There is growing evidence to support the use of bariatric surgery in people with type 2 diabetes, even if they are not classified are morbidly obese, an expert says.
Associate Professor John Wentworth, an endocrinologist with the Centre for Obesity Research and Education at Monash University was talking to the limbic about his recent paper published in Diabetes Care.
The five-year outcomes study that randomised people with diabetes with a BMI of between 25 and 30 to gastric band surgery or usual care found that surgery equated to clinically meaningful improvements in HbA1c, HDL cholesterol and quality of life.
Average weight loss over the study period was 12.2% in the surgery group and 1.8% in the medical care (difference 10.4%, 95% CI 6.9–13.8).
People randomised to the surgery group were also more likely to be in remission at five years compared to those receiving usual medical care (23% vs 9%).
According to Professor Wentworth the findings suggest bariatric surgery could be extended to patients beyond the morbidly obese – with benefits for individuals and the healthcare system.
He said his findings also supported those of a recent US study.
“The US study found bariatric surgery was superior to medical therapy alone in resolving hyperglycaemia in patients with type 2 diabetes. And they couldn’t find any more benefit in people with a BMI >35 than those with BMI in the range 27-34,” he said.
“We need to get serious about diet and lifestyle in Australia, but at the same time, this is a clinically effective treatment that needs to be higher on the list of potential options,” he said.
“If you’re looking at the quality of life gains, then they are comparable to the gains experienced by patients who undergo a total knee replacement,” he told the limbic in an interview.
Associate Professor Wentworth said the economic argument for bariatric surgery in type 2 diabetes was also becoming harder to ignore.
“Many people want this surgery but can’t get access to it because very little is funded in the public health system.”
The study found the $13,910 price tag for surgery was partially offset by direct savings of $4,256 on glucose lowering medications.
“Our next goal is to define a patient population who will really save the health system money within say five years.”