An article in this week's JAMA [JAMA. 2008;299(3):316-323] and an accompanying editorial [JAMA. 2008;299(3):341-343] are worth reading. They a provide a balance to the newsmedia hoopla. We all know that Type 2 diabetes is mainly the result of obesity. With stomach surgery to restrict food intake it is hardly surpriing that diabetes tests should indicate rapid improvement. Prior intervention included sromach stapling which is more intrusive than banding.As expected, the surgical group lost more weight than the medical/behavioral group (20.7% vs 1.7%), and the amount of weight lost was the dominant predictor of diabetes remission. The percentage weight loss generally required for diabetes resolution was 10%, which was achieved in 86% of surgical patients but in only 1 patient in the medical group. Behavioral intevention continues to be disappointing. The JAMA editorial notes that It is time for a major shift in the way the health care community considers diabetes treatment goals.
This is an instance in which surgery may be more effective and lasting than medical treatment.
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