Prediabetes Prevention (Continued)
At the other end of the treatment spectrum from prevention, bariatric surgery was the center of an intriguing controversy. Certain types of bariatric surgery have been shown to reduce or even eliminate the symptoms of diabetes in over 95% of patients, and many doctors are excited about its potential as a treatment for diabetes. This effect is due to more than just weight loss; there seems to be a pronounced effect on hormones released by the gut (including incretins) that leads to normalization of the metabolic symptoms of diabetes. However, bariatric surgery is currently only indicated by National Institute of Health (NIH) guidelines for people who are overweight (BMI above 35). Many surgeons and physicians believe that obesity should no longer be the criterion for eligibility. Rather, they think that it should be available to people with severe type 2 diabetes where other treatment options have failed. Many see surgery as a drastic option, however, since there is a small but significant risk of death due to surgical complications. The consensus amongst the experts on both sides of this argument was that further clinical trials will be required to determine who is best suited for bariatric surgery. Currently, it seems that success after bariatric surgery is strongly associated at least with a short duration of diabetes (so that the pancreas is still functioning), but a more detailed understanding will likely be necessary to change NIH guidelines.
Overall, it is a promising trend that clinical endocrinologists are switching to a more preventative mindset. Unfortunately, as several audience members pointed out during question and answer sessions, endocrinologists generally don't actually see at-risk patients until they already have diabetes. Primary care physicians (PCPs) must therefore be the front line for prevention, and the clinical endocrinological community must focus on educating PCPs on early detection and intervention.
Nick Wilkie, editor of diaTribe (diaTribe.us), also contributed to this article. diaTribe is a free online newsletter for patients who looking for more information on products and research.
Reprinted with permission by Close Concerns
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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