Intended for healthcare professionals

Student Clinical review

Type 2 diabetes and bariatric surgery

BMJ 2012; 344 doi: (Published 09 March 2012) Cite this as: BMJ 2012;344:e992
  1. Derek K-H Ho, fifth year medical student1,
  2. Carel W le Roux, reader2
  1. 1Imperial College London, London, UK
  2. 2Imperial Weight Centre, Imperial College London

Does providing gastric bypass surgery pay for itself in patients with a high body mass index?

It all started with patient HK’s legal action against her primary care trust three years ago.

HK, a 40 year old woman, had gastric banding surgery in 2000 when she weighed 111 kg, which led to a weight loss of 49 kg. The band subsequently had to be removed because of complications. She wanted the primary care trust to allow her to have gastric bypass surgery when her weight rose to 100 kg after removal of the band.1 The trust denied her request, stating that although her body mass index (BMI) was 37.8 kg/m² and she had obesity related comorbidities such as glucose intolerance, she fell short of the trust’s local guideline of offering gastric bypass surgery only to patients with a BMI ≥50 kg/m².

In January 2011, after a legal challenge, the primary care trust agreed for her to proceed with surgery. It was carried out at University College Hospital by Marco Adamo, who raised the long ignored point, “The reason why she’s entitled to have surgery is for metabolic reasons . . . we are trying to prevent the development of diabetes.”2

Surgery for diabetes?

Isn’t gastric bypass surgery a weight loss operation? Where does diabetes come in? Many trials have already shown that bariatric surgery results in more than just weight loss.345

Type 2 diabetes mellitus, resulting from peripheral insulin resistance and impaired insulin secretion, accounts for over 80% of cases of diabetes in Europe.6 Patients can develop microvascular and macrovascular complications, including retinopathy, nephropathy, neuropathy, and cardiovascular disease. Treatment traditionally entails taking drugs to achieve glycaemic control, reducing cardiovascular risk factors, and treating the complications. No medical or surgical cure for type 2 diabetes mellitus existed before …

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