As weight-loss surgery has become more common over the last several years, doctors have had tantalizing clues that certain procedures bring dramatic reduction in type 2 diabetes -- beyond getting their ability to reduce the patient’s weight.

The surgery appears to have stopped damage to the pancreas, reversing the cause of diabetes as well as alleviating the symptoms, the researchers reported Tuesday in the journal Diabetes Care.

A year ago researchers at the Cleveland Clinic carried out a careful trial of 150 patients with diabetes that was not being adequately controlled. One-third got gastric bypass, one-third were given a device similar to a lap band that reduces stomach volume, and the rest received the best drug therapies. The goal was to reduce the participants’ blood sugar to below normal levels.

In the patients who got the bypass surgery the results were dramatic.

"It's pretty amazing," bariatric surgeon Dr. Philip Schauer of the Cleveland Clinic said at the time. “Many of our patients, even within hours of the operation, their blood sugar becomes normal … even before they've lost any weight at all.”

The big question was, would the results last? In a one-year follow-up study, published in the journal Diabetes Care on Tuesday, the answer is yes. "Gastric bypass surgery seems to uniquely restore pancreatic beta-cell function, presumably by targeting belly fat and modifying the hormones in the gastrointestinal tract," Dr. Sangeeta Kashyap, an endocrinologist with the Cleveland Clinic, said in a statement. "Gastric bypass remarkably targets belly fat where hormones that are toxic to the body develop."

The pancreas makes insulin, which in turn control blood sugar. People with diabetes can't control their blood sugar as well, and the excess sugar damages organs such as the eyes and kidneys. The pancreas worked again in patients who had the surgery, Kashyap says. "This is something that is very novel and something we don’t see with medications or with insulin," she said.

A gastric bypass procedure makes the stomach smaller by dividing it into two sections and connects a portion of the small intestine to one of the stomach pouches, reducing the amount of calories absorbed by the body. Curiously, another surgical procedure called sleeve gastrectomy, which also reduced stomach volume, caused the patients to lose just as much weight, but it did not bring the same dramatic reduction in diabetes.

The doctors are not sure how the bypass surgery changes the hormone balance in the body to cure the diabetes. And they hope someday they might achieve the same effect without the surgery.

The Cleveland Clinic doctors want to treat more patients before they are confident they have a cure. An estimated 26 million Americans have type 2 diabetes and it has been called one of the fastest-spreading epidemic ever.

If it continues to be successful, the main issue will be whether major surgery costing $25,000 -- and often not covered by insurance -- is too drastic a treatment. In response any doctors point out that uncontrolled diabetes often leads to kidney problems, heart attacks, strokes, amputations and death. For many diabetic patients medical costs far exceed $25,000. So, if the diabetes cannot be controlled in other ways, the surgery may become far more common.

Related:

Diabetes patients benefit from weight-loss surgery

High-glycemic foods tied to diabetes risk

Big rise in diabetes, especially down South

By MyHealthNewsDaily Staff

More young and middle-aged adults are having strokes, a new study suggests.

In 1994, 12.9 percent of strokes occurred in adults between ages 20 and 55, whereas in 2005, 18.6 percent of strokes occurred in this age group, according to the study of stroke rates in a four-county region of Ohio and Kentucky.

Additionally, the data showed that the average age of people who experienced a stroke fell from 71 in 1994 to 69 in 2005.

"The reasons for this trend could be a rise in risk factors such as diabetes, obesity and high cholesterol," said study author Dr. Brett Kissela, of the University of Cincinnati College of Medicine in Ohio. However, factors such as improved diagnosis may also have contributed to the increase, he said.

"Regardless, the rising trend found in our study is of great concern for public health, because strokes in younger people translate to greater lifetime disability," Kissela said.

In the study, researchers looked at data on all stroke patients between ages 20 and 54 seen at hospitals, clinics and nursing homes during three separate, yearlong periods: July 1993 through June 1994, and the calendar years of 1999 and 2005. Only a patient's first stroke was included in the analysis.

The stroke rate among people over age 75 decreased between 1994 and 2005, according to the study, and other studies have shown a general decrease in stroke rates over recent decades. For example, the Framingham Heart Study reported a decline in stroke rates between 1950 and 2004.

"Any decline in stroke incidence is positive from a public health prospective, but reduced incidence in older ages is counterbalanced by the worrisome trend of younger strokes," Kissela and colleagues wrote in their study. Strokes at younger ages can mean a greater loss of productive life years, and greater health care expenses over time.

The new findings show that the trend toward younger stroke patients was seen in both African-Americans and Caucasians. The yearly stroke rate among African-Americans increased between 1994 and 2005 from 83 strokes to 128 strokes per 100,000 people, according to the study. Among Caucasians, the yearly stroke rate increased from 26 strokes to 48 strokes per 100,000 people over the same period.

Most of these increases were seen in a type of stroke called an ischemic stroke, which occurs when an artery bringing blood to the brain is blocked. (Another type — called a hemorrhagic stroke, which occurs when a blood vessel leaks or bursts — was less common.)

While the reasons for the increased stroke rate among younger people are not entirely clear, the researchers pointed to the findings of a separate survey of people in the region, which showed an increasing percentage had high cholesterol. Data from national surveys also show that rates of diabetes, high cholesterol, and obesity increased over the study period, they said.

"The good news is that some of the possible contributing factors to these strokes can be modified with lifestyle changes, such as diet and exercise," Kissela said.

One question raised by the study is whether the increase is partly due to better diagnoses of stroke, according to two researchers who wrote an editorial accompanying the new study in the journal. 

"The progressive adoption of MRI as a diagnostic tool during the study period challenges the validity," of comparing the stroke rates between the early 1990s and 2005, wrote Drs. Sally Sultan and Mitchell S. V. Elkind, both neurologists at Columbia University Medical Center in New York City.

While the researchers tried to account for the increased use of MRI in their study, it likely still had an effect, Sultan and Elkind said.

However, if strokes are affecting more young people, there are public health implications, they said. "If strokes occur at earlier ages, as life expectancy increases, stroke-related disability will increase even more," they wrote.

Beyond Vegetables and Exercise: 5 Surprising Ways to Be Heart Healthy

6 Foods That Are Good for Your Brain

Chocolate Consumption Lowers Men's Stroke Risk

 By Robert Bazell
Chief Science and Medical Correspondent
NBC News

How hard is shift work on a worker's body? 

Research out Wednesday from Brigham and Women’s Hospital in Boston demonstrates very precisely the way fighting the body's natural sleep patterns can increase the risk of type 2 diabetes, the most common form of the disease.

More than 21 million Americans are “shift workers,” according to U.S. Census figures. That is, they labor during the hours that most of us set aside for rest or sleep, either all or part of the time. That number is increasing 3 percent a year because of the nature of our service economy and the need for ever more people to take whatever work they can.

The sleep research team at Brigham and Women’s, under the direction of Dr. Charles Czeisler, has spent decades documenting how shift work can lead to increased obesity, heart disease, diabetes and many other health problems. In this latest research in their sleep lab they show how one mechanism creates the risk.

Twenty-one healthy volunteers were subjected to varying hours of sleeping and waking, light and dark, all designed to disrupt the body’s natural internal clock (the circadian rhythm.)

Within a few days, when the subjects ate a normal meal, their bodies did not respond in a normal way.

“Glucose levels went much higher and stayed that way for several hours,” said neuroscientist Orfeu Buxton, Ph. D., the study's lead author. “This was because of decreased insulin released from the pancreas. Together these reflect an increased risk of diabetes.”

The stress was so severe that during the three-week experiment three of the healthy volunteers became pre-diabetic. Fortunately, after nine days of normal sleep and waking, all symptoms disappeared.

Still, the experiment clearly demonstrates that shift work can make people diabetic. For people who already have diabetes or are pre-diabetic, it can make the conditions worse.

The advice from the scientists for those who perform shift work -- either out of necessity or choice:

• Try to make your daily clock as normal as possible.
• Get good sleep during the day -- finding, if you can, a quiet, very dark room. 
• Don’t eat big meals at a time when you feel your body clock is out of whack.

Sound advice, experts would agree.  But anyone who works odd hours knows how challenging such simple routines can be in the demands of a normal family and social life. This latest research is further evidence out-of-whack sleep’s harm to our health.

The research is published in Science Translational Medicine.  You can read an abstract here: 

http://stm.sciencemag.org/lookup/doi/10.1126/scitranslmed.3003200

 Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC

More from Robert Bazell:

Dental X-rays linked to brain tumor risk

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Study: Most early cancer research is wrong

Regular prostate screening can reduce deaths. Now what?

A "sensational" new finding could be the beginning of a cure for type 2 diabetes, a disease described in an editorial accompanying the research in the New England Journal of Medicine as “one of the fastest growing epidemics in human history.”

Two studies find that weight loss surgery can eliminate the symptoms of type 2 diabetes in a large proportion of volunteers. That might not seem surprising, since obesity is the major risk factor for the disease. But in these studies, published in the New England Journal of Medicine and presented Monday at the annual meeting of the American College of Cardiology, many of the patients got better within weeks, days, sometimes even hours after the surgery -- long before they lost any weight.

“It’s pretty amazing,” said Dr. Phil Schauer of the Cleveland Clinic, the lead author on one of the studies. Schauaer’s study divided 150 patients with out-of-control diabetes into three groups. One-third got the best drug therapy, one-third got the surgical procedure sleeve gastrectomy, and the last group gastric bypass. The goal was to get the patients’ blood sugar (measured by the A1C test familiar to diabetics) below the normal level of 6 percent. Forty-two percent of the bypass patients reached the goal after one year compared to 37 percent of the sleeve patients and only 12 percent on medical therapy.

But those numbers “don’t even begin to show how successful this was," according to Dr. Steve Nissen, another author of the paper from the Cleveland Clinic. He points out that at the beginning of the study most of the patients were taking three or more medications to control their diabetes. But after a year almost none of the gastric-bypass patients needed medication.  Forty-four percent required daily insulin injections before surgery and none did after.  Diabetes is a major risk factor for heart disease.  Most of the surgery patients saw their HDL, the good cholesterol, shoot way up and their artery clogging triglycerides drop sharply.

“This is sensational,” Nissen told me.

The second study from the Catholic University of Rome and Weill Cornell Medical College followed 60 patients for two years and produced even stronger results.  In that experiment one-third of the volunteers got drug therapy, one third bypass surgery, and the last group underwent bilopancreatic diversion, an even more severe weight-loss operation where surgeons block part of the small intestine.

After two years none of the patients on drug therapy reached the goal of normal blood sugar levels while 75 percent of those who underwent bypass did and as did fully 95 percent of those undergoing the bilopancreatic diversion.  The authors of the study say these patients have achieved “complete diabetes remission.” Though the doctors have followed them for only two years, there is no indication that the diabetes is returning in any of them.

Why, in some patients, do the positive effects take place long before they lose weight? Marla Evans, 56, one of the volunteers who got a sleeve gastrectomy in the Cleveland study put it this way, “I was a diabetic, and then after the surgery, within a few days, the diabetes was much better, and within a month or two there was no diabetes in my blood at all.”

Most experts believe the operations somehow set off massive changes in the body’s hormones. Exactly what and how remains a mystery.

“This is hotly debated area,” Dr. Rudy Leibel of Columbia University, an authority on metabolic hormones told me.  And it is critical because if scientists can figure out how to bring about the changes that control the diabetes without surgery or with far less invasive surgery, the treatment could easily be more widespread.

But even now medicine faces the question:  Is it worth undergoing surgery that costs about $25,000 and carries a significant risk of dangerous complications and unpleasant side effects to treat type 2 diabetes? The answer, most experts say, is that most type 2 diabetics (type 1 diabetes is an auto-immune disease not impacted by this research) can stay well with diet, exercise and medication. But those who cannot control their disease face complications including heart and kidney disease, along with loss of limbs and visions. One person with uncontrolled diabetes can run up millions in medical bills.  So a surgery that was considered extreme not long ago may become a standard treatment for many people with one of the most common diseases of modern times.

Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and Twitter.

To read the articles:

• Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
• Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes
• Surgery or Medical Therapy for Obese Patients with Type 2 Diabetes?

Related: 

• Opinion: Deen's diabetes confession a sticky hypocrisy
• White rice may increase your risk of diabetes

Watch NBC's Robert Bazell speak with Dr. Philip Schauer, surgeon and director of the Cleveland Clinic's Bariatric and Metabolic Institute.

The Food and Drug Administration announced Tuesday that people who take popular cholesterol-lowering drugs called statins may have an increased risk of raised blood sugar levels and could also be at greater risk of getting Type 2 diabetes. In addition, some people who take statins have reported memory impairment.  

Statins, some of the most-prescribed drugs on the market, are taken by millions of Americans.

In a statement, the FDA noted the benefits of taking the drugs often outweigh the risks.

“The value of statins in preventing heart disease has been clearly established,” said Amy G. Egan, M.D., M.PH., deputy director for safety in FDA’s Division of Metabolism and Endocrinology Products. “Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects.”

The FDA will be modifying the drug package insert found in the following statin products to include the federal safety agency's new concerns:

• Altoprev (lovastatin extended-release)
• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin).

Products containing statins in combination with other drugs include:

• Advicor (lovastatin/niacin extended-release)
• Simcor (simvastatin/niacin extended-release)
• Vytorin (simvastatin/ezetimibe).

Click here to visit the FDA's website and learn more.

By Jane Derenowski
NBC News producer

Part 3: LOOKING BACK TO THE LAND

The last part of the Back to Basics journey took me and NBC's Chief Science Correspondent Robert Bazell to the small town of Sells, Ariz. This is home to the Tohono O'odham Indian Nation. The Nation has recently struggled with alarmingly high rates of type 2 diabetes and obesity, but it is now looking to the past to create a healthier future. 

Years ago, they relied on farming and ate a diet rich in fruits, vegetables, and grains. But along the way, the practice was abandoned along with many traditions.

Now, with the help of Nation elders, young and old alike are returning to the farms and reviving customs such as storytelling, O'odham dance, and singing.

The result: slow but steady progress toward better health and a re-birth of the Tohono O'odham culture.

Learn more about the Back to Basics series.

Part 1: Give kids time to play

Part 2: Take a social media break