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Specialists Call for Gastric Surgery to Be Standard Diabetes Treatment

Published 30 May 2016

Specialists Call for Gastric Surgery to Be Standard Diabetes Treatment
Gastric surgery should be offered as a standard treatment option for people with diabetes and could help them control their condition for years without medication, the world's leading diabetes organizations said on Tuesday.
In a joint statement which they said constituted one of the biggest shifts in diabetes treatment guidelines since the advent of insulin, the 45-strong group said bariatric, or metabolic, surgery could have a significant benefit for thousands of patients.
Francesco Rubin, a professor and chair of metabolic and bariatric surgery at King's College London and one of the authors of the new guidelines, said many countries across the world are in the midst of "an epidemic of diabetes".
While surgery would not be suitable for all, and should not be seen as a silver bullet solution for the global diabetes problem, Rubino said patients should be offered a range of options - including lifestyle changes, medications and surgery.
"For some, surgery may be the best choice," he told reporters at a briefing in London.
Type 2 diabetes is a long-term condition characterized by insulin resistance. Many patients can manage their diabetes with medication and diet, but the disease is often life-long and is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
A recent World Health Organization study found that the number of adults with diabetes has quadrupled in the past four decades to 422 million. International Diabetes Federation (IDF) estimates that by 2040 this will rise to 642 million.
The new guidelines say surgery designed to reduce the stomach and induce weight loss should be recommended to treat all diabetes patients whose body mass index (BMI) is 40 or over, regardless of their blood glucose control, as well as those with a BMI of 30 and over whose blood sugar levels are not being controlled by lifestyle changes or medications.
The guidelines, published in the journal Diabetes Care, were endorsed by 45 international organizations, diabetes specialists and researchers, including the IDF, the American Diabetes Association, the Chinese Diabetes Society and Diabetes India.
Obesity surgery involves the removal of part of the stomach or the re-routing of the small intestine in a bypass operation.
The guidelines are based on a substantial body of evidence, including 11 randomized trials, showing that in most cases surgery can lead to reductions in blood glucose levels below the Type 2 diabetes diagnosis threshold or to a substantial improvement in blood glucose levels.
In many cases this would lead to patients being able to give up or significantly reduce their diabetes medications.
Novo Nordisk, Sanofi and Eli Lilly are the world's leading suppliers of insulin and other diabetes drugs.
"Surgery represents a radical departure from conventional approaches to diabetes," Rubino said. "These new guidelines effectively introduce...one of the biggest changes for diabetes care in modern times."

Scientific American

13 comments


Nicolamp
on 30/05/2016

I recently completed a bariatric weight loss programme at my local diabetic unit. I lost 4 stone in 24 weeks on the Milk Programme. I know not everyone is able to tolerate it but it worked for me. I'd far rather this than to have surgery. After years of being unable to exercise & with worsening bloods I now swim up to 4 times per week & I walk 2 or 3 times per week too. 

I met the endocrinologist when my diabetes went out of control when I had steroids to treat ms. It's been life changing & life enhancing. 


Groovychick
on 02/06/2016

I was offered a gastic band, but turned it down, I wasn"t overweight enough!It was offered coz I have a few comorbiditys! I looked into it & went to the imformation eveing,& saw the surgon, but decided it wasn"t for me, My GP arrgeed! but hosptail drs hassled me about it! It is not the magic answer! It should only be as a last resort! Education is the key & having councling or CBT is a far better option! It is up to the person concred & they have to make the right desion for them! Anyone thinking about it needs to be fully informed so they can do what is right for them.


robjmckinney • Ambassador
on 13/06/2016

Weight does seem important for about half of diabetes 2 patients, least we forget it is normally age related and thin people do suffer from this disease. My brother had the surgery and had an unpleasant side effects, he has remained insulin controlled diabetic. As for me as diabetic 2 patient who developed throat cancer and survived. The treatment caused a massive weight loss leading to my diabetes moving from insulin controlled to diet controlled. So clearly two examples in one family showing the usefulness of losing weight in at least one case.

What I would like to see is more effort to resolve the condition before it develops the disease in our young people. Simple low cost monitoring and encouragement to help people would be a better investment than treating after development of disease!


Groovychick
on 19/06/2016

Of course losing weight helps, I have been losing weight & my sugars are much better  I have also had my meds changed, I have two other factors that caused my diabeties, I have POCS & both my mum & my auntie( who are sisters) have it!So it winds me up when the drs just blame my weight! 


on 01/07/2016

Bariatric surgent isn't always the answer as that in itself can create other health problems as in my sisters case.  She was very overweight and type 2 diabetic and she did lose a massive amount of weight.  However years down the line she now has iron and vitamin deficiencies despite a sensible diet as well as other complications and a limited diet of food she can eat.  She now suffers from other health conditions needing medication as well as her diabetes returning.  So Bariatric surgery isn't the best option for everyone who's diabetic.  I am diabetic and overweight but not heavy enough to warrant surgery nor would I have it anyway.  I am losing weight slowly and will continue to lose more as I am doing now.  

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