Many weight-loss surgery patients shed Type 2 diabetes along with their pounds
CHAMPAIGN — Type 2 diabetes used to weigh down Peggy Jenvey's life.
It drained her energy. Her blood pressure rose. Her weight was too high, but the medications she had to take made the extra pounds tough to lose, she said.
Eight years ago, the Thomasboro woman took a drastic step.
With her weight hitting more than 300 pounds at the high point and diets failing her, she underwent gastric bypass surgery, one of several surgical procedures done for weight loss.
The surgery helped her shed 120 pounds, and it improved her health almost immediately.
She was able to cut her use of blood-pressure medication in half in two weeks, and she was off all medications — including insulin for her diabetes — within a month, Jenvey said.
These days, all the 59-year-old Jenvey takes is vitamin supplements recommended for people who have had weight-loss surgery. Her weight remains in a healthy range and she's got a lot more energy, she said.
"They won't ever say you're cured of diabetes," Jenvey added. "But in eight years, my blood sugars have all been in the good, normal range."
Dr. Uretz Oliphant, a bariatric surgeon with Carle Physician Group, said it's not completely clear how gastric bypass surgery works to reverse Type 2 diabetes.
But the research continues, and he considers it a valid treatment option for diabetics who have tried and failed to lose weight through diet, he said.
Two studies published in March in the New England Journal of Medicine reinforce Jenvey's experience: One of them, a Cleveland Clinic study, found many of the people with poorly controlled diabetes who underwent either gastric bypass or sleeve gastrectomy for weight loss had "dramatic, quick improvements" in their blood sugar, said the study's leader, Dr. Philip Schauer, a professor of surgery and director of Cleveland Clinic's Bariatric and Metabolic Institute.
"In fact, it wasn't unusual for us to have them weaned off all medications," he said.
Some people went home from the hospital medication-free, and that was just two days after the surgery, Schauer said.
The study didn't address the mechanism for how the surgery works to reverse diabetes, Schauer said. That's coming in follow-up research.
But other studies have suggested an "incretin" effect takes place in which there's a release of hormones from the gut that stimulates the pancreas, particularly the beta cells, to make more insulin, he said.
After a year, the patients who underwent the two forms of surgery for their diabetes lost more weight than those who received intensive medical therapy, and higher percentages of the surgery patients achieved blood sugar in the normal range.
"But we can't explain all the benefits on weight loss alone, because the improvements occur so rapidly," Schauer said.
Oliphant said conventional medical therapy has been somewhat lacking in terms of consistent, long-term diabetes control without complications, partly because some patients don't follow through on their medications and instructions.
The good news is, these studies have shown surgery may offer another option for better long-term control, he said.
Europeans have been using bariatric surgery as a treatment for diabetes for years, and Oliphant has seen it produce dramatic effects for diabetics in his own practice, he said.
"I've seen them taken off their medicines and reverse complications," he added.
The obesity connection
Type 2 diabetes is distinct from Type 1, an autoimmune disease in which the body produces little or no insulin.
With Type 2 diabetes, the body doesn't produce enough insulin or is unable to use it efficiently. Obesity raises the risk for Type 2 diabetes because it affects the regulation of blood sugar levels, and gradually, the body loses the ability to keep blood sugar in a normal range.
People inherit a predisposition for diabetes, but lifestyle can play a major role in setting diabetes in motion.
About 85 percent of people who develop Type 2 diabetes are overweight, according to the National Institutes of Health.
Nearly 8 percent of Champaign County's population now has diabetes, and the rate has steadily been on the rise, according to Carole Murphy, a diabetes educator with Christie Clinic and part of the county's new diabetes coalition.
The coalition was launched last November by a group of local health care providers and agencies that looked at local and national diabetes statistics and decided to work together to reduce its negative effects in the community over the next five years.
From 1996 to 2000, 2.4 percent of the county's population was diabetic. From 2007 to 2009, "we jumped to 6.3 percent. It tripled," Murphy said.
"You start increasing your risk when you become overweight, and obesity just manifests it more quickly," Murphy said.
Nearly 36 percent of adults and 17 percent of children in the U.S. are now obese, according to the latest statistics.
If current trends aren't turned around with better diet, more activity and healthier weights, future projections aren't very promising.
"One in three Americans will have diabetes by 2050, and in the minority population, the projection is one in two will have diabetes, and the cost is astronomical," Murphy said. "It's $174 billion annually, and that's for the treatment."
Diet and diabetes
Dr. Nathan Walker, an internal medicine physician at Christie Clinic, said there are misconceptions about diabetes being a lifelong disease, and he wishes people would talk to their doctors about it.
Statistically, 85 percent of Type 2 diabetes is reversible, primarily through weight loss, he said.
"I fight with that conception that diabetes is incurable," he said.
Walker said he considers surgery an extreme step, fine for those who need it.
But he tries to help others who want to lose the weight through diet with a medical weight loss program at Christie Clinic called Transformations.
Walker said he has seen diabetics on this program reduce their medications in the first weeks.
"A lot have eliminated them completely," he added.
And not just diabetic medications, he said. Blood pressure and cholesterol medications are also reduced or eliminated.
The program is a low-carb diet of less than 1,000 calories a day that combines coaching, education and protein packets.
Patients are intended to remain on the weight-loss diet for three months, cook their own food and purchase the protein products, Walker said. Afterward, he said, patients are switched to a maintenance diet.
Walker said patients who lose 7 percent to 10 percent of their body weight will experience a significant reduction in their blood sugar level, and those who lose 25 percent — what he considers a reasonable loss for most patients — "in my personal experience, that's a cure."
For Christie Clinic employee Julie Welch, 42, of Tolono, the diet may effectively be just that.
Diagnosed with Type 2 diabetes five years ago, Welch underwent a LAP-BAND procedure for weight loss in late 2010, but lost just about 40 pounds when she needed to lose more like 150, she said.
She decided to try the Transformations diet program starting last October, and six months later, says she feels "amazing."
She has lost 60 additional pounds to date for a total 100-pound loss. Just one month into the program, she was off one of the three insulins she was taking, and three months ago, was able to discontinue all three, she said.
"I was so sick of constantly having to stick myself with needles," Welch recalled. "I was doing seven shots a day, all in the stomach, and all of the testing in my finger."
Now? At her last check, Welch said, her blood sugar was just over normal range — though not high enough to need insulin injections — and she's hopeful about the next test coming up.
She's got more energy. She takes the stairs at work and manages the walk from the parking lot downtown to the clinic without being breathless.
"You hardly ever see me using the elevator any more," she said.
Surgery or diet
Losing enough weight can make diabetes go away, Oliphant said. But a significant number of people can't lose the weight through diet alone, or they lose it and it comes back.
"They just can't do it," he said.
For now, Oliphant said, surgery and diet are both treatment options for obesity and diabetes.
"I think the jury is still out on whether there is a surgical cure for diabetes," he added.
Oliphant advocates trying a medically supervised diet first, and if that fails, surgery may be an option.
Patients should also consider the risks and complications involved, both of which are minimal, he said.
Bariatric surgery can cost between $11,500 and $26,000, with insurance coverage varying, and surgical candidates are those with a body mass index of 40, or 35 with an obesity-related disease, according to the American Society for Metabolic & Bariatric Surgery.
For someone 5 feet, 9 inches tall, a BMI of 40 would be a weight of 271 pounds.
The complication rate for gastric bypass surgery is about 5 percent, and the death rate is about 0.5 percent, the organization said.
Jenvey said bariatric surgery isn't an easy way out.
But for her, it's been worth it, she said.
"I'd do it again, but if you think it's an easy fix for weight, it's not. You still have to do the work," she warned.
People must decide for themselves how to pursue a healthier weight, Murphy said. But the risks that come with diabetes are well worth avoiding, she advised.
Diabetics are at higher risk for heart disease, stroke, blindness, kidney damage and nerve damage.
"It's not a disease you can take lightly," Murphy said.
Factors that increase risk for Type 2 diabetes
- Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG).
- Being over age 45.
- Having a family history of diabetes.
- Being overweight.
- Being inactive and failing to exercise regularly.
- Having low HDL cholesterol or high triglycerides, high blood pressure.
- Being certain racial and ethnic groups (non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives).
- If you are a woman, having had gestational diabetes, or having had a baby weighing 9 pounds or more at birth.
Source: American Diabetes Association