Diabetics eye obesity surgery to tame blood sugar

Cristina Iaboni poses for a portrait in her home in Bethany, Conn., on Saturday, June 12, 2010. Iaboni, a diabetic, has found a doctor who is testing weight loss surgery on diabetics who are merely overweight or a tad obese in an attempt to curb the chronic disease. Scientists in recent years have discovered that diabetes all but disappeared in some obese patients soon after the operation. Many were able to achieve normal blood sugar and ditch their medications. (AP Photo/Thomas Cain)

The surgery is fairly safe. In a 2009 study, death, serious complications or the need for a repeat procedure occurred in 1 percent who received bands, about 5 percent who had minimally invasive gastric bypass and nearly 8 percent who had traditional bypass.

The American Diabetes Association said there's not enough evidence to generally recommend surgery for diabetics with a BMI lower than 35 outside of an experiment.

That's how Iaboni got the procedure. At 5-foot-5 and 191 pounds, she was obese with a BMI of 31.8, but not heavy enough to qualify for regular surgery under the federal BMI limits. She paid $30,000 for the surgery and hospital stay to be part of the study.

Before the operation, she would be nauseated from the diabetes medications and felt lousy all the time. When people learn that she had surgery, many react in surprise.

"They would say, `You're not heavy. Why would you do this?' People thought I did it for the weight loss," Iaboni said.

Her surgeon, Dr. Francesco Rubino, has been pleased with her progress so far. He has plans to operate on two others as early as this month. Eventually, he hopes to enroll 50 patients with Type 2 diabetes and track if their diabetes goes away after surgery.

"It's important to tell patients this is a promising option, but of course we can't promise this is the cure for diabetes for everybody," he said.

Diabetes treatment is expensive. According to the diabetes association, those with the disease spend on average $11,744 a year on health care. A little over half of that is directly related to diabetes. Expenses include hospital stays, medications and supplies, and doctor visits.

A recent analysis by the North Carolina-based nonprofit RTI International found that gastric bypass and banding are cost-effective methods of reducing complications and death in obese people with diabetes.

The money spent on surgery "appears to provide good value," said Thomas Hoerger, who presented the findings last month at a meeting of health economists.

Some experts question whether achieving normal blood sugar is enough to justify getting surgery. Does the surgery permanently reduce a person's risk of diabetes complications such as nerve, kidney and foot damage?

"I don't believe we're at a point where we can tell people that we know the answer to that," said Dr. Robert Kaplan of the UCLA School of Public Health.



American Diabetes Association, http://www.diabetes.org

American Society for Metabolic and Bariatric Surgery, http://www.asmbs.org

BMI calculator, http://www.nhlbisupport.com/bmi

The Associated Press