In 2010, Kristen Hugus of Castle Shannon, Pa., was 36, at her highest weight, and had been diagnosed with type 2 diabetes for nine years. At the time, she was working as an operating room nurse at a UPMC hospital. Several of the recovery room nurses she knew had worked in UPMC Bariatric Services. One of her coworkers came in one day with a flier that contained information about a study that was being led by Dr. Anita Courcoulas, Chief of Minimally Invasive Bariatric and General Surgery at UPMC.
The purpose of the study was to investigate the various weight loss interventions and the effects on patients with diabetes. Patients were randomized into weight loss surgery or a medical/lifestyle program based on established interventions shown to reduce the risk of diabetes. Over time, the researchers across four studies pooled the data together into one study, which was completed in 2022. Long-term outcomes were analyzed at seven and, when possible, 12 years post-randomization.
“These results show that people with overweight or obesity and type 2 diabetes can make long-term improvements in their health and change the trajectory of their diabetes through surgery," says Dr. Courcoulas.
The Path to UPMC
Weight loss was not Kristen's primary motivation for undergoing bariatric surgery.
“The goal was to be a healthier diabetic,” she says. She was diagnosed with diabetes in an emergency room one early morning in 2001. From there, her primary care physician (PCP) referred her to an endocrinologist. Kristen credits her PCP for providing her with comprehensive education “from the get-go.”
This involved making significant changes to her diet. The diagnosis “requires you to change your life,” she says.
To take part in the study, Kristen underwent several diagnostic tests before surgery. She also agreed to be followed for years after surgery. Patients were randomly selected into one of three treatment groups: gastric band surgery, gastric sleeve surgery or gastric bypass surgery, or lifestyle management. Kristen was randomized into the group that underwent the gastric bypass procedure. She had her surgery at UPMC Magee-Womens Hospital in November 2010.
The Study Results
The study showed that patients in the bariatric surgery group consistently had lower HbA1c levels than did patients in the medical/lifestyle group. HbA1c measures blood sugar levels. At year 7, more than 18.2 percent of surgery patients had achieved diabetes remission, compared to 6.2 percent of patients in the medical/lifestyle group. At year 12, no patients in the medical/lifestyle group were in remission, compared to 12.7 percent in the surgery group.
“This shows that people with Type 2 diabetes — even those below the BMI threshold for bariatric surgery for weight loss alone — should be offered bariatric surgery as a treatment for inadequately controlled diabetes,” said Dr. Courcoulas.
Kristen Today
Kristen lost 65 pounds — more than a third of her initial weight upon entering the study. She has remained at approximately 125 pounds in the 13+ years since surgery. During her pregnancy, Kristen was on insulin to control her diabetes. She could not eliminate it even after delivering her daughter in 2006. But after surgery, she could stop taking insulin — although she still takes one medicine to control her blood sugar.
Dr. Courcoulas said that most patients in the study had had diabetes for a shorter period than Kristen.
“I won’t say it’s not awesome being skinny … but for me the biggest motivation was being the best mother for my daughter,” Kristen says. “I’ve never in her life talked to her about health in terms of weight. I talk to her about health in terms of healthy choices. I always say I’m a lot healthier. I’m finally in control of the person I want to be.”
“I have my daughter, my former co-worker, and Dr. Courcoulas and her team to thank,” says Kristen. She also says it’s important for people in Pittsburgh to know that UPMC has so many research studies in which they can participate. “We’re so lucky that we have these resources in Pittsburgh,” she says.
Kristen’s treatment and results may not be representative of all similar cases.