Mary Pickett, M.D., is a lecturer for Harvard Medical School and an assistant professor of medicine at Oregon Health & Science University in Portland, OR. At OHSU, she practices general internal medicine and teaches medical residents and students.

Question:

Is gastric bypass surgery going to be available in the near future for type 2 diabetics?

Answer:

For the right person, gastric bypass surgery can be a successful way to treat obesity and improve health. For a person with diabetes, obesity surgery not only reduces weight, but often can reduce or eliminate the need for diabetes medicines (although this is not guaranteed). Gastric bypass surgery also can improve complications associated with excessive weight, such as high blood pressure and sleep apnea; and it can improve blood cholesterol readings.

So far, obesity surgery is an option if you have diabetes, but only if you are also seriously obese. The National Institutes of Health gathered interested doctors at a "Consensus Conference on Obesity." This group felt that surgical treatments for obesity were worth considering for people who had diabetes if their body mass index (BMI) was above 35.

In January 2008, a study published in the Journal of the American Medical Association demonstrated that obesity surgery can send type 2 diabetes into remission if the surgery is done within the first two years of the person being diagnosed. This study included 55 newly diagnosed diabetics between ages 20 and 60 who were obese. Half of the participants had gastric banding surgery to reduce the size of their stomachs. The other half was treated in the usual way. The people who had surgery lost an average of 21% of their body weight. The other group lost less than 2% on average. Two years after treatment, 73% of those who had surgery (22 out of 29 patients) had blood sugar levels below the number used to diagnose diabetes -- and they were not taking medication! For this group, type 2 diabetes was considered to be "in remission." Only 13% of the group that did not have surgery had a remission at the two-year evaluation.

How long type 2 diabetes will stay in remission is unknown. This study only included people who were newly diagnosed. It is less likely that a person who has had diabetes for many years would have a remission after surgery.

Surgery is not an easy way out of obesity or an easy way out of diabetes. Complications and side effects are possible. Also, surgery for obesity does not enable obese people to eat without strict attention to calories. (You might say it is no "cake-walk.") Losing weight and maintaining the loss after obesity surgery requires a long-term effort by the person to limit calorie intake and remain physically active.