Editorials

Is surgery a magic bullet against diabetes?

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4552 (Published 06 July 2012) Cite this as: BMJ 2012;345:e4552
  1. Sri G Thrumurthy, honorary research fellow,
  2. Ravindra S Date, honorary senior lecturer (University of Manchester),
  3. Muntzer Mughal, head of upper gastrointestinal service
  1. 1Gastrointestinal Services Division, University College London Hospital, London NW1 2PG, UK
  1. muntzer.mughal{at}uclh.nhs.uk

Recent trials in obese people with diabetes show excellent short term results but long term data are needed

The prevalence of type 2 diabetes and obesity is rising.1 In 2010, the global prevalence of type 2 diabetes was estimated at 8.3% of the adult population; the World Health Organization expects this to rise to 9.9% by 2030, and this poses a costly public health challenge.2 3 Between 20% and 25% of patients with morbid obesity have type 2 diabetes and its complications.4 Less than half of patients with moderate to severe type 2 diabetes on medical treatment achieve and maintain adequate glycaemic control.5

The findings of several observational studies and level two meta-analyses suggest that bariatric surgery in obese and non-obese patients with type 2 diabetes leads to rapid and sustained control of hyperglycaemia and other cardiovascular risk factors.6 7 8 9 Furthermore, large administrative datasets have shown that the overall cost of bariatric surgery for these patients is fully offset by reduced expenditure on antidiabetic drugs within 26 months of surgery.10 Both a consensus meeting and the International Diabetes Federation have recommended bariatric surgery as an adjunct in the management of type 2 diabetes,11 12 and long awaited level one evidence to support the superiority of surgery over drugs …

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