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

[Guest guest]

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.p\

df>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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