Diabetes cured by Surgery to Treat Obese

Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did — 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery. Type 1 diabetes, a much less common form of the disease, involves the immune system and is not linked to obesity.

Remission of Type 2 diabetes after weight-loss surgery is not a new finding; doctors have known about it for years. But the new research is the first effort to find out scientifically how it measures up against medical treatment in similar groups of patients with the disease.

The 60 people in the study had an average age of 47 and were assigned at random to have either surgery or medical care. All were obese, with a body mass index, or B.M.I., of 30 to 40. A B.M.I. over 25 is considered overweight, and over 30 is obese. (A person who is 5 feet 6 inches tall with a B.M.I. of 25 would weigh 155 pounds; with a B.M.I. of 30, 186 pounds; a B.M.I. of 35, 216 pounds; and a B.M.I. of 40, 247 pounds.)

Based on guidelines created by the National Institutes of Health in 1991, weight-loss surgery is generally only recommended for people whose B.M.I. is 40 or more, unless they also have Type 2 diabetes, in which case a B.M.I. of 35 is the cutoff. In this study, 13 people, or 22 percent, had a B.M.I. under 35.

Criteria for the surgery might be changed so that it could be offered to diabetes patients early enough to reverse the disease.

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