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Weight-Loss Surgery Weighed as Diabetes Rx
Date:9/12/2008

p>Typically, type 2 diabetes is managed through a combination of lifestyle modifications, including changes in diet and increased physical activity, various medications and sometimes insulin injections. Adding surgery to the mix would represent a seismic shift in the management of the disease.

Dr. Philip R. Schauer, director of the Cleveland Clinic Bariatric and Metabolic Institute and past president of the ASMBS, concedes that some endocrinologists are uncomfortable with the notion of treating diabetes surgically.

"Essentially, it's the quintessential medical disease, and for somebody to suggest surgery as a potential treatment or 'cure,' that's a very radical concept," he said. But Schauer believes the evidence thus far shows great potential. "I think an astute investigative clinician would recognize that there's enough there to say, 'Wow, we really should look at this,'" he said.

Prominent medical journals such as the Journal of the American Medical Association and the New England Journal of Medicine have recently reported findings that bolster the argument for a surgical approach.

In one pivotal study, Australian researchers compared conventional diabetes care with gastric banding. After two years, patients in the surgical group were five times more likely to experience a remission of their type 2 diabetes than those receiving the usual treatments.

In another study, a U.S. team compared two groups of obese patients -- one that had gastric bypass surgery and one that did not and followed them for an average of seven years. Deaths from diabetes were 92 percent lower among patients who had the surgery.

Most diabetes experts would like to see more data on the long-term safety of these procedures before forging ahead. There are also unanswered questions about the cost-effectiveness of bariatric surgery, which averages $17,000 to $25,000 per procedure, according to the ASMBS.

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