Treatment

Bariatric Surgery and Type 2

Gretchen Becker Health Guide March 30, 2012
  • In November 2010, Health Central sent me to Cleveland, where the Cleveland Clinic was having a conference on medical innovations for obesity. Several physicians spoke about about the benefits of bariatric surgery, especially the Roux-en-Y surgery, which seems to improve symptoms of type 2 diabetes as...

10 Comments
  • Ann Bartlett
    Health Guide
    Mar. 30, 2012

    This is the best review of the information!  Thank you for posting and I hope healthcentral sends this to a few media sources! Smile

    • Gretchen Becker
      Health Guide
      Mar. 30, 2012

      Thanks, Ann. Rereading those Cleveland studies brought me back to the conference where I met you. It was nice to get to know you.

  • Aggie
    Mar. 31, 2012

    One more comment on bariatric surgery. One of my cousins had bypass surgery and it almost killed her. She was very ill and had to be readmited to the hospital twice. Now, after a few years, she has regained almost all the weight she had lost after the surgery. Bariatric surgery is being promoted without patients being aware of just how drastic a measure...

    RHMLucky777

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    One more comment on bariatric surgery. One of my cousins had bypass surgery and it almost killed her. She was very ill and had to be readmited to the hospital twice. Now, after a few years, she has regained almost all the weight she had lost after the surgery. Bariatric surgery is being promoted without patients being aware of just how drastic a measure it is.

  • Aggie
    Mar. 30, 2012

    First, one comment on A1c. People are still treating the numbers as if they were the disease. An improvement in surrogat outcomes (lower numbers) does NOT mean that the treatment will prevent or delay complications, or have any other meaningful outcome to the patient 10 years down the road.

     

    Now, for a less optimistic take on the surgery:

     

    Bariatric...

    RHMLucky777

    Read More

    First, one comment on A1c. People are still treating the numbers as if they were the disease. An improvement in surrogat outcomes (lower numbers) does NOT mean that the treatment will prevent or delay complications, or have any other meaningful outcome to the patient 10 years down the road.

     

    Now, for a less optimistic take on the surgery:

     

    Bariatric Surgery: The Most Life Altering Decision You Will Ever Make

     

    http://junkfoodscience.blogspot.com/2007/01/junkfood-science-weekend-special.html

    • Gretchen Becker
      Health Guide
      Mar. 30, 2012

      Aggie, The A1c isn't the only factor in  diabetes, but it's a good indication of our control unless we've had a lot of highs and a lot of lows. There's some indication that yo-yoing numbers might be worse than high numbers. We do know that high A1cs are related to complications.

       

      Not clear to me how you'd judge successful diabetes treatment if you...

      RHMLucky777

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      Aggie, The A1c isn't the only factor in  diabetes, but it's a good indication of our control unless we've had a lot of highs and a lot of lows. There's some indication that yo-yoing numbers might be worse than high numbers. We do know that high A1cs are related to complications.

       

      Not clear to me how you'd judge successful diabetes treatment if you don't think A1c is important.

    • Aggie
      Mar. 30, 2012

      Everyone assumes that control, based on the numbers, is what matters in diabetes. It isn't. What matters are the complications and deaths that are caused by diabetes. The question is, how much does changing the numbers (control) result in meaningful outcomes for patients? That is not so clear, and  people may think they are OK just because their numbers...

      RHMLucky777

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      Everyone assumes that control, based on the numbers, is what matters in diabetes. It isn't. What matters are the complications and deaths that are caused by diabetes. The question is, how much does changing the numbers (control) result in meaningful outcomes for patients? That is not so clear, and  people may think they are OK just because their numbers are better. The pharmaceutical companies only test for how their treatments change the numbers (not to mention the fact that they often report their results in terms of relative risk reduction, which is misleading), and doctors and the FDA are starting to question that approach.  Long term studies are not done that prove lowering the numbers reduces the risk of complications.

       

      http://www.healthnewsreview.org/2011/12/surrogate-outcomes-progression-free-survival-important-issues-for-journalists-consumers-to-grasp/

       

      http://cjasn.asnjournals.org/content/3/1/159.full

       

      I hope the second link works. It's an article from a medical journal.

    • Gretchen Becker
      Health Guide
      Mar. 31, 2012

      Aggie, the DCCT was done to show that lowering A1c would reduce complications, and it did for microvascular complications. The effect of A1c on macrovascular complications is not as clear-cut, but some studies have shown an effect.

       

      A1c is not perfect, but you haven't indicated what you'd use instead.

       

      It's not wise to think the A1c isn't important...

      RHMLucky777

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      Aggie, the DCCT was done to show that lowering A1c would reduce complications, and it did for microvascular complications. The effect of A1c on macrovascular complications is not as clear-cut, but some studies have shown an effect.

       

      A1c is not perfect, but you haven't indicated what you'd use instead.

       

      It's not wise to think the A1c isn't important so it's OK if it's 10.

    • Aggie
      Mar. 31, 2012

      I'm not saying that it is OK if one's A1c is 10. What I am saying is that there is no hard evidence that the hypogycemic drugs for type 2 diabetes do much to prevent complications just because they reduce A1c. Maybe they do have long-term benefits, but the hard evidence is just not there. The data from past studies, including the one you mentioned, have been...

      RHMLucky777

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      I'm not saying that it is OK if one's A1c is 10. What I am saying is that there is no hard evidence that the hypogycemic drugs for type 2 diabetes do much to prevent complications just because they reduce A1c. Maybe they do have long-term benefits, but the hard evidence is just not there. The data from past studies, including the one you mentioned, have been massaged beyond recognition to show a benefit when it may not exist. Also, as I mentioned before, often the results of studies are reported on the basis of a reduction in relative risk, which can be meaningless.

       

      It is possible that folks are being lulled into a false sense of security on the basis of their numbers, when that is not necessarily an accurate reflection of what is happening in their bodies. I would say there is more that is unknown about diabetes than is known, and for now, I beleve that there is too much reliance on A1c and other surrogate measures. It remains to be seen, 10 years or more down the road, if these drugs do, in fact result in fewer or less severe complications from the disease. People also need to keep in mind that all drugs have risks and side effects as well as benefits.

       

      I am not trying to convince anyone to give up their medications, by any means. I am not a doctor. This is merely my opinion based on what I have read on the subject. The more information we have from reliable sources, the better we will be able to make decisions for ourselves. That is why I have posted from sources who are raising a caution flag on the way success in diabetes treatment is measured.

       

      I always enjoy reading your posts, and I hope you don't mind my being contrary at times.  :-)

    • Gretchen Becker
      Health Guide
      Mar. 31, 2012

      Aggie, I don't mind your being contrary. We learn more by questioning than by just saying "Great post!"

       

      But when we have some evidence for something, if that evidence isn't perfect, there's no point in throwing it out until we have the perfect randomized double-blinded controlled trial. We do a lot of things for which there's no long-term evidence. Has...

      RHMLucky777

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      Aggie, I don't mind your being contrary. We learn more by questioning than by just saying "Great post!"

       

      But when we have some evidence for something, if that evidence isn't perfect, there's no point in throwing it out until we have the perfect randomized double-blinded controlled trial. We do a lot of things for which there's no long-term evidence. Has aspirin ever been tested with a randomized, double-blinded controlled trial? What are the long-term effects of the many supplements people take? What are the long-term effects of polio vaccination? Did we know that when we vaccinated millions of kids? Should we have waited?

       

      Relative risk isn't meaningless; it just often inflates results that aren't very large. DCCT wasn't the only one to show fewer complications with lower A1c, which has also been linked with lower heart disease, although the statistics aren't as good.

       

      Diabetes is stressful enough as it is without telling people that they may go blind and lose their legs no matter what they do.

       

      I'm sorry your cousin had a bad result with bariatric surgery. I know of 4 people who have had the operation and 3 of them almost died. However, they didn't. It's also not great to weigh 400 pounds, and for people who have tried everything else and not succeeded, perhaps the surgery is their best bet.

       

      I don't think it's being promoted without letting patients know about the risk. It's the popular press that is causing all the stir. The NEJM said they didn't think it was ready for prime time.

       

       

    • Aggie
      Apr. 02, 2012

      Well, I don't think I was saying that people will have horrible complications no matter what they do. Honestly, I don't think anyone knows who will and who won't suffer such complications. In fact, there are studies now on diabetics who seem to remain free of complications in spite of their disease.

       

      You are correct in that we all have to make decisions...

      RHMLucky777

      Read More

      Well, I don't think I was saying that people will have horrible complications no matter what they do. Honestly, I don't think anyone knows who will and who won't suffer such complications. In fact, there are studies now on diabetics who seem to remain free of complications in spite of their disease.

       

      You are correct in that we all have to make decisions based on incomplete evidence. That will probably be true for many, many years to come. I still think it has yet to be shown that hypoglycemic drugs are any better than the standard recommendations to lose weight, exercise, etc. Obviously, most people think the drugs are beneficial. Only time will tell, and everyone has to make his or her own decision on how to deal with diabetes.

       

      Here is an analysis on the bariatric surgery story from a site that evaluates the value of stories on health:

       

      http://www.healthnewsreview.org/2012/03/framing-of-weight-loss-surgery-type-2-diabetes-news/