Editorial |

Gastrointestinal Surgery as a Treatment for Diabetes

David E. Cummings, MD; David R. Flum, MD, MPH
JAMA. 2008;299(3):341-343. doi:10.1001/jama.299.3.341.
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Approximately one-third of adults in the United States are obese,1 and largely because of this, at least as many have diabetes or prediabetes.2 With these escalating twin epidemics, the health care community has been challenged to develop novel treatment strategies.

In this issue of JAMA, Dixon and colleagues3 report a 2-year study in which patients with recently diagnosed type 2 diabetes and a body mass index (BMI) of 30 to 40 were randomly assigned to receive conventional medical/behavioral therapy (medical therapy and a focus on weight loss through lifestyle modification) or laparoscopic adjustable gastric banding (LAGB) plus conventional medical/behavioral therapy. The results were clear and striking. Complete remission of diabetes at 2 years was achieved in 73% of the patients in the LAGB group vs only 13% of those in the medical/behavioral therapy group, and the former experienced larger reductions in blood glucose levels, glycated hemoglobin levels, estimated insulin resistance, use of diabetes medication, and several features of the metabolic syndrome. No serious surgical complications were reported, and minor surgical mishaps seemed no worse than the adverse reactions to diabetes-related pharmacotherapy.

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