loading...
Marshall Melnychuk/Healthy Observations
By Marshall Melnychuk
The 1st International Abu Dhabi Diabetes Congress was held last week and a paper from the Journal, Annals of Surgery was presented called Recommendations for the Evaluation and use of Gastrointestinal Surgery to Treat Type 2 Diabetes Mellitus.
Over the last two decades as bariatric surgery has become a popular intervention for the obese and morbidly obese the number of procedures has climbed dramatically. In Canada and the USA in 2008, as reported in the Journal Obesity Surgery, about 220,000 procedures were performed by an estimated 1,625 surgeons. That’s an increase from about 70,000 in 2001.
As the numbers of surgeries have climbed worldwide many new studies have been done and new outcomes discovered. It has been known for decades that all three main types of the surgery, gastric sleeve, gastric bypass, and gastric band, have a dramatic effect on the disease of Type II Diabetes. And ‘dramatic’ may be putting it mildly. Cure is the word perched on the lips of many practitioners – and who can blame them. Studies have shown that from 50%-97% of cases of Type II Diabetes are improved or resolved through bariatric surgery. ‘Resolved’ means that within a few days, yes days, of the surgery (there are differences in percentages depending on which procedure is performed) the patients are able to completely go off all medications for diabetes and show no medical signs of the disease even after follow-up several years later. That sounds like a cure to me.
If you watched CBS 60 Minutes segment on gastric surgery, (click here) you will probably default to the cure word too. Johnson and Johnson is the largest medical supply company in the world and manufactures the Realize adjustable gastric band which is used in a growing number of LAGB surgeries. On their website realize.com they describe a list of health benefits associated with LAGB including benefits to high blood pressure, cholesterol, sleep apnea and acid reflux. Googling “bariatric surgery health benefits” will produce thousands of articles to read – bottom line, gastric surgery has an incredible effect on Type II Diabetes.
So now, as the citation in the first paragraph states, we are seeing the evolution of the lessons learned from millions of surgeries to the point of it being recommended as a treatment for diabetes. This is a significant step in my mind but raises a few questions. The benefit from bariatric surgery is compelling but is diabetes really the problem or is it a result of the problem?
The three top risk factors associated with Type II Diabetics are; obesity, sedentary lifestyle, and poor eating habits. The lifestyle factors leading to obesity (with few exceptions) are sedentary lifestyle and poor eating habits. Shouldn’t the surgery be accompanied with an attempt to help the patient acquire the lifestyle skills so they don’t succumb to the same behavioural factors that lead them down the path of ill-health the first time? If we don’t treat the real cause won’t it just show up again in some other way?
A study in the New England Journal of Medicine in August of 2007 (click here to see abstract) titled ‘Long-Term Mortality after Gastric Bypass Surgery’, illustrates the problem. While this study is specific to gastric bypass surgery the results are relevant to all bariatric surgery. To quote the conclusion, “Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer. However, the rate of death from causes other than disease was higher in the surgery group than in the control group.” ‘Deaths from causes other than surgery translates into deaths from accidents and suicide (there is no differentiation between the two) which are 58% higher than the control group.
Currently one in two hundred people die directly as a result of gastric bypass surgery, (LAGB mortality is about 1 in 2000) that is 0.5% which presents a real fear for someone going for that procedure. But the even greater fear is what could happen in the months and years after the surgery. When you see statistics of suicide rates climbing significantly it points sharply to the fact that the surgery did not solve the problem: there is something deeper going on.
It makes me think of the studies that show suicide rates of women that have breast augmentation surgery being triple that of women who do not have it. Do people go into the procedure with unrealistic expectations of how it may improve their lives?
It is clear that overall the benefits far outweigh the costs when it comes to performing bariatric surgery on select obese and severely obese patients with Type II Diabetes – costs to the patient and society in the form of medications and medical services, and benefits to the patient and society as far providing the opportunity to enjoy a productive life. But for many that have come to the point of needing surgery, diabetes is the symptom; the cause runs much deeper.
The surgery will provide people with an opportunity to improve their lives but it should be a requirement of the practitioners delivering the procedure, and the regulatory bodies overseeing it, to ensure that counselling and education on lifestyle skills will be delivered as well.
It may be true that we can now cure diabetes with a scalpel, but have we really done the patient a benefit if the issues that are the
Marshall Melnychuk is a manager and partner at iQuest Healthcare and Fitness Centre. For more information go to www.iquesthealth.ca
