Is It a Viable Treatment for Glucose Control in Type II Diabetes
Traditional medical management of type II diabetes may be challenged in the near future by a more drastic approach to achieving glycemic or glucose control, weight loss, and minimizing secondary effects of diabetes. Bariatric surgery has been found effective in achieving glycemic control in two recent studies.
The CDC estimates over 8% of American adults suffer from diabetes. Nearly 90% of those afflicted with diabetes require treatment with insulin and/or other medications. The total direct and indirect cost of treating diabetes in the Unites States is over $178 billion annually. And this was an estimate from 2007. The incidence of diabetes has been quickly on the rise since these estimates were published. Diabetes leads to many costly and debilitating conditions including heart disease, stroke, lower extremity amputation, kidney failure and blindness.
Conventional medical therapy for diabetes is limited. Effectiveness is variable depending on many factors, especially patient compliance. ADA Diet, insulin, and oral medication to lower blood glucose levels (glycemic control) are traditional approaches to medical management of diabetes. Glycemic control is essential to treating diabetes. Glycated hemoglobin levels determine glycemic control and are measurable with a goal of around 6.5 – 7 %. People with levels above the goal will experience approximately a 40% increase in complications for each 1% increase in glycated hemoglobin levels.
Two recent studies suggests that bariatric surgery was more effective than traditional medical management of diabetes. Both studies were randomized controlled trials consisting of severely obese patients with uncontrolled type 2 diabetes.
The following is a summary of the results of one of the studies:
- At two years follow up, NONE of the medically managed patients achieved glycemic control.
- 75% of the gastric bypass group achieved glycemic control to normal levels, 6.35%.
- Age, sex, baseline BMI, diabetes duration, and weight loss were not predictors of success at 1 month, 3 months, or 2 years for any subjects.
Results of the other study were as follows:
- Bariatric surgery was nearly 4 times more successful than medical management alone for reaching glycemic control.
- Average glycated hemoglobin levels were 6.5% for the bariatric surgery groups.
- Average glycated hemoglobin levels were 7.5% for the non surgical group (1 point higher or 40 times more likely to have complications).
- Gastric bypass was slightly more effective than sleeve-gastrectomy.
- Average weight loss was 65 pounds in the bypass group, 55 pounds in the sleeve-gastrectomy group, and 11 pounds for the non surgical group.
- The surgical groups had a significant decrease in the use of medications to manage glucose, blood pressure, and lipids.
- The nonsurgical group increased the use of all 3 types of these medications.
- 4 % of surgical patients underwent re-operation.
The above results are significant enough that one would have to consider the effectiveness of bariatric surgery as a viable treatment approach to managing diabetes. The benefits do not come without possible risks as with any surgery. Another drawback is cost. Nearly all insurance companies do not provide coverage for bariatric surgery. Bariatric surgery averages $25,000 per procedure and initially does not appear cost effective. In one way, that sounds like a lot of cash for diabetes treatment. On the other hand, $178 billion annually to medically manage diabetes in America would cover the cost of over 7.1 million bariatric surgeries. Hmmm, food for thought. Do the math for a few years and that’s a lot of surgeries.