Concerns About Surgery for Diabetes

Bariatric surgery for obese type 2 diabetes patients needs more research

(RxWiki News) Recently, two studies were published showing that surgery may be better than drug treatment for obese diabetes patients. While these findings may change some doctors' approach, experts are expressing their concern.

The Endocrine Society has released a statement encouraging doctors to think about a few factors before suggesting weight-loss surgery to obese patients with type 2 diabetes.

As surgery can lead to a number of complications, the Endocrine Society points out that weight-loss surgery is not for everyone.

"Talk to your doctor about the best diabetes treatments for you."

The two studies published last week compared surgery to drug treatment in obese patients with type 2 diabetes. They both found that surgery led to better diabetes control than normal medical treatment.

Still, the Endocrine Society cautions, "Bariatric surgery is not a guarantee of successful weight loss and maintenance."

In one study - which was conducted by Geltrude Mingrone, M.D., of the Catholic University of Rome, and colleagues - researchers found that obese diabetes patients had a higher drop in blood sugar levels after two types of weight-loss surgery, compared to those who received normal medical treatment.

Another study - by Philip R. Schauer, M.D., of the Cleveland Clinic, and colleagues - found similar results: weight-loss surgery led to greater improvements in blood sugar levels than drug treatment.

In its statement, the Endocrine Society gives us a few points to consider in interpreting the results of these studies.

First, the findings of both studies suggest that surgery may be a better method for weight loss and diabetes treatment in obese patients. However, "what these studies do not highlight is the risks of surgery, specifically the short and long term surgical, nutritional, and metabolic complications," the authors of the statement write.

Surgery can lead to a number of complications, including ulcers, iron deficiency, vitamin B12 deficiency, internal hernia, and metabolic bone disease among others.

Second, both studies involved a small number of patients (60 in Dr. Mingrone's study and 150 in Dr. Schauer's).

Third, both studies took place in weight-loss surgery centers where surgeons and other medical personnel had a good deal of experience working with severely obese patients. This experience means that the health care professionals were well-prepared to deal with complications both before and after surgery. This may have played a part in the low rates of complications.

In addition, both studies looked at only short-term outcomes.

Type 2 diabetes is a chronic disease - meaning it can last for a long time, with the possibility of progressively getting worse. According to the authors of the statement, "Only long-term studies can established the ability of surgery to impact quality of life and [risk of death] in type 2 diabetes."

They go on to suggest that future research should study the effectiveness of care after surgery. That is, does post-surgery treatment reduce the rate of obesity-related chronic illnesses like type 2 diabetes? Does it reduce the risk of death from such illnesses?

The Endocrine Society recommends that doctors think about several factors before sending their obese diabetes patients into surgery.

"These include the patient's [body mass index] and age, the number of years of diabetes, and an assessment of the ability to comply with long-term lifestyle changes that are required to maximize surgery and minimize complications," they write.

They conclude that patients, their doctors, and other experts should talk to one another before deciding to use surgery as treatment.

"The success of weight loss surgery in patients with obesity and diabetes ultimately depends on the partnership of patient, endocrinologist, surgeon, and a support team in the continuum of the long-term care of the patient," they write.

Both of the studies were published in the New England Journal of Medicine.

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Review Date: 
April 3, 2012