Late Season Blackberries

Surgery Sooner for Diabetes?

It’s getting pretty hard to ignore the possibility of a huge missed opportunity for better health outcomes caused by not considering bariatric surgery sooner for diabetes and obesity. Another study was published this week that finds better 5-year outcomes in people treated surgically for diabetes and relatively mild obesity in comparison to people treated medically.

This particular study is a retrospective cohort study published in JAMA Surgery. But the findings are similar to a recent prospective, randomized, controlled study that showed superior 5-year outcomes for surgery compared to medical therapy for diabetes and obesity. In this week’s publication, the authors found significantly better A1C levels (a measure of diabetes control), a much higher rate of diabetes remissions, and healthier weight status.

In an invited commentary, Robin Blackstone discussed barriers to wider utilization of bariatric surgery:

The barriers are significant. Cost of the procedure, complications, lack of surgical manpower, poor access to financially supported care, the problems of weight regain, and clinician and payer bias against surgery limit application as a population solution. These barriers are unlikely to change and may be magnified in very large populations.

Yet it’s increasingly hard to ignore the fact that surgery is the best tool we have for treating diabetes and obesity. You simply won’t find objective data for anything else that comes close. It’s also a fact that most of the people who could benefit don’t want surgery. Systematic bias against people who opt for surgery is a well-documented phenomenon that no doubt accounts for some of this reluctance to seek surgery.

An open dialog about this missed opportunity is warranted. Even if the only outcome is renewed commitment to research for finding better options. People living with obesity will benefit.

Click here to read more from Reuters, here to read the new study, and here to read Blackstone’s commentary.

Late Season Blackberries, photograph © Liz West / flickr

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September 18, 2015