Weight-loss surgery, long considered a treatment largely reserved for people with severe obesity, may also be a good and safe option for the treatment of uncontrolled type 2 diabetes in those who are overweight or have mild to moderate obesity, according to researchers from Cleveland Clinic in Ohio who presented their findings at ObesityWeek 2015.

Cleveland Clinic researchers say this study is the largest ever-published series of bariatric surgery in patients with type 2 diabetes and body mass index (BMI) of 35 kg/m2 or less. They studied 1,003 patients from North America with a BMI of between 25 and 35, with the average BMI being 33.5 kg/m2. Forty-six patients had a BMI of 30 or less. All had weight-loss surgery, or what is known as bariatric or metabolic surgery, between 2005 and 2013. Four-in-10 patients were taking insulin injections and 60 percent were on oral medications for their diabetes before surgery. Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

“Bariatric surgery is emerging as a safe and effective option for managing type 2 diabetes in patients with mild obesity,” says Dr. Alexander Abkin, MD, FACS, Laparoscopic and Bariatric Surgeon and President of Advanced Laparoscopic Surgeons of Morris, LLC, who was not involved in the study. “We are seeing significant improvement or remission of type 2 diabetes in most lower BMI patients. Current evidence suggests that baseline BMI is unrelated to diabetes remission following bariatric and metabolic surgery. The data, which is from a large sample size of patients with type 2 diabetes, shows a modest early morbidity (4%) and low mortality (0.2%) following bariatric surgery in non-severely obese patients. These data are important because most patients with diabetes fall into this BMI category.”

According to guidelines from the National Institutes of Health (NIH), a person is overweight if their BMI is between 25 and 30, and considered to have obesity, if their BMI is 30 or more. Severe obesity begins at a BMI of 35 kg/m2. The NIH guidelines, which have not been updated since 1991, consider surgery an option only for people with a BMI of 35 or more with one or more obesity-related conditions such as diabetes or a BMI of 40.

Dr. Abkin says that over the last quarter century, however, the field of bariatric surgery has significantly evolved with introduction of new less invasive surgical approaches (e.g. laparoscopic surgery) and surgical procedures (e.g. sleeve gastrectomy), which have led to improvement in the safety profile of surgery.

The study showed bariatric and metabolic surgery had a high degree of safety in lower BMI patients. The operations included gastric bypass (57%), gastric banding (23%), sleeve gastrectomy (19%) and duodenal switch (1%). The 30-day postoperative mortality rate was 0.2 percent and the cumulative rate of 16 postoperative adverse events was 4 percent. The procedures were generally two hours in length and patients were discharged from the hospital within two days.

“A two-hour operation and a two-day hospital stay has the potential to resolve or improve what is a chronic, progressive and dangerous disease,” said Alexander Abkin, MD, FACS, FASMBS. “The risk-benefit profile that has emerged for bariatric surgery in people with type 2 diabetes and low BMIs is very favorable and should be considered as a treatment option in carefully selected patients.”

Last year, Cleveland Clinic researchers presented a study that found the 30-day complication rate associated with metabolic surgery, specifically gastric bypass in patients with type 2 diabetes and BMIs of 35 or more, was 3.4 percent, about the same rate as laparoscopic cholecystectomy (gallbladder surgery) and hysterectomy. Hospital stays and readmission rates were similar to laparoscopic appendectomy. The month-long mortality rate for metabolic or diabetes surgery was 0.3 percent, about that of total knee replacement, and about one-tenth the risk of death after cardiovascular surgery (Published in the Diabetes, Obesity & Metabolism journal 2015; 17(2):198-201).

Previous studies have shown that metabolic and bariatric surgery improves type 2 diabetes in nearly 90 percent of patients and diabetes goes into remission in up to 50 percent.

To contact Dr. Abkin for further questions regarding the article or about patient referrals, please call 973-410-9700 or email info@alsnj.com.

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ReShape™ The Non-Surgical Weight Loss Procedure

The ReShape Procedure is a new, FDA approved, non-surgical approach to weight loss that is proven to help people achieve and maintain significant weight loss. It is completely different from any diet, program, or procedure you may have tried or considered before. The ReShape Procedure was specifically designed for patients with a lower BMI (between 30–40). ReShape may be a good weight loss option for people who do not qualify or do not want surgery.

With ReShape, two connected balloons filled with saline (salt water) are placed temporarily inside your stomach in an outpatient medical setting. The procedure lasts about 20 minutes while you are comfortably sedated under light anesthesia. An endoscope is used to insert the balloons into the stomach, and saline is used to inflate the balloons when they are properly positioned. Once the balloons are inflated, the endoscope is removed and the insertion procedure is complete. The balloons remain in the stomach for 6 months.

When filled with saline, the balloons help you lose weight and encourage healthy eating habits by taking up room in your stomach, so there is less space for food. You can still eat the healthy foods you enjoy, but the balloons act as built-in portion control, helping you feel full and less hungry.

After six months, the balloons are deflated and removed during a similar endoscopic procedure.

Dual-Balloon Technology

Only the ReShape Procedure places two connected, medical-grade and saline-filled balloons inside your stomach for six months. The ReShape Integrated Dual Balloon is designed to take up room in your stomach, which creates a feeling of fullness and may help you feel satisfied with less food. The dual balloon is designed to conform to the curvature of the stomach for comfort, and also includes an anti-migration feature, so if one balloon deflates, the second balloon prevents the device from passing into the intestines for increased safety.

The balloon placement is completed endoscopically, without surgery, in an outpatient setting. There are no incisions, scars, or permanent changes to your digestive system. The procedure is completely reversible, and patients are often able to return to work and normal activities in just a few days.

The balloons are a weight loss jump-start. Many patients experience rapid weight loss initially, providing the motivation required to keep going and make the changes stick. You also receive a full year of personalized coaching to support your success and help you make the changes that will encourage a lifetime of healthy living.

One Year of Comprehensive Coaching and Support

ReShape combines the portion-controlling benefits of the balloons with comprehensive coaching to change your eating habits, enhance your physical fitness, and help you adopt a healthy lifestyle that supports long-term success. While the balloons are inside your stomach, you will meet (monthly) with coaches and receive personalized nutrition, fitness, and behavior guidance to help maximize your success. After the balloons are removed, you will continue to meet with your coaching team to make sure that you maintain your healthy lifestyle to reach your goals. With ongoing coaching support, most patients maintain their weight loss or continue to lose weight.

Patients also have access to the ReShape Patient Portal, a comprehensive tool that has everything you need to track your success. The portal includes: weight logging, food logging, activity tracking, goal setting, articles and recipes, community forums, important reminders, and the ability to easily share data with your doctor.

Life-Changing Weight Loss, Without Surgery

ReShape is a proven way to achieve significant weight loss. In a recent study, patients lost more than twice as much weight with ReShape than with diet and exercise alone.¹ Most ReShape patients keep the weight off or continue to lose, even after the balloons are removed.

ReShape is a non-surgical procedure. If you do not want or do not qualify for surgery, the ReShape Procedure may be a good option for you.

For more information, call 973-410-9700 or email info@alsnj.com

Reference:

1. Ponce J, Woodman G, Swain J, et al; for the REDUCE Pivotal Trial Investigators. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity [published online ahead of print December 16, 2014]. Surg Obes Relat Dis. 2014. doi: 10.1016/j.soard.2014. 12.006.