We reported back in February of this year based on our 10 year study that weight loss surgery was able to put type II diabetes into remission for a majority of patients even before they left the operating table. We also predicted that the FDA would lower the BMI requirements for coverage from 35 and higher to 30 - 35, which they did the following month for Lap-Band surgery.
Our last prediction in that report was that surgery type mattered and that gastric bypass was more effective than other surgeries and it appears that also is true as the researchers of the aforementioned report also found that gastric bypass has a much better cure rate.
Our data also showed that bariatric surgery eliminated hypertension in a majority of patients. And this week, an advanced release of a peer-reviewed article in Surgery for Obesity and Related Diseases states that gastric bypass significantly reduced the inflammation associated with cancer and diabetes. Their study is part of a bigger series that is intended to show that gastric bypass surgery helps the body fight high-risk diseases. Our data also supports that hypothesis.
In fact, our data showed that even though some patients gained all of their weight back, their type II diabetes did not necessarily return.
Of course, gastric bypass surgery is expensive and not without risk, some quite serious. But the cost of surgery is one-time (assuming that there are no complications). And even at $20,000 - $25,000 per surgery, it should be cost effective given the elimination of the life-long need for expensive medication and supplies as well as the savings from a decrease in diabetes-related complications.
In 2008, a University of Quebec at Montreal study that showed that insurance companies recouped the cost of surgery in 2-4 years. As reported by Reuters today, Dr. Jon Gould of the University of Wisconsin and head of their weight loss surgery program stated that costs can be recouped in 18 months to 2 years.
So why isn't this surgery used more? In some cases, insurance has not caught up with science and some patients might not be ready for the risk. But why else?
Given all of the work we have done in diabetes, I personally do not think diabetes type II is a manageable disease. At least, not the way it is managed today. The current methods of diabetes management seem unsustainable - drugs are expensive with a myriad of side effects, even reasonably compliant patients find that their drugs stop working over time, and physicians seem at a loss of what to do with their patients.
In the US alone, there are 18 million people in the US diagnosed with diabetes and many would qualify for this surgery. And the data shows and has shown for at least 10 years, that weight loss surgery is an effective tool.
Time to rethink diabetes.
"I personally do not think diabetes type II is a manageable disease."
ReplyDeleteI lost a dad and grandmother to diabetes. My mother is controlled with medication. I've lost 80 pounds and walk 30 miles a week. My GP says that there are exercise and diet moderated diabetics, but that I am an exercise and diet CURED diabetic. My HBA1c's are better than when I was on Metformin. I attend weekly counseling for weight management. It has been challenging, but in a very positive, affirming way.
So respectfully, I disagree. Type II is eminently manageable, though most people lack the will and in some cases, the information and support to embrace the lifestyle commitments necessary. 80 pounds ago, I rejected bariatric surgery as too invasive. The lifestyle and hormonal changes that come with bariatric surgery are profound -- anything but benign. It is an option, one that should be approached not as a panacea, but with due consideration after other options have been exhausted.
First, congratulations. It sounds like you have made great progress. In our work, I see people with diabetes have the best success by dedicating themselves to diet and exercise. So many others with diabetes agree wholeheartedly with your approach.
ReplyDeleteThe three legs of diabetes management seem to be diet, exercise and medication. But too many patients and physicians seem to rely on medication and do not put enough emphasis on diet and exercise. And medication seems to be the most volatile part of the equation.
Unfortunately for those who rely solely or mostly on medication, I see far less success. Too many people are consistently changing drugs as they can no longer tolerate side effects and/or the drugs no longer seem to work for them. So your mother sounds immensely dedicated; congrats to her too.
We just completed a study of patient experiences with 17 oral diabetes medications. The results are dramatic and somewhat heart-breaking. While a good many people feel that they are mostly under control, so many others are struggling.
I agree with you that some people lack the will they need to be successful. But I see more people with a lot of desire but they don't seem to be armed with enough or the "right" information. So I still believe that a large number of people are not having success managing their disease.
And I agree with you on bariatric surgery; most people see it as a tool, a powerful one, but a tool nonetheless. Most took a lot of time makig their decision and wanted to inform others that it is a choice worth considering especially as the results can be astonishing. One thing I did find quite interesting was that the prep work for surgery required a great deal of discipline so people could not choose this option lightly.
I wish you continued success. It sounds like you have what it takes to beat diabetes so how can we get others to take the same kind of steps?
The problem with diabetes is the "lifestyle cascade." You're raised a certain way, you eat, work, socialize, exercise, engage media a certain way, you are diagnosed and prescribed a medication. You take diabetes meds the way you take antacids, pop the pill, expecting the symptoms go away with no further intervention. This is an acculturated laziness that I think pharma marketing sometimes at least tacitly supports.
ReplyDeleteSo yes, if you take a certain pill and make no other lifestyle changes and that pill has a certain side-effect profile, you will likely see those side-effects. You become discouraged and start shopping. And we dearly live and love to shop. ;-)
I've been shopping for decades for a diet pill. I've take Meridia for years and for its relatively modest efficacy, there's another side-effect profile to worry about. There was a recent (Forbes I think) article, written by a weightloss clinic director about the frustrating search for the Holy Grail of diet pills. He faults the FDA's denial of license to appetite or caloric absorption mediators whose side-effects are in his opinion, more than outweighed by the side-effects of obesity. I don’t know. Is the FDA's take on obesity colored by the politics of obesity or measured by diligent science in the public interest?
I think that docs are reliant on meds in a slightly different way. They preach lifestyle modification, but know, as was the case with my father, that most patients will only pay lip service to them. They become weary of patients like Dad, say "oh yeah, I'm doing this or that" when the labs tell an entirely different story. Docs want to see results – even with noncompliant patients. Medications provide results, but at cost.
I was fortunate (if you can call it that). With two parents who are diabetic, a father who died of it recently, a grandparent who also died of it; I very clearly saw the road ahead if I made no changes. I wanted no part of it. Most people don't understand that about diabetes – that the "end game" is one where the disease gradually chips away at everything that makes you an active, engaged person. If I was to make a diabetes PSA, I'd find a way to dramatize that "fork in the road." I'd show how one path leads to my dad in his final days in hospice, a gray, shivering, unresponsive shell of the man he once was. This is a very scary disease. People need to be scared.
But there is also the empowered path, along which their futures are very much in their hands. What set me on my path was a very specific longterm vision of myself at 90, a spry old gent going camping with my grandchildren. My 40-something lifestyle and physical conditions were so out of line with my vision. Meds became, not a solution, but a tool to buy me a time to make changes in line with my goals. My GP, who is an extraordinary communicator, saw that I was engaged and willing and cheerleaded my vision. After a couple years, she became confident enough to set "going off meds" as a milestone.
I was skeptical until the next two HBA1c reports showed values lower than when I was on meds. Such a feeling of power from that revelation! At that point it wasn't about living with a chronic condition. It was about a cure. If only you could bottle that "feeling of power."
... continues ...
In the balance, I am lucky. My diabetes was mild enough to be manageable with lifestyle modifications. I know there are type 2's out there counting every calorie, scouring glycemic indexes for the right choices, monitoring, exercising, sticking themselves with insulin, yet still their sugar values are brittle. These people have my deepest sympathy and understanding. I only know a small part of the battle they face.
ReplyDeleteI don't know how many diabetics are "curable" Type 2's. I suspect that the numbers are significant. They, like me, need the education, support and sense of empowerment to make the changes that will prevent the progression of the disease.
By the way, the clinic I attend counsels gastric bypass patients too. In fact, I think it is the bulk of their business. They do behavioral therapy and we all know that behavioral change takes time and consistent willful application. I've come to accept that with or without pharmaceutical support, appetite management is ultimately a behavior issue.
There is no way to do any of this quickly and no guarantees. It sucks. Americans like guarantees. We've been acculturated to expect them. This is a less satisfying, fuzzy sort of change where you can slip back into old patterns quite easily.
I have just one advantage. I know with some certainty what waits for me if I regain the weight and become sedentary again. And as I said before, I will have no part of it. If the only cure or guarantee I can get is the one I make, I'll take it.
Thanks for a great discussion Michele.
Thanks, Richard. Diabetes is an important topic for us so I hope you will participate in more threads.
ReplyDeleteI agree with you when you say diabetes is scary. From our data, we see diabetes take people apart organ-by-organ and limb-by-limb.
There may be no fast answer as you say. It may be that getting more people to be scared is part of getting more people to take diabetes as seriously as you do.