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In This Issue:
Florencia Halperin
For patients with type 2 diabetes and obesity, new research led by Florencia Halperin, MD, chief of Endocrinology at BWFH, medical director of the Program for Weight Management and co-director of the Center for Weight Management and Metabolic Surgery at BWH, suggests gastric bypass surgery as an effective treatment option.
The study followed patients age 21 to 65 with type 2 diabetes diagnosed more than one year before the study. They each had a body mass index of 30 to 42 and a hemoglobin A1c (HbA1c) level greater than or equal to 6.5 percent, indicating diabetes. All participants were receiving diabetes medications. Of the 38 patients, 19 were randomized to receive Roux-en-Y gastric bypass surgery at BWH and 19 were randomized to participate in an intensive diabetes medical and weight management program for type 2 diabetes at the Joslin Diabetes Center.
"I've always been interested in the connection between obesity and diabetes," said Halperin. "Surgery has come on the scene as a very good treatment for obesity. Very early on after gastric bypass surgery, doctors taking care of those patients noted that people who had diabetes and who underwent the surgery for weight loss, had very significant improvements in their diabetes. The really interesting thing is that the diabetes gets better very quickly, before they lose significant weight. There seems to be something unique about the surgery that may have a specific effect on diabetes, not just on weight."
In her study, Halperin found that at the one-year mark, the proportion of patients achieving HbA1c below 6.5 percent and fasting glucose below 126 mg/dL was higher following surgery (58 percent) than in the medical and weight management program (16 percent). Other outcomes, including weight, waist circumference, fat mass, lean mass, blood pressure and triglyceride levels decreased and high-density lipoprotein cholesterol increased more after gastric bypass surgery compared with the medical and weight management program.
"There are still a lot of things that we don't understand," said Halperin. More and more, gastric bypass is being considered a metabolic surgery rather than just weight loss surgery. As a result, patients with type 2 diabetes may have more treatment options in the future. "It's really exciting that people have options, because surgery is not right for everyone, and an intensive weekly medical weight loss program is not right for everybody." With continued research, the hope is to better understand which treatment option is best for the individual patient.