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Surgery must be recognised as a treatment option for Type 2 diabetes

But Tuesday’s guidelines mark the first time the surgery is recommended specifically as a diabetes treatment rather than as obesity treatment with a side benefit. Philip Schauer, M.D., of Cleveland Clinic said these new guidelines are important because they give doctors another tool when treating those with type 2 diabetes who are not responding well to traditional medical therapy. About 26 million Americans have diabetes, mostly the Type 2 form where the body gradually loses the ability to produce or use insulin to turn food into energy. Many can control the disease with diet, exercise, medication or insulin — but years of poorly controlled diabetes can lead to heart attacks, strokes, kidney failure, amputations or blindness. Among them was a trial conducted by Cleveland Clinic, which showed that those with Type 2 diabetes who had bariatric surgery were better able to meet their target blood sugar level goals than those who received traditional medical therapy. Studies have long shown that most obese diabetics who undergo bariatric surgery see their blood sugar control dramatically improve. Some even reach normal levels despite quitting their regular medicine.

But others have remained in remission for years. Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. For example, compared with the general population, the prevalence of obesity is lower in men of Bangladeshi and Chinese family origin, whereas it is higher for women of African, Caribbean and Pakistani family origin (as reported in ‘Bariatric surgery for obesity’ by the former National Obesity Observatory, now Public Health England’s obesity knowledge and intelligence team, in 2011). They conclude the surgery should be a regularly considered option for certain diabetes patients – with the emphasis on better blood sugar control instead of pounds lost. Bariatric surgery can lead to an average 2% reduction in HbA1c (average blood glucose over 3 months) in patients with a BMI over 35 kg/m2. Class III obesity is defined as a body mass index (BMI) of 40 or more. “The UK is in the midst of an epidemic of diabetes, like many other countries around the world, and prevention of Type 2 diabetes remains crucial”; said Professor Francesco Rubino, Chair of Metabolic and Bariatric Surgery at King’s College London, Consultant surgeon at King’s College Hospital and first author on the guidelines report.

“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. These patients should have access to all effective treatment options; for some, surgery may be the best choice” he added. The ADA reports that in 2012, 29.1 million Americans, or 9.3 percent of the population, had diabetes, and 1.4 million Americans are diagnosed with diabetes every year. Those procedures are more effective in the management of diabetes.

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