Bariatric surgery not a 'last resort' for diabetics
Last Updated: 2011-03-28 18:21:20 -0400 (Reuters Health)
By Karla Gale
NEW YORK (Reuters Health) Weight loss surgery should not be a last resort for obese patients with type 2 diabetes, according to the International Diabetes Foundation (IDF).
Instead, bariatric surgery should be considered a legitimate treatment for diabetes, the IDF advised in a policy statement issued today at the Second World Congress on Interventional Therapies for Type 2 Diabetes, held in New York City.
"Blood glucose is often normalized within days of weight-loss surgery, and most patients can reduce or even stop using diabetes medications," said Professor Paul Zimmet, from the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, and co-chair of the IDF Task Force on Epidemiology and Prevention.
Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery at New York-Presbyterian/Weill Cornell Hospital, added, "The morbidity and mortality of bariatric surgery are similar to that of elective gall-bladder surgery and no one considers that dangerous."
The bottom line, according to the IDF: bariatric surgery is appropriate for type 2 diabetics with a body mass index (BMI) of 35 when lifestyle modification and medications have failed to control blood glucose levels. When patients have other major cardiovascular risk factors or co morbidities, surgery should be considered at a BMI of 30. In Asians and other high-risk ethnic groups, surgery may be prudent at even lower BMIs.
At a press briefing, IDF researchers described an algorithm for metabolic control in obese type 2 diabetics. When changes in lifestyle diet modification, weight control, and physical activity are insufficient, metformin should be added.
But if patients don't reach treatment goals on metformin, the IDF advises that surgery be considered for patients with BMI over 35, and that it be a priority for those with a BMI 40.
Patients with a lower BMI can try a sulphonylurea. But if that doesn't work, the IDF says patients with a BMI 30 are eligible for surgery, and those with a BMI 35 should be prioritized.
The researchers said the longer a patient is diabetic, the less likely it is that bariatric surgery will cure the diabetes which is why surgery should be considered earlier in the course of disease.
Despite its relative safety, Dr. Rubino pointed out that patient who undergo surgery "require comprehensive and ongoing multidisciplinary care and monitoring," and nutritional supplementation.
Professor John B. Dixon of Monash University in Melbourne, Australia noted that while most diabetic patients benefit from the surgery, hyperglycaemia may eventually return. However, he added, "a prolonged period of normal glycemic control benefits patients even if they relapse."
This type of procedure, now often called "metabolic surgery," is "remarkably cost effective even cost-saving for patients with BMIs over 35," Dr. Dixon told Reuters Health.
Now, Dr. Rubino added, "It will be up to national diabetes associations to educate primary care physicians about metabolic surgery. And patients should definitely be informed of the ground-breaking research that went into our position statement." The IDF is an umbrella organization of over 200 national diabetes associations with more than 2 million members in over 160 countries.
The IDF consensus meeting was supported with unrestricted educational grants from Allergan Inc., Ethicon Endo-Surgery, and MetaCure Inc. The presenters noted that none of these companies, or their representatives, was involved in developing the report.
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