Diabetes Surgery Summit Issues Call to Use Bariatric Surgery as a Type 2 Treatment

The statement, published online November 23 in the Annals of Surgery, is seen by attendees at the recent Diabetes Surgery Summit in Rome as the precursor to the establishment of a new medical discipline,

| Dec 4, 2009

Fifty science and medical diabetes experts, representing 22 international organizations*, have issued a consensus statement that calls for bariatric surgery to be used as a treatment for type 2 diabetes. The statement, published online November 23 in the Annals of Surgery, is seen by attendees at the recent Diabetes Surgery Summit in Rome as the precursor to the establishment of a new medical discipline, "diabetes surgery."

Bariatric, or gastric bypass, surgery uses surgical stapling of the upper stomach or encirclement by an adjustable sleeve to control the hunger pangs and food consumption of morbidly obese people. "Morbidly obese" is defined as having a body mass index of 35 or more, which is roughly equivalent to being overweight by a factor of at least 40 percent. (For example, if a person's normal weight should be 150 pounds, a BMI of 35 would indicate a weight of at least 210 pounds.

In many cases, patients undergoing bariatric surgery have also been people with type 2 diabetes. In a high percentage of instances, their diabetes symptoms have been either radically reduced in intensity or even eliminated, sometimes within a week of having the surgery. This side effect, which scientists cannot fully explain, has led to the creation of a new set of terms to describe the degrees of "remission" among type 2s who have had the surgery (see "Remissions," Not "Cures" on this website).

It has also led to calls for a change in the criteria by which patients become eligible for the surgery. Currently, no one may undergo the surgery specifically to relieve or abate diabetes symptoms. The attendees at the Diabetes Surgery Summit would like to change those criteria in two ways: first, allow the surgery to be done to address type 2 diabetes as its main purpose, and second, lower the BMI required for the surgery below its current 35 kg/m² threshold. The consensus statement says that this threshold, equivalent to a BMI of 30 to 35, may be appropriate not only for type 2s, but also for people with "mild to moderate obesity."

Standing in the way of lowering the BMI requirement are the parameters for bariatric surgery issued by the National Institutes of Health in 1991. The NIH has responded to the consensus document with a call for research into the effects of bariatric surgery that specifically focuses on type 2 or milder forms of obesity. It has issued several formal Requests for Application for projects that will study those questions.

Diabetes Health also recently commented on the appearance of newspaper ads that, while they mention the current use of bariatric surgery as a radical weight control measure, also mention its beneficial effects on type 2. The consensus document from Rome is one more step along a road that could see bariatric surgery join the arsenal of weapons available to fight diabetes.

*Attendees included representatives from the American Diabetes Association, the American Society for Metabolic and Bariatric Surgery, Diabetes United Kingdom, The Obesity Society and the European Association for the Study of Diabetes.

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Categories: Bariatric Surgery, Diabetes, Diabetes, Food, Type 2 Issues, Weight Loss


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Comments

Posted by Anonymous on 9 December 2009

My neighbor had this procedure done. It took 6 follow up surgerys and almost a year for her to feel better. She had many complications and could not keep any food down for months. She had the procedure at a major hospital who specialized in the surgery. Yet they did not have good followup and never suggested any counseling prior to the surgery. This surgery changes your life forever! Be sure you are completely informed before making the decision. You may be getting rid of your Type 2 Diabetes but you will be left with many other problems. This procedure has a major impact on the way you eat.

Posted by Anonymous on 10 December 2009

As a type 2 who was morbidly obese, and had RNY done, but still uses insulin... overall I would say that overweight Type 2's should have this done if they can afford it. And I mean permanent surgery such as RNY or DS, *NOT* lap-band.

I can't eat hardly anything either now, but that is the point.

It isn't easy.. I do not think non-diabetics who weigh less than 300 lbs should do this. The 450 pounders out there should. Between: Do everything else possible first.

It is difficult, it is severe-- it's the "Clockwork Orange" solution to the problem in all cases.

I still use insulin.. but I'm down to 1/5 as much. I'm using about 40 units a day now where I was using over 200. Seeing that my non-obese father and grandfather were insulin dependent T2's I now suspect I'm really a "Type 1.5".

I'm disappointed I didn't go into remission like 86% of those who have this done. But still, I expect my A1C to be well under 6.0% next time from 6.7% previous.. and get better with further weight loss. My FBG's are down to 70's-low 100's from 150's at best before.

It is a risk and a gamble.. but the risk is low in 2010. I believe I added 10+ years to my life by doing this and I had to trade food for that. The good news is that once the procedure is done you are almost never hungry and you just don't care about food as much as before.

Is there a risk of gaining the weight back? yes.. but I'm older and wiser and watching my weight every day. I won't let obesity happen again.

My advice for someone considering this is to go to a center where the procedure is done laproscopically and the surgeon has done over 200 such operations. If that is the case your risks of complications are about the same as a Caesarian section.


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