It has been shown that obese patients with diabetes benefit a lot from bariatric surgery, however less than 10% of the patient who qualify undergo the procedures. Given the severe adverse outcomes of uncontrolled diabetes, how patients, providers and insurers can be educated on favorable outcomes of surgery, so that more patients can benefit from it?
http://care.diabetesjournals.org/content/38/4/659
very important discussion,it depends on guidelines of that perticular country.Educate the family physicians first ,patients later,favourably change the law of the land so that insurers will respond.Medical personnel like Dr Lee Kaplan and Dr Franscisco Rubino are already at work educating and propagating metabolic surgery .Still lot more awareness has to come across the world like in USA.
In morbid obese patients who has comorbidity such as diabetes and hypertention, we suggest the sleeve gastrectomy procedure. I think that this procedure is more physiologic than the others. There is no need additional drugs including minerals and vitamins.
I also think Sleeve gastrectomy is a great option for obese patient with early stage diabetes, however, in patients with advanced diabetes (i.e. those who require insulin), similar to the patients included in Dr. Ardestani's paper Gastric bypass might be their only chance for diabetes remission. I was wondering in your opinion what drives the short term vs. long term benefits of bariatric surgery?
As Dr.Reddy rightly stated, this is indeed a very important discussion.
First of all, bariatric surgeons must refrain from calling this a "cure" for DM. We can say "remission" or "control" . Also, following surgery, the duration of control of DM is currently unknown.
In spite of high quality evidence pouring in supporting good control of DM in majority of obese subjects after bariatric surgery, our endocrinologist & diabetologist brothers tend to be cautious in referring patients. This attitude has to first change - the patient has to get well by any means & that should be the ultimate aim.
As far as recommending sleeve or bypass is concerned, that is an entirely different discussion which is irrelevant here.
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