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Recent studies suggest that bariatric surgery may lead to impressive resolutions—or even cures—for people suffering from obesity and type 2 diabetes, a disease affecting more than 20 million people in the U.S.
“Weight loss lowers blood sugar levels and leads to better quality of life,” said David Lautz, MD, director of Bariatric Surgery at BWH. “Weight loss surgery has become a go-to option for obese patients with type 2 diabetes because of the successes we’ve seen.”
However, Allison Goldfine, MD, head of clinical research at the Joslin Diabetes Center, cited recent advances in medical care for patients with type 2 diabetes. “New drugs have become available, and there is a new understanding that patients who participate in medical programs providing multidisciplinary care for diabetes and weight management are more likely to make sustained changes in their lifestyle, which also greatly promote healthy outcomes,” she said.
Lautz and Goldfine are teaming up for a two-year study of which option is most effective for diabetic patients who are overweight, but not obese. They will examine whether patients who have surgery or participate in intensive medical diabetes and weight management programs are more successful in terms of blood sugars and other health measures.
In the SLIMM-T2D (Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes) study, about 100 patients will be assigned randomly to a surgical procedure or to enroll in a medical management program called Why WAIT? (Weight Achievement and Intensive Treatment), which was pioneered at Joslin in 2005.
“Unlike common simple diet and exercise plans that are often
minimally effective, the Why WAIT? lifestyle modification program is a proven tool for weight and diabetes management,” said Goldfine.
Why WAIT? includes adjustments to diabetes medications to enhance weight reduction, a structured diet with regular food and meal replacements, adherence to Joslin nutrition guidelines, weekly learning sessions with an exercise physiologist and an individualized exercise plan and weekly group behavioral modification sessions led by a psychologist. After the 12-week program, participants attend monthly support sessions to maintain their weight loss.
The SLIMM-T2D study is the first to examine patients with relatively mild degrees of excess body weight, by including participants with a body mass index (BMI) in the range of 30 to 42. Bariatric surgery is currently approved for patients with a BMI greater than 35 and at least one other medical condition, such as diabetes. However, because the procedure appears to be so effective in treating type 2 diabetes, researchers are interested in studying whether it might also be effective in treating milder cases of obesity.
Previous observational studies estimate that 60 to 90 percent of bariatric surgery patients who were obese and had type 2 diabetes were later able to maintain normal blood glucose levels without medication. However, patients can achieve marked improvement in their blood sugars when appropriately using FDA approved medications.
The SLIMM-2D study is supported by a grant from the National Institutes of Health funded through the American Recovery and Reinvestment Act of 2009.