Diabetes study could create new class of surgical candidates

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A study published by the New England Journal of Medicine could create waves in the type 2 diabetes community. The study, which followed 150 patients with uncontrollable type 2 diabetes, showed gastric bypass may be the best intervention, trumping medication and sleeve-gastronectomy, which is a variation of gastric bypass.

The results showed the gastric bypass kicked type 2 diabetes into remission and was of particular note because the changeover happened before patients hit their weight goals. Most of the surgery patients also reined in their glucose levels without medication.

Of added value was that the patient class hovered in the 30-35 BMI range, which is a unique class, because it focuses on a group that is not necessarily the heaviest of heavy-set sufferers.

President of the American Society for Metabolic & Bariatric Surgery Robin Blackstone told MM&M that the results may prompt doctors to discuss surgery with patients sooner. She also said it was important to note that the glucose control occurred before weight loss. Gastric banding, which restricts the stomach as opposed to rewiring the gastrointestinal track, can ameliorate diabetes, but only after weight loss.

Blackstone noted that the findings show that the surgery “isn't really about obesity anymore.” She said that the results essentially create a new type of gastric bypass surgery by converting patients in a BMI range that was previously excluded from surgical consideration into viable surgical candidates.

“They're not surgical candidates for the treatment of obesity, but they are for the treatment of diabetes.”

She said she expects it may take a few years before insurers are persuaded that these patients are indeed surgical candidates, but that doctors may begin discussing the surgery as a treatment option for this discrete set of patients within the year.

The significance for the overall diabetes community could be substantial—the Centers for Disease Control reports that 90% to 95% of all adult diabetes cases are type 2 diabetes. Predictions are that associated triggers, including a soaring obesity rate, are going to push the number of type 2 diabetes cases even higher, adding even greater pressure on the direct medical costs—$116 billion—the CDC associates with the disease. This is in addition to the $58 billion in indirect costs, such as lost productivity, the agency links to both forms of diabetes.
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