Fact: Reversing Diabetes -- Gastric Bypass vs. Gastric Banding vs. Diet & Exercise
Researchers randomly assigned 61 participants with type 2 diabetes to one of three weight-loss interventions: Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or an intensive weight-loss program focused on cutting calories and increasing exercise. Patients were 47 years old on average, living with dangerously elevated blood sugar levels and obesity. The study lasted for five years, and even though this was a small study, the results show a dramatic difference between the three arms of the study. Any degree of weight loss, even that achieved by non-surgical means (typically about 5% of starting weight as shown in this study), can help control health issues such as diabetes, lipids, and hypertension. After five years, six people who got the Roux-en-Y procedures, or 30%, achieved partial or complete diabetes remission, compared with four people, or 19%, of the participants who had gastric banding, the study found. No one in the diet-and-exercise group achieved remission. Also, 56% of the people who had Roux-en-Y procedures had stopped taking medications to manage diabetes by the end of the study, compared with 45% of the people who had laparoscopic adjustable gastric banding and none of the participants in the lifestyle group. People who had the Roux-en-Y bypass lost an average of 25% of their body weight, compared with about 13% with the lap-band and 5% in the group assigned to intensive lifestyle management. The conclusion from the study was that people who undergo gastric bypass surgery are more likely to achieve remission of diabetes than those who try to lose weight by dieting and exercising. “The findings add to evidence suggesting that surgical weight loss may be the best approach to achieving diabetes remission," said Dr. Courcoulas of the University of Pittsburgh Medical Center, the study's lead author. Journal of Clinical Endocrinology & Metabolism, online January 9, 2020. REUTERS | 
This past week, our four interns learned about basal/bolus dosing and the value of an insulin pump and CGM for managing type one diabetes. We went through the standard calculations to figure out carb ratios and correction factors, and they got plenty of experience figuring out doses based on those ratios. We had them adjust for low glucose, high glucose, and they even managed to figure out how to accurately calculate the actual amount of carbs to raise glucose.