Weight-loss surgery patients miss out on diabetes checks

GPs should be wary of labelling type 2 diabetics as 'cured' by weight-loss surgery to avoid them missing vital checks, experts have warned.

Screening: patients who have weight-loss surgery could miss out (Photograph: SPL)
Screening: patients who have weight-loss surgery could miss out (Photograph: SPL)
Bariatric physicians at the Diabetes UK Professional Conference 2012 in Glasgow last week said surgery can have ‘profound’ beneficial effects on patients’ diabetes.

But there is little evidence it can immediately cut diabetic comorbidities, they said. Telling patients their disease is in remission or cured puts them at ‘greater danger’ of being excluded from tests such as ret­inal screening and foot checks.

'Improved insulin sensitivity'
Professor Nicholas Finer, consultant endocrinologist and bariatric physician at University College Hospital London, said that patients achieved improved or normal fasting glycaemia after surgery, and would ‘certainly have improved insulin sensitivity’.

But he added: ‘Patients who go home after bariatric surgery having miraculously had their diabetes medication withdrawn I think are at greater danger of being abandoned.

‘What will happen when they go to their GP – are they now diabetic or non-diabetic? Are they on the diabetic register, are they off it? Will they get retinal screening or not?’

Professor Finer agreed with American Diabetes Association advice that diabetes should not be considered ‘cured’ or in remission for at least five years after surgery.

Consultant surgeon James Byrne of University Hospital Southampton said there was ‘good evidence’ that surgery could improve or cure diabetes.

But he said it was ‘much more difficult to prove’ cost effectiveness, and pointed to a lack of good comparative evidence on the value for money of gastric band and gastric bypass.

The BY-BAND multicentre RCT is seeking to compare the two procedures.

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