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Is surgery a panacea for diabetes?
... maybe for the doctor, but not the patient
If bariatric surgery is to be encouraged in the management of type II diabetes, the biggest challenge for doctors will be to persuade patients with a seemingly asymptomatic disease to have such drastic surgery. Patients may well understand that their glycaemic control isn’t ideal, their weight excessive, and the potential implications of this. But are these factors sufficient in their minds to warrant surgery?
Surgery may well reduce BM readings and cause significant weight loss however, I think it is all too easy for medics to focus on these benefits and forget about the future consequences for the patient.1,2
All surgery has an immediate risk and anaesthetic is a particular danger for those who are overweight. Complications associated with bariatric surgery depend on the procedure employed.2 Malabsorption can be common and may result in gastrointestinal symptoms (diarrhoea, abdominal pain, flatulence etc) and more general symptoms (anaemia, infertility, peripheral neuropathy, night blindness etc.)2 Patients have to follow a strict post-operative diet to ensure the weight loss is maintained and to reduce the chances of developing dumping syndrome. However, some studies suggest that this unpleasant condition occurs in up to 70% of patients following gastrointestinal bypass procedures.3 Currently little is known about the long-term nutritional and clinical consequences of altering gastrointestinal anatomy.2
It should also be pointed out that there is a 1% mortality associated with bariatric surgery, some people fail to lose a significant amount of weight despite surgery, and others will regain weight post-operatively. 3
So, is surgery a panacea for diabetes? Well perhaps for the doctor who is focused on cost effectiveness, BMI and HbA1C values. But for the asymptomatic diabetic... I think not.
1) Thrumurthy SG, Date RS, Mughal M. Is surgery a panacea for diabetes? Student BMJ, volume 20, November 2012.
2) Hammer HF. Medical complications of bariatric surgery: focus on malabsorption and dumping syndrome. Dig dise 2012;30:182-186.
3) Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioural aspects of bariatric surgery. Obesity research vol 13, issue 4, April 2005.
Competing interests:
No competing interests
23 November 2012
Anna R Mattinson
Medical Student
The University of Edinburgh
Chancellors Building, Little France, RIE, Edinburgh
Re: Is surgery a magic bullet against diabetes?
Is surgery a panacea for diabetes?
... maybe for the doctor, but not the patient
If bariatric surgery is to be encouraged in the management of type II diabetes, the biggest challenge for doctors will be to persuade patients with a seemingly asymptomatic disease to have such drastic surgery. Patients may well understand that their glycaemic control isn’t ideal, their weight excessive, and the potential implications of this. But are these factors sufficient in their minds to warrant surgery?
Surgery may well reduce BM readings and cause significant weight loss however, I think it is all too easy for medics to focus on these benefits and forget about the future consequences for the patient.1,2
All surgery has an immediate risk and anaesthetic is a particular danger for those who are overweight. Complications associated with bariatric surgery depend on the procedure employed.2 Malabsorption can be common and may result in gastrointestinal symptoms (diarrhoea, abdominal pain, flatulence etc) and more general symptoms (anaemia, infertility, peripheral neuropathy, night blindness etc.)2 Patients have to follow a strict post-operative diet to ensure the weight loss is maintained and to reduce the chances of developing dumping syndrome. However, some studies suggest that this unpleasant condition occurs in up to 70% of patients following gastrointestinal bypass procedures.3 Currently little is known about the long-term nutritional and clinical consequences of altering gastrointestinal anatomy.2
It should also be pointed out that there is a 1% mortality associated with bariatric surgery, some people fail to lose a significant amount of weight despite surgery, and others will regain weight post-operatively. 3
So, is surgery a panacea for diabetes? Well perhaps for the doctor who is focused on cost effectiveness, BMI and HbA1C values. But for the asymptomatic diabetic... I think not.
1) Thrumurthy SG, Date RS, Mughal M. Is surgery a panacea for diabetes? Student BMJ, volume 20, November 2012.
2) Hammer HF. Medical complications of bariatric surgery: focus on malabsorption and dumping syndrome. Dig dise 2012;30:182-186.
3) Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioural aspects of bariatric surgery. Obesity research vol 13, issue 4, April 2005.
Competing interests: No competing interests