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

[Guest guest]

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

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

Check out my blog: mixture of deals and nutrition

Magazines.com – $5 off + 28% cashback exp.

3/31<http://thefrugaldietitian.com/?p=17588>“The

Complete Idiots Guide To The Mediterranean Diet” By A. Tessmer, RD

LD $11.52 <http://thefrugaldietitian.com/?p=17405>Made my own " funny but

real " movie: Me interviewing a " potential " Dietetic

student<

*Healthy Diet at any Age: We are NOT just looking

*

*at the years people have behind them but also the

*

*quality of the years ahead of them.*