CSN-CommunityPost-Bariatric Surgery for Diabetes

New guidelines last week suggested surgery as Type 2 diabetes treatment for people who are obese, containing some who are lightly obese. Is “metabolic surgery” something you should think about it?

The guidelines were suggested by the American Diabetes Association, the International Diabetes Federation, and 43 different medical groups around the world. They were issued in the June issue of the journal Diabetes Care.

If you are bulky and have an HbA1c of 7.0 or above, your physician may soon suggest you have one of these surgeries. You will be stated the surgery will lower your blood sugar and your weight, which usually happens. You may not be told about the adverse effects. How do you decide?

When performed to manage diabetes, weight-loss, or bariatric surgery is recognized as “metabolic surgery.” The named covers Roux-en-Y “gastric bypass” surgeries, which decreases your abdomen to a small pouch and plugs it into the mid of the small intestine. It also contains “sleeve gastrectomy,” The deep part of the stomach is removed, and the rest is stapled together into a sleeve shape. Wrapping a band around the abdomen to shrink it (“gastric banding“) is now considered metabolic surgery. Other surgeries restructure the bowel in different forms.

Surgeons have been pleased to consider that their weight-loss operations also lower blood sugars, though they understand how that happens entirely. It’s possibly not the weight loss. Again and again, the improvements in diabetes numbers come long before consequential weight loss occurs.

A conference in Rome in 2007 informed that people were getting off their diabetes medicines and reducing their HbA1c scores after an operation. After eight years, a follow-up conference in London assured to make metabolic surgery an official suggestion.

Not all people who have diabetes will be told to get an operation. Those with Type 2 diabetes and a body-mass index equivalent to or over 40.0, or a BMI between 35.0 to 39.9 and poorly managed Type 2 diabetes, will be suggested to get it. Those with poor control and BMI from 30.0 to 34.9 should “think” surgery. You can measure your own BMI here.

What’s the evidence?

 The proof for the diabetic procedure is building up slowly and still does not have long-term follow up. The longest trials, known as STAMPEDE, are following roughly 150 people with high BMIs and poorly managed diabetes. One set got gastric bypass; one got sleeve gastrectomy; and one got intensive non-surgical medical care, including counseling and medicines.

Half of the people in the surgery groups had their HbA1c level below 7.0% at five years. Less than a quarter in the medical treatment category did. One in five people in the surgery groups had their HbA1c down to 6.0% or less, without medications, meaning their diabetes was remission. Nobody in the medical therapy category did that well.

There were no essential differences between categories in eye or kidney function, cholesterol, or blood pressure. The surgical class lost much more weight than the medically maintained group. They also required fewer heart medications and scored higher on quality-of-life measures.

Other studies have shown similar benefits. Outcomes vary depending on the people and the types of surgery.

None of the researches says much about the adverse effects, but there are many. A big one is malnutrition because people eat less and absorb less of what they consume. The government’s health data site MedlinePlus warns: “If you have gastric bypass procedure, you will need to take extra minerals and vitamins for the rest of your life,” but that might not wholly prevent malnutrition problems such as osteoporosis.

All the operations have significant risks, though they are becoming safer. Sleeve gastrectomy frequently causes anemia because blood leaks through the stapled stomach. Gastric bypass has chances of infection and blood clots, and digestive problems involving ulcers, gallstones, and reflux.

WebMD reported that “Nearly 20% of people who opt for weight-loss surgery need further operations for difficulties, and as many as 30% deal with complexities relating to malnutrition.” These malnutrition effects can contain “cognitive decline, neuropathy, and loss of muscle strength,” according to clinical psychologist and eating disorder experts Deb Burgard, Ph.D., FAED.

All these surgeries permanently change your connections with food. It’s common to get abdominal pain and nausea. You can consume only small amounts at a time, very slowly, chewing well, avoiding certain foods, and always deciding what is safe to eat. It’s a lot like maintaining a diabetes diet, only more so. Eating for satisfaction may become a thing of the past.

You can view more about the various methods and their pros and cons here.

Are the findings biased?

 25% of the authors of the guidelines in Diabetes Care are weight-loss surgeons. The guidelines are trying to persuade insurers and governments to fund the surgeries, which cost $25,000, even if there are no difficulties.

As stated to CBS News, “Insurance coverage has become very common over the last decade but remains spotty, and various insurers limit coverage to seriously obese people.”

“The clinical community,” stated the guidelines, “should work together with healthcare regulators to recognize metabolic operation as an suitable intervention for Type 2 diabetes in people with obesity and to introduce appropriate reimbursement policies.”

Translation: Insurers should cover the surgery, and governments should tell them to do so.

But what should you do? What do you need to know about these procedures to make an informed decision? More next week on what the different surgeries are, how they work, and how they affect your life.