Re: Re: Bariatric Surgery Recommended for Obese Patients With Type 2 Diabetes - FYI

[Guest guest]

100% agree - I have a friend with serious long term quality issues with her

gastric bypass surgery (over 5 years). She tells me often she would prefer

to be obese.

>

>

> The " long term " studies these guidelines were based it is studies of follow

> ups of 2-3y. In studies with follow ups longer than 5y (there aren't many)

> you see that a lot of the patients regain most of the weight lost, become

> again resistant to insulin and need drugs again to control their diabetes.

> Also a huge fat loss in a matter of months (fat that was gained for years)

> can lead to a fast release of xenobiotics that were store in fat which are

> going to be harmful to several organs. Not to even mention the several

> mineral and vitamin deficiencies those procedures cause that lead to

> osteoporosis, renal lithiasis and other complications. And you don't see

> those appearing in the 1st years. How can they estimate a life time cost

> from studies only based in 2-3 follow ups and not even estimating the costs

> of the complications of the procedure?

>

> Think out of the box

>

> Cátia Borges

>

>

>

> >

> > Bariatric surgery is an appropriate treatment for people with type 2

> > diabetes who are obese, the International Diabetes Federation (IDF)

> > announced today.

> >

> > Although such operations cost anywhere from $20,000 to $30,000, they will

> > reduce healthcare expenditures in the long run, according to a new IDF

> > position paper<

> http://www.idf.org/webdata/docs/IDF-Position-Statement-Bariatric-Surgery.pdf

> >on

>

> > the subject. The surgery, the IDF explains, often normalizes blood

> > glucose levels and reduces or avoids the need for medication.

> >

> > In addition, curbing diabetes can stave off costly complications such as

> > blindness, limb amputations, and dialysis, said Francesco Rubino, MD,

> > director of the IDF's 2nd World Congress on Interventional Therapies for

> > Type 2 Diabetes, meeting today in New York City.

> >

> > " When we talk about whether we can afford bariatric surgery, we have to

> ask

> > what will be the cost if we don't treat the patient, " Dr. Rubino told

> *Medscape

> > Medical News*. " Studies have shown the surgery to be cost-effective. So

> > there is a return on investment. "

> >

> > The IDF puts the lifetime cost of diabetes in the United States at

> $172,000

> > for a person diagnosed at age 50 years and $305,000 at age 30 years. More

> > than 60% of this amount is incurred in the first 10 years after

> diagnosis.

> >

> > Under the new IDF guidelines, patients with type 2 diabetes warrant

> > bariatric surgery when their body mass index is 35 kg/m2 or higher, or

> when

> > it is between 30 and 35 kg/m2 and their diabetes cannot be controlled by

> > medicine and lifestyle changes. This latter indication is even stronger

> when

> > there are other major cardiovascular risk factors, including

> hypertension,

> > hyperlipidemia, and a history of heart attacks, said Dr. Rubino, chief of

> > the Gastrointestinal Metabolic Surgery Program at New York-Presbyterian

> > Hospital/Weill Cornell Medical Center.

> >

> > The body mass index action points can be reduced by 2.5 kg/m2 for Asians.

> >

> > The guidelines were drawn up by an IDF taskforce of diabetologists,

> > endocrinologists, surgeons, and public health experts who met in December

> > 2010.

> >

> > *Trials Needed to Compare Surgical Procedures*

> >

> > The new recommended indications for performing bariatric surgery on

> patients

> > who are both diabetic and obese match those announced last

> > month<http://www.medscape.com/viewarticle/737792>by the US Food and

>

> > Drug Administration for expanded use of the Lap-Band

> > Adjustable Gastric Banding System (Allergan) to treat obesity.

> >

> > The US Food and Drug Administration originally approved the product,

> > designed for laparoscopic adjustable gastric banding (LAGB), for adults

> with

> > a BMI of 40 kg/m2 or higher and those with a BMI of 35 kg/m2 or higher

> who

> > have additional risk factors. Under the expanded indications, the LAGB

> > system also can be used for adults with a BMI of 30 to 40 kg/m2 and 1

> > additional obesity-related condition who have failed to lose weight

> despite

> > diet, exercise, and pharmacotherapy.

> >

> > The use of bariatric surgery to treat diabetes has sparked

> > controversy<http://www.medscape.com/viewarticle/738769>in healthcare

>

> > circles. Critics question the wisdom of wielding a scalpel to

> > solve a medical problem, especially when clinicians have more drugs at

> their

> > disposal to deal with diabetes.

> >

> > At the same time, a study published

> > online<http://www.medscape.com/viewarticle/739355>last week in the

>

> > Archives of Surgery has raised doubts about the efficacy of

> > LAGB. Researchers following 151 patients who underwent LAGB for obesity

> > concluded that the procedure yielded " relatively poor long-term

> outcomes, "

> > with nearly half the patients needing their bands removed and 60% overall

> > requiring some kind of reoperation. The authors, who performed the

> surgeries

> > in question during the mid-1990s, added a caveat: they had used an older

> > dissection technique.

> >

> > " The band is only one option, " Dr. Rubino told Medscape Medical News,

> noting

> > that gastric bypass procedures have demonstrated a greater endocrine

> effect

> > than LAGB. " We are learning that some types of diabetes are well treated

> by

> > lap-banding early in the disease process. The answer is in patient

> > selection. "

> >

> > The IDF taskforce calls for randomized controlled trials to compare

> > different bariatric procedures for diabetes between themselves, " as well

> as

> > emerging non-surgical therapies. "

> >

> > --

> > Ortiz, MS, RD

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>

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> >

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> > *

> >

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> > *

> >

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> >

> >

> >