Should bariatric surgery be used as a way to cut diabetes/obesity rates?
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Diabetes
Should bariatric surgery be used as a way to cut diabetes/obesity rates?
Discuss any aspect of type I or type II diabetes mellitus here
I recently posted a blog on bariatric surgery: http://doc2doc.bmj.com/blogs/diabetes/_bariatric-surgery-diabetes I wonder if bariatric surgery is becoming a part of your armentarium and am posting th
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Forums » Open clinical » Diabetes » Should bariatric surgery be used as a way to cut diabetes/obesity rates?
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Should bariatric surgery be used as a way to cut diabetes/obesity rates?
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Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 16/3/2012 2:06 PM GMT
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
I recently posted a blog on bariatric surgery: http://doc2doc.bmj.com/blogs/diabetes/_bariatric-surgery-diabetesI wonder if bariatric surgery is becoming a part of your armentarium and am posting this poll to find out. Additionally I am interested to know who do you refer for bariatric surgery and what have your results been?
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 16/3/2012 9:21 PM GMT
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello Dr. Diabetes: I do not think so. I believe it is a too much of an agressive method, avaiable to many few people, with many serious side-effects, and unknown long term safety and effectiveness effects on hard diabetic/obesity complications. For me it is a still (and dangerous) experimental method. All Best, Joey |
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 16/3/2012 10:43 PM GMT
on bmj.com
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Posts: 1790
First: 7/3/2009 Last: 24/5/2013 |
No. Bariatric surgery is a radical method to be used only when all others fail and in carefully selected cases. I don't believe in surgery as prevention. Remember the various vagotomies used for peptic ulcers back in the eighties? Well, does anybody think nowadays that surgery is the regular method to cure peptic ulcer?
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 3/5/2012 9:12 PM BST
on bmj.com
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Posts: 4
First: 3/5/2012 Last: 6/12/2012 |
Bariatric surgery is not the solution to the obesity epidemic. It is the the most effective means of treating type 2 diabetes in the obese and possibly over weight. There is no other alternative that is anywhere as effective. The comparison with peptic ulcer disease is erroneous, there is now a very effective medical treatment, hpylori eradication. Bariatric surgery is not prophylactic, it is therapeutic. |
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 4/5/2012 5:35 AM BST
on bmj.com
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Posts: 10
First: 27/4/2012 Last: 15/5/2012 |
hello everyone, the american diabetes asso. in their artical diabetes care 2011 have recommended bariatric surgery for type 2 diabetes who have BMI /> 35 kg/msq. who are difficult to control with lifestyle and drugs. have a nice day |
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 5/5/2012 3:46 PM BST
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
I believe that we have to add bariatric surgery to our srmentarium, but we must be selective in our referrals and be sure that the program offers the psychological and medical support needed for successful outcomes. |
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 5/5/2012 4:44 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
I completely do agree with Dr.Joey Rio & Dr.Yoram Chaiter about routine use of bariatric surgery. Although the american diabetes association in their artical 'diabetes care 2011' have recommended bariatric surgery for type 2 diabetes who have BMI /> 35 kg/msq.& are difficult to control with lifestyle and drugs, it is still not advisable as it does not modify the very basic defective mechanism in diabetics, & instead would add to the morbidity & complications significantly. |
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Re: Should bariatric surgery be used as a way to cut diabetes/obesity rates?
posted at 5/5/2012 8:14 PM BST
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
It is interesting that internist seem so resistant to considering bariatric surgery as an option. We have decades of data showing that it is an effective option that reverses diabetes and its associated risk factors. While not a causal decision, i still contend that in selected patient it is an option. Review JAMA. 2004;292(14):1724-1737. doi: 10.1001/jama.292.14.1724 Bariatric Surgery A Systematic Review and Meta-analysis Henry Buchwald, MD, PhD; Yoav Avidor, MD; Eugene Braunwald, MD; Michael D. Jensen, MD; Walter Pories, MD; Kyle Fahrbach, PhD; Karen Schoelles, MD [+] Author Affiliations Author Affiliations: Department of Surgery, University of Minnesota, Minneapolis (Dr Buchwald); Ethicon Endo-Surgery Inc, a Johnson & Johnson company, Cincinnati, Ohio (Dr Avidor); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (Dr Braunwald); Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn (Dr Jensen); Department of Surgery, East Carolina University School of Medicine, Greenville, NC (Dr Pories); and MetaWorks Inc, Medford, Mass (Drs Fahrbach and Schoelles). Corresponding Author: Henry Buchwald, MD, PhD, University of Minnesota, 420 Delaware St SE, MMC 290, Minneapolis, MN 55455 (buchw001@umn.edu). ABSTRACT Context About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. Objective To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). Data Sources and Study Selection Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. Data Extraction A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). Data Synthesis A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. Conclusions Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement. |
Forums » Open clinical » Diabetes » Should bariatric surgery be used as a way to cut diabetes/obesity rates?
