Gastric bypass surgery helps diabetes but doesn't cure it

People with earlier, less severe diabetes benefit more in HMO Research Network study

2012-11-27

(Press-News.org) SEATTLE—After gastric bypass surgery, diabetes goes away for some people—often even before they lose much weight. So does that mean gastric surgery "cures" diabetes? Not necessarily, according to the largest community-based study of long-term diabetes outcomes after bariatric surgery. For most people in the study, e-published in advance of print in Obesity Surgery, diabetes either never remitted after gastric surgery or relapsed within five years.

Among the two thirds of the study's patients whose diabetes at first went away, more than a third re-developed diabetes again within five years after gastric surgery. After adding in the one quarter of patients whose diabetes never remitted after surgery, most (56 percent) of the study's patients had no long-lasting remission of their diabetes following gastric surgery. However, when diabetes did go away, the research team extrapolated, it stayed away for a median of eight years.

Which kinds of obese people with type 2 diabetes are likely to get the most benefit from gastric surgery? "Our results suggest that, after gastric surgery, diabetes stays away for longer in those people whose diabetes was less severe and at an earlier stage at the time of surgery," said principal investigator David E. Arterburn, MD, MPH, a general internist and associate investigator at Group Health Research Institute. "Gastric surgery isn't for everyone," he said. "But this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn't seem to be a cure for most patients."

The multi-site study tracked 4,434 adults at Kaiser Permanente Northern California, Kaiser Permanente Southern California, and HealthPartners for 14 years: from 1995 to 2008. The research arms of all three of these integrated health care delivery systems—and Group Health Research Institute, where the study's results were analyzed—belong to the HMO Research Network. The patients had type 2 diabetes that was either controlled with medication or else uncontrolled, and they were also obese enough to be candidates for gastric bypass surgery.

"Diabetes is an increasingly common disease that tends to keep getting worse relentlessly," Dr. Arterburn said. More than 25 million American adults have diabetes—and as populations age and keep gaining weight, 50 million are predicted to have it by 2050. Already, diabetes accounts for 5 percent of all U.S. health care spending. And it raises the risk of blindness, kidney disease, heart attacks, strokes, and deaths.

"Prevention is by far the best medicine for diabetes," Dr. Arterburn said. "Once you have diabetes, it's really hard to get rid of. Attempts to treat it with intensive lifestyle changes and medical management have been disappointing." For instance, the National Institutes of Health recently halted the Look AHEAD study of intensive lifestyle changes for people with diabetes. Despite improvements in risk factors like body weight, fitness, and blood pressure, sugar, and lipids, that study showed lifestyle changes did not lower the outcomes that matter most: heart attacks, strokes, and deaths.

"No wonder so many were excited to learn that diabetes can remit after gastric surgery—even, in some cases, before any significant weight loss—and many were hoping that gastric surgery might be a 'cure' for diabetes," Dr. Arterburn said. "Our study is the first major evidence that diabetes often recurs after gastric bypass surgery." Still, he added, even after diabetes comes back, having had a long period of post-surgery remission is likely to have many positive effects, such as fewer complications of diabetes: less damage to eyes and kidneys, and fewer heart attacks, strokes, and deaths. The researchers are now funded by the National Institutes of Health to study that possibility in this same population. Dr. Arterburn is also leading a randomized controlled pilot trial of intensive behavioral treatment vs. gastric surgery at Group Health with colleagues from the University of Washington.

It's still not clear whether diabetes relapse happens because of gaining weight back or because of underlying the progression of diabetes. But patients' weight—before and after surgery—was not strongly correlated with remission or relapse of diabetes in this population.

INFORMATION:

As part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program, the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services funded this project under contract HHSA290-2005-0033-I-TO10-WA1, led by Dr. Arterburn.

Drs. Arterburn's co-authors were: Andy Bogart, MS, and Mary Kay Theis, MA, MS, of Group Health Research Institute; David McCulloch, MD, of Group Health Cooperative; Nancy E. Sherwood, PhD, and Patrick J. O'Connor, MD, MPH, of HealthPartners Institute for Education and Research; Stephen Sidney, MD, MPH, of the Kaiser Permanente Northern California Division of Research, in Oakland; Karen J. Coleman, PhD, of Kaiser Permanente Southern California, in Pasadena; Guilherme M. Campos, MD, of the University of Wisconsin, in Madison; Sebastien Haneuse, PhD, of Harvard School of Public Health, in Boston; and Joe Selby, MD, MPH, of the Patient-Centered Outcomes Research Institute (PCORI), in Washington, DC. Dr. Arterburn is also an affiliate associate professor of medicine and Dr. McCulloch is a clinical professor of medicine at the University of Washington School of Medicine

Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) is the health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of its sister agency, the National Institutes of Health. AHRQ is a home to research centers that specialize in major areas of health care research such as quality improvement and patient safety, outcomes and effectiveness of care, clinical practice and technology assessment, and health care organization and delivery systems. It is also a major source of funding and technical assistance for health services research and research training at leading U.S. universities and other institutions, as well as a science partner, working with the public and private sectors to build the knowledge base for what works—and does not work—in health and health care and to translate this knowledge into everyday practice and policymaking.

HMO Research Network

The HMO Research Network includes 19 research centers, each associated with a health care delivery system. Researchers at the centers collaborate on multi-site studies in real-world health care settings across the United States and in Israel. With access to information on more than 16 million ethnically and geographically diverse patients, these researchers are finding solutions for common and rare health problems. Since 1994, the Network has been answering pressing questions about keeping people healthy and delivering effective care.

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Located in Oakland, Calif., the Division of Research employs over 600 staff working on more than 250 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org.

About the Kaiser Permanente Department of Research and Evaluation

The Department of Research and Evaluation (R&E) conducts high quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences, and behavioral research as well as clinical trials. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit www.kp.org/research.

HealthPartners Institute for Education and Research

HealthPartners Institute for Education and Research is dedicated to improving health through discovery, the translation of research, and health professional education. Our researchers are dedicated to conducting high-quality, public-domain health research, proposed and led by multidisciplinary teams of independent PhD- and MD-level investigators rigorously trained in statistics, economics, epidemiology, and other fields. The Institute is part of a larger organization consisting of HealthPartners, Regions Hospital, and clinics.

Group Health Research Institute

Group Health Research Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.

[Attachments] See images for this press release:

ELSE PRESS RELEASES FROM THIS DATE:

To get the best look at a person's face, look just below the eyes, according to UCSB researchers

2012-11-27

They say that the eyes are the windows to the soul. However, to get a real idea of what a person is up to, according to UC Santa Barbara researchers Miguel Eckstein and Matt Peterson, the best place to check is right below the eyes. Their findings are published in the Proceedings of the National Academy of Sciences. "It's pretty fast, it's effortless –– we're not really aware of what we're doing," said Miguel Eckstein, professor of psychology in the Department of Psychological & Brain Sciences. Using an eye tracker and more than 100 photos of faces and participants, Eckstein ...

Penn researchers make flexible, low-voltage circuits using nanocrystals

2012-11-27

PHILADELPHIA — Electronic circuits are typically integrated in rigid silicon wafers, but flexibility opens up a wide range of applications. In a world where electronics are becoming more pervasive, flexibility is a highly desirable trait, but finding materials with the right mix of performance and manufacturing cost remains a challenge. Now a team of researchers from the University of Pennsylvania has shown that nanoscale particles, or nanocrystals, of the semiconductor cadmium selenide can be "printed" or "coated" on flexible plastics to form high-performance electronics. The ...

Did you see that? How could you miss it?

2012-11-27

You may have received CPR training some time ago, but would you remember the proper technique in an emergency? Would you know what to do in the event of an earthquake or a fire? A new UCLA psychology study shows that people often do not recall things they have seen — or at least walked by — hundreds of times. For the study, 54 people who work in the same building were asked if they knew the location of the fire extinguisher nearest their office. While many of the participants had worked in their offices for years and had passed the bright red extinguishers several times ...

Study advances use of stem cells in personalized medicine

2012-11-27

Johns Hopkins researchers report concrete steps in the use of human stem cells to test how diseased cells respond to drugs. Their success highlights a pathway toward faster, cheaper drug development for some genetic illnesses, as well as the ability to pre-test a therapy's safety and effectiveness on cultured clones of a patient's own cells. The project, described in an article published November 25 on the website of the journal Nature Biotechnology, began several years ago, when Gabsang Lee, D.V.M., Ph.D., an assistant professor at the Johns Hopkins University School ...

Genome decoded: Scientists find clues to more disease-resistant watermelons

2012-11-27

ITHACA, N.Y. – Are juicier, sweeter, more disease-resistant watermelons on the way? An international consortium of more than 60 scientists from the United States, China, and Europe has published the genome sequence of watermelon (Citrullus lanatus) — information that could dramatically accelerate watermelon breeding toward production of a more nutritious, tastier and more resistant fruit. The watermelon genome sequence was published in the Nov. 25 online version of the journal Nature Genetics. The researchers discovered that a large portion of disease resistance genes ...

Rapid changes in climate don't slow some lizards

2012-11-27

DURHAM, N.C. -- One tropical lizard's tolerance to cold is stiffer than scientists had suspected. A new study shows that the Puerto Rican lizard Anolis cristatellus has adapted to the cooler winters of Miami. The results also suggest that this lizard may be able to tolerate temperature variations caused by climate change. "We are not saying that climate change is not a problem for lizards. It is a major problem. However, these findings indicate that the thermal physiology of tropical lizards is more easily altered than previously proposed," said Duke biologist Manuel ...

Metabolic protein launches sugar feast that nurtures brain tumors

2012-11-27

HOUSTON - Researchers at The University of Texas MD Anderson Cancer Center have tracked down a cancer-promoting protein's pathway into the cell nucleus and discovered how, once there, it fires up a glucose metabolism pathway on which brain tumors thrive. They also found a vital spot along the protein's journey that can be attacked with a type of drug not yet deployed against glioblastoma multiforme, the most common and lethal form of brain cancer. Published online by Nature Cell Biology, the paper further illuminates the importance of pyruvate kinase M2 (PKM2) in cancer ...

American University biologist discovers new crab species

2012-11-27

Areopaguristes tudgei. That's the name of a new species of hermit crab recently discovered on the barrier reef off the coast of Belize by Christopher Tudge, a biology professor at American University in Washington, D.C. Tudge has been interested in biology his whole life, from boyhood trips to the beach collecting crustaceans in his native Australia, to his undergraduate and PhD work in zoology and biology at the University of Queensland. He has collected specimens all over the world, from Australia to Europe to North and South America. Until now, he has never had ...

Study links improved consumer welfare to increased prescription drug advertising efforts

2012-11-27

Athens, Ga. – More people are better off thanks to the impact of an influx of direct-to-consumer advertising spending than they would be without those marketing efforts, according to a study recently published by Jayani Jayawardhana, an assistant professor in the University of Georgia College of Public Health. The multi-year study focused on advertising efforts surrounding cholesterol-reducing prescription medications. Jayawardhana found increased levels of consumer welfare due to direct-to-consumer advertising than when compared to situations without this type of marketing. ...

SwRI team reports Cassini finds a video gamer's paradise at Saturn

2012-11-27

Call it "PAC-MAN, the Sequel." Scientists with NASA's Cassini mission have spotted a second feature shaped like the 1980s video game icon in the Saturn system, this time on the moon Tethys. The pattern appears in thermal data obtained by Cassini's composite infrared spectrometer, with warmer areas making up the PAC-MAN shape. "Finding a second PAC-MAN in the Saturn system tells us that the processes creating these 'PAC-MEN' are more widespread than previously thought," said Dr. Carly Howett, the lead author of a recently published paper in the journal Icarus. "The Saturn ...

Gastric bypass surgery helps diabetes but doesn't cure it

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: