By Meena Amso
A joint statement by leading diabetes organisations and endorsed by 45 worldwide scientific societies this week called for surgery to be recognised for the first time as a standard treatment option for type-2 diabetes.
Weight loss surgery can play an important role in achieving blood sugar control and reduction in cardiovascular risk factors, say international experts who are calling for greater use of bariatric surgery to treat type-2 diabetes.
Bariatric surgery involves reducing the size of the stomach using a gastric band or removal of part of the stomach. The procedure can cost upwards of $15,000.
Writing in the journal Diabetes Care, scientists claimed the move may be one of the most significant changes in diabetes care since the introduction of insulin in the 1920s. The recommendation is based on a review of findings from a number of short and midterm randomised clinical trials.
The authors recommended bariatric surgery for type-2 diabetes patients with a Body Mass Index (BMI) of 40 and over, or lower for patients struggling to control high sugar levels.
Publicly funded bariatric surgery in New Zealand is prioritised for those with BMI greater than 40 or BMI 35-40 if they have another significant condition expected to improve significantly with surgery such as type-2 diabetes, sleep apnoea, or arthritis requiring joint replacement. It does not include patients with uncontrolled type- 2 diabetes with BMI 30-34.9 largely due to running costs and capacity limitations.
Jim Mann, Professor of human nutrition and medicine at the University of Otago said limited access to bariatric surgery is a problem in New Zealand.
“In most district health boards in New Zealand it is very difficult to get bariatric surgery even for people with a BMI over 40 who have co-morbities such as diabetes.”
Senior lecturer in medicine at Auckland University Dr Rinki Murphy agreed and hoped diabetic patients would get fairer access to the surgery.
“Disparities in patient selection, patients’ choice, and negative societal attitudes to obesity and bariatric surgery, may be some of the reasons for low uptake of surgery in certain ethnic groups – particularly under-representation of Pacific people.”
Immediate past President of New Zealand Society for the Study of Diabetes Associate Professor Jeremy Krebs warned that caution should be exercised with any recommendations made.
“Our particular concerns relate to the recommendation for those with a BMI of greater than 40 to be expedited to surgery, and the lack of emphasis on dietary intervention in those with a BMI of 30-50, prior to considering surgery.”
For 55-year-old Auckland diabetic patient Munther Batta, bariatric surgery was life changing.
Batta underwent surgery in September 2014 as part of a trial at Auckland’s North Shore Hospital, which resulted in him no longer needing insulin to control his blood sugar levels.
“They told me to stop insulin two weeks before the operation, since that time till now, I’ve had no insulin.”
Featured image: CC flickr Mason Masteka