to improve your well-being and reduce your medication needs. Discuss with your doctor a referral to a professional or program to provide proper guidance and supervision to acquire new skills necessary for success.

Dr. L. Raymond Reynolds is a professor of endocrinology and molecular medicine, and is clinical director of the Barnstable Brown Kentucky Diabetes and Obesity Center.

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