Thursday, May 3, 2012

Bariatric Surgery Better Than Medical Treatment for Morbidly Obese Diabetics

Bariatric surgery (weight-loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).

Bariatric surgery, Wikipedia

May 3, 2012 -  I shall begin with conclusions of two articles that appeared in the April 26, 2012 issue of the New England Journal of Medicine.

·         “In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone.  Further study will be necessary to assess the durability of these results.
 (Philip S. Schauer and 9 co-authors, Bariatric Surgery versus Intensive Medical Therapy  in Patients with Diabetes’)

·         “In severely obese patients with type 2 diabetes, bariatric surgery resulted in better glucose control than did medical therapy.  Preoperative BMI and weight loss did not predict the improvement in hyperglycemia after these procedures.”
 (Geltrude Mingrone, MD, and 10 coauthors, “Bariatric Surgery versus Conventional Medical Therapy  in Type 2 Diabetes”

And so the results are in – performing bariatric surgery is better than medical therapy for controlling diabetes in morbidly obese subjects.   Morbidly obese may be thought of as being 100 pounds or more overweight or having a Body Mass Index (BMI) of 40 or more.  In the 2nd study,  disappearance of diabetes did not occur in any of the medical treated patients, but 75% of gastric-bypass group and 95% of the biliopancreatic-diversion group.

These studies remove much of the ambiguity about whether to be treated medically or surgically. 
If you are a  morbidly obese diabetic,  ambiguity is not a good place to live.  Chances are you have tried multiple diets to lose weight,  have low esteem, and have been accused of being lazy or having no self-control.

If you are a physician , you may be faced with vexing questions. To cut or not to cut?  To risk surgical complications?  Or to risk the common complications of uncontrolled diabetes – stroke, heart attacks,  blindness,  kidney failure, and amputations?

If you are a government or health plan paying annual bills for diabetics,  which usaully  run $12,000 to $15,000 a year, you may be asking.  Should I pay the high price for bariatric surgery in the short run,   or the cost of treating complications in the long run?    Or you may be saying, these kind of studies justify the establishment of a Patient-Centered Outcome Research Institute (PCORI) and Comparative Effective Research, both part of Obamacare.

Tweet:   2 New England Journal of Medicine articles indicate bariatric surgery effectively treats morbidly obese diabetics  and may cure diabetes.

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