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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


Groovychick
on 04/07/2016

I know many people who have had more health problems as a result of having Bariatric surgery! One being loads of excess skin, having to pay thousands to have it removed! only for it to get infected! My friend has put weight on even after having a gastric sleve!  she said she is always hungry & can hardly eat anything other wise she has really bad indigestion! I was offered it but turned it down! I gave it alot of thought, went to the information eveing & saw the surgen! But i knew it wasn"t for me, I got alot of stick for it from my sugren & hepotoist, he said your fat & all your health problems are of your own making go away! he was so rude, I did complant about him but was persaured not to make it offical! now I would! having Bariatic is huge desion & I had the right to say no! so don"t be bullied into it, if you know it"s not what you want! 


goose64
on 11/07/2016

For a lot of usI think counselling to discover why we overeat would be useful 


bellabee
on 11/07/2016

Hi, My husband is type 2 diabetic and is on insulin and meds and has the condition under control. His blood readings are good, between 5 - 8. My question is, can the condition be reversed? When will the medical profession say to him that he no longer needs insulin or tablets?  Thanks, Ann


robjmckinney • Ambassador
on 12/07/2016

Hi Bellabee,

Depends whether your husband is overweight and that weight was the reason for the development of the disease. Weight loss can reduce the effects of diabetes, I myself moved from insulin dependency to diet control through massive weight loss. Several times I have reduced weight to avoid insulin dependency in my early years of diagnoses. Yet my brother had weight reduction surgery and remained insulin dependent. So it is possible and the bonus is that you can return to a normal driving licence instead of the three year review with the threat of withdrawing of licence off your husband's back. 


bellabee
on 13/07/2016

Hi, well that is certainly good news, at the diabetes clinic he was not given any encouragement at all in regards to halting the condition. When I asked if it can be reversed, they said it is almost impossible. She had only seen one patient who had.

The type 2 was brought on from carrying too much weight. He has also been through a major op to remove the prostrate, it was very large and cancer was found. Since the op he has lost about 10kg and is hoping to get cycling again now.

Thanks very much for your response.

Ann.

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