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‘Bariatric surgery for type 2 diabetes always produces a good outcome’
Author(s) -
Andrews Robert C,
Chen Mimi Z,
Logue Jennifer
Publication year - 2014
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.1907
Subject(s) - medicine , weight loss , blood pressure , diabetes mellitus , type 2 diabetes mellitus , obesity , type 2 diabetes , surgery , endocrinology
Weight is very important in type 2 diabetes (T2DM); 1 kg of weight gained annually over 10 years is associated with a 49% increase in risk of developing T2DM in the subsequent 10 years. In patients with T2DM a weight loss of 5–10% results in a 0.5% reduction in HbA1c, a 5mmHg decrease in systolic blood pressure and diastolic blood pressure, a 0.13mmol/L increase in HDL cholesterol, and a 0.45mmol/L decrease in triglycerides.1 For these reasons the ADA and EASD recommend that weight loss should be strived for in all patients who have T2DM. In spite of this recommendation, few patients with T2DM are offered comprehensive weight loss programmes; instead treatment focuses on using medication to control glucose, blood pressure and lipids, with many of these medications causing weight gain. In the past, excuses for not targeting weight loss have been that it is hard to maintain weight loss in the long-term without high levels of contact or continuation of weight loss drugs. Bariatric surgery, however, does not suffer from the above problems. The mean 20 years’ weight reduction in the Swedish Obese Subjects study, a very large prospective study, was 15–25% dependent on the type of surgery performed, and contact levels required post surgery were low.2 This and other studies have led NICE to state that bariatric surgery should be offered to patients with a BMI of 35–40kg/m2 who have obesity-related conditions such as diabetes mellitus or obstructive sleep apnoea, or in those with a BMI of 40kg/m2 or greater regardless of weightrelated comorbidities. Updated NICE guidance due in the New Year is likely to suggest that the BMI cut-off for surgery in patients with T2DM should be lowered to 30kg/m2. In spite of these NICE recommendations, many physicians are reluctant to refer patients for bariatric surgery. The common reasons stated for this are: there are no long-term data that bariatric surgery improves diabetes control; there are no outcome data on macroand microvasular diabetes complications; there are no data that bariatric surgery is better than medical therapy; bariatric surgery is very risky; complication rates are high and can be very serious; there are no cost-effective data; and most of our patients do not want surgery. The following takes each of these statements in turn.