Weight loss surgery such as bariatric surgery or where the stomach is banded so that the patient tends to eat less could be the next best weapon against diabetes after insulin.
Australian researchers have found that obese patients with diabetes who had weight loss surgery were five times more likely to get their disease under control than those who dieted.
The study, documented in the Journal of the American Medical Association, is among the first to look at surgery as a potential treatment for obese patients with type 2 diabetes.
Type 2 diabetes is closely linked to obesity and is on the rise worldwide. At least 170 million people are estimated to have the disease and the number is predicted to at least double by 2030.
Bariatric surgery involves altering the digestive system to limit food intake. This type of surgery has been growing at a rapid pace, with the number of procedures rising to 200,000 in the United States in 2006, from just 13,000 in 1998.
The operation is performed through small slits . It involves looping a band around the top of the stomach to reduce it into a small pouch so that people eat less and yet feel full. Other weight-loss operations are more extreme and involve cutting or stapling the stomach and rearranging the small intestine. Of the 205,000 weight-loss operations performed in the United States last year, 25 percent to 30 percent used the gastric banding.
John Dixon of Monash University in Melbourne and colleagues decided to test if surgically induced weight loss could be an effective treatment for type 2 diabetes.
Dixon's team examined 60 obese people with a body mass index greater than 30 but less than 40. Body mass index or BMI refers to a ratio of the height and weight. A BMI of 30 or greater is considered obese.
The subjects were given either surgery or a weight loss program that focused on diet and lifestyle changes.
Those in the surgery group were treated with an adjustable gastric banding device which limited food intake. Both groups also received conventional diabetes medications.
At the end of two years, 73 percent of the diabetics who had surgery no longer had diabetes, compared with 13 percent of those in the diet group. Diabetic subjects who had got surgery also needed far fewer diabetes medications.
On an average the surgical group lost 20.7 percent of their body weight, compared with 1.7 percent in the diet and lifestyle group.
According to researchers, it was the large weight loss, and not the surgery per se, that helped the patients.
"This has important implications as it suggests that intensive weight-loss therapy may be a more effective first step in the management of diabetes than simple lifestyle change," note the researchers.
At the same time , the new results probably do not apply to all patients with type 2 diabetes. In this case, the subjects had fairly mild cases of recent onsets- all had received the diagnosis within the previous two years. According to experts, for people who have more severe and longstanding diabetes, the disease may no longer be reversible, no matter how much weight is lost.