“Assessing The Obese Diabetic patient For Bariatric Surgery: Which Candidate Do I Choose?”
So, you are diabetic and obese, the time has come to that stage where you are looking for weight loss options; whether it is surgical or non-surgical. While many people who are obese and diabetic do not consider weight loss to be their first option, it is now becoming a fact that “for diabetic morbidly obese patients, surgery should not be considered as the last option but as an appropriate treatment”.
One such paper that researched this area concluded, “it is clear that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with non-surgical medical treatment”. In conclusion, the research found that in the surgical group, there had been a 63.5% remission rate compared to only 15.6% in the non-surgical group.
While a variety of factors would need to be taken into account when assessing whether surgery is a viable option, such as patient-risk factors and surgical factors, it is clear that weight loss surgery has an effective impact on type-2 diabetes. The authors of the research paper state those who fail with the non-surgical options remain morbid and obese and their diabetes unaffected.
So what are your options? On one hand, non-surgical options have their draws, however, on the other hand, bariatric surgery should not be considered as the last resort for obese patients. The surgery can have a significant impact on weight loss and type-2 diabetes. In fact Professor Michel Gagner, Professor of Surgery, Herbert Wertheim School of Medicine, stated that bariatric or metabolic surgery “should be performed as a mass treatment as a means of treating millions of patients with diabetes and other metabolic diseases”.
Multiple studies have examined the efficacy of lifestyle intervention and have found very little positive effects or benefit in regards to type-2 diabetes. Ideally a risk stratification should be provided to identify pre-diabetes conditions in obese subjects in order to identify high risk individuals to potentially prevent the occurrence of type 2 diabetes and its related systemic complications. In an ideal world prevention would be better than solutions for a cure but until we seriously address our lifestyle surgery will still remain an appropriate treatment for obese diabetic patients.
Diabetes Metab Syndr Obes. 2015; 8: 255–262.
Published online 2015 Jun 8. doi: 10.2147/DMSO.S50659
Authors: M.Rafaelli, L.Sessa, G.Mingrone & R.Bellantone