In many cases this would lead to patients being able to give up or significantly reduce their diabetes medications. “Formally ratified by an unprecedented array of societies representing diverse medical and surgical specialties from around the world, these new guidelines can serve as a global reference for the use and study of GI surgery as an intentional treatment option for T2D”, according to an article in the journal Diabetes Care.
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“This is why the National Institute for Health and Care Excellence (NICE) must make it explicit in its type 2 diabetes guidelines that those with type 2 diabetes who meet the recommended criteria for obesity surgery should be referred for early assessment for surgery and supported to make an informed choice”.
About half of patients go into remission from diabetes for at least five years after weight loss surgery, trials found.
“These recommendations are now stated in the NICE obesity guidelines, but are not fully incorporated in current NICE type 2 diabetes guidelines”.
Bariatric surgery is now only used to treat obesity – but it should be offered even to those who are not morbidly obese as a standard treatment for Type 2 diabetes, specialists from around the world told respected journal Diabetes Care. The statement is endorsed by the American Diabetes Association.
“This is because there is a wide body of evidence that shows surgery is an effective treatment option for type 2 diabetes and can be cost effective for the NHS”.
And one study showed nearly all patients were able to stop taking insulin or other injectable medication to control their blood sugar.
These procedures remove parts of the stomach or reroute the small intestine.
Although metabolic surgery is fairly safe, when compared to commonly performed operations, there are still risks of complications and long-term nutritional deficiencies.
In the report, metabolic surgery is defined as the use of gastrointestinal operations, originally created to induce weight loss (“bariatric surgery”), with the primary intent to treat type 2 diabetes and obesity.
“I guess what these guidelines may improve is more representative referrals from the ethnic groups that are affected disproportionately, by both diabetes and obesity, and that’s Pacific and Maori groups”.
Those with a BMI of 30 or over – the threshold for being clinically obese – should also have surgery as an option if their blood glucose levels are not well-controlled despite taking tablets, insulin or following weight-loss programmes. As an example, a 5-foot-8 person who weighs 240 pounds has a BMI of 36.5, the CDC says. While diabetes involves imbalances in hormones and metabolism, there’s enough evidence, the doctors say, that bariatric surgery, which involves shrinking the size of the stomach, cannot only physically affect how much people eat but also how the body breaks down calories and metabolizes them as well.
Professor Rubino, also a consultant surgeon at King’s College Hospital, said 11 clinical trials had shown that the role of the gut was key to finding a cure for diabetes. But as standard care often isn’t enough, “it’s time for something new”.
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Spokesman Associate Professor Jeremy Krebs said they’re concerned about recommendations for those with a BMI of more than 40 to be expedited to surgery, and the lack of emphasis on dietary intervention in those with a BMI of 30-35, prior to considering surgery.
