Lessons Learned from Popular Diabetes Strategy - Weight Loss Surgery

CHICAGO — There are millions of people battling diabetes that are not able to control their weight using diet and exercise alone. Their genetics and other factors have programmed them to be obese. If they are insulin dependant, insulin may actually make them more prone to be overweight. Medicare has recently begun covering bariatric (weight loss) surgery although significant death rates have previously been reported in Medicare patients undergoing the procedure. However, the risks of death and other complications after bariatric surgery appear similar between patients younger and older than age 60, and also between Medicare recipients and non-recipients, according to a study in the June issue of Archives of Surgery, one of the JAMA/Archives journals.

"Obesity has become the leading cause of preventable death in the United States," according to background information in the article. "Rates of obesity have continued to climb in the last decade across all age groups. Surgery for morbid obesity is currently the most effective treatment." The success of bariatric surgery has expanded the treatment of morbid (severe) obesity and its conditions for patient populations that had not previously been served. Peter T. Hallowell, M.D., and colleagues of University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, reviewed the cases of 892 patients who had gastric bypass surgery from 1998 to 2006. The patients were divided into four groups:

·         Group one, 46 patients age 60 to 66 years was compared with group two, 846 patients age 18 to 59 years.

·         Group three, 31 Medicare recipients (age 31 to 66), was compared with group four, 861 non-Medicare recipients (age 18 to 64).

The age, sex and body mass index of each patient were documented as well as time spent in the operating room, length of stay, other illnesses and complications — including death. When the research team analyzed the data, they found:

·         When comparing older (group one) and younger (group two) patients, the male-female ratios and the BMIs were similar between both groups.

·         The average length of the hospital stay was a half-day longer for group one than for group two.

·         The older group spent an average of 17 minutes less in the operating room than the younger group.

·         There was no statistically significant difference found between the two groups for any postoperative complication or death.

"No mortality was seen in the older group (group one) at 30 days, 90 days or one year. Three deaths occurred within 30 days in the younger group (group two) with one additional death within one year," the authors note.

When comparing Medicare and non-Medicare patients, group three (Medicare patients) had a greater average BMI of 56 and spent an average of 14 minutes longer in the operating room. Medicare patients also spent an average of a day-and-a-half longer in the hospital. There was no significant difference between the two groups for any complication or death after surgery. No Medicare patients died at 30 days, 90 days or one year. Three non-Medicare patients died within 30 days and one additional patient died within one year.

"Bariatric surgery can be performed in carefully selected Medicare recipients and patients 60 years or older with acceptable morbidity and mortality," the authors conclude. "We believe that these results reflect careful patient selection, intensive preoperative education and expert operative and perioperative management. Our results indicate that bariatric surgery should not be denied solely based on age or Medicare status."

If you are considering weight loss surgery, you should consult with your physician that helps you manage your diabetes. Your doctor will have a pretty good idea how beneficial weight loss surgery could be for you, and he or she will be able to weight the risks against the potential rewards.

Source: American Medical Association, Archives of Surgery. 2007;142:506-512.