Weight Loss Surgery: New Option for Diabetics?

Many patients with Type 2 diabetes long for the day when they will be able to manage their blood sugar without medication.

Traditionally monitored through diet and exercise, an experimental study conducted by the Cleveland Clinic may help determine if another option, stomach bypass surgery, could make that dream a reality for more patients.
 
Stomach bypass surgery, also known as stomach stapling, actually works by reducing the stomach to the size of a thumb, allowing patients to control their food intake more effectively.  Some diabetics who were once morbidly obese have been able to go off of their medication after the surgery, a phenomenon some health professionals say may be due not only to the weight loss itself, but because of the “disruption” of certain hormones within the digestive tract that affect blood sugar.

The key word in these cases is “morbidly obese”, which is defined as being at least 100 pounds overweight; morbid obesity is also parameterized by BMI.  Currently, the recommendation is for BMI to be calculated at 40 or over before surgery, or over 35 if a medical condition is present before it’s prescribed for a patient.  The BMI calculation is what helps determine whether or not insurance companies will pay for the procedure.  The cost of the surgery itself is weighed against amount of health care revenue that will be saved once the patient loses weight (Associated Press).

BMI and Obesity

There’s no disputing that some diabetics improve their condition dramatically after weight loss surgery.  The controversy surrounding the procedure is the definition of obesity, and the limitations that have been placed upon it.

One in five people with diabetes is morbidly obese; the other 4 do not fit that definition.  Specifically, a person is considered “overweight” if their BMI is over 25, while they are deemed “obese” with BMIs over 30.  Clearly, there are diabetics who do not qualify under the current recommendations, which were compiled in 1991 by the National Institutes of Health.

But Dr. Philip Schauer of the Cleveland Clinic feels strongly that surgery for diabetics who are overweight or simply obese (not morbidly so) could also benefit greatly from the procedure.  He’s recruiting 150 diabetic patients with BMIs between 27 and 43 to have the surgery performed.  Comparisons will then be made between those who have the surgery and those who take medication to control their blood sugar.

At this point, the American Diabetes Association currently feels evidence is lacking that the procedure is a reasonable option for those with BMIs under 35, outside of an experiment.

Monetary Costs of Diabetes

The ADA estimates that the national cost of diabetes is $174 billion.  This total includes $116 billion in health care costs arising from complications; the remainder is determined in terms of lost productivity.  Specifically, $1 out of every $10  spent on health care is due to diabetes.

For information on how to calculate  individual costs of the disease, consult the ADA website, which provides a diabetes cost calculator.