Weight loss surgery to tackle Type 2 diabetes

By Editor
27th November 2014
Latest news, NICE

The NHS should offer weight loss surgery to thousands more people in order to tackle an epidemic of Type 2 diabetes, according to health watchdog NICE.

NICE is recommending all patients with a BMI of 35 or over who have recent-onset Type 2 diabetes should be assessed for surgery. Patients must have tried and failed to achieve clinically beneficial weight loss by all other appropriate non-surgical methods and be fit for surgery.

Weight loss surgery is also beneficial for people with a BMI of 30-34.9 who have recent-onset type 2 diabetes that is very poorly controlled, NICE has said.

A quarter of the UK population is now obese, fuelling a rise in cases of Type 2 diabetes, as well as heart disease, fatty liver disease and cancer. One in 20 people in the UK has type 2 diabetes. It is a progressive disease that causes heart disease, stroke, blindness, kidney failure and limb amputations.

Every year, 24,000 people die prematurely because of the condition. Every week, the NHS carries out 100 amputations caused by Type 2 diabetes.

NICE has updated its guideline on the identification, assessment and management of overweight and obesity. NICE has a suite of guidance available to help prevent obesity and help people to lose weight.

Dr Rachel Batterham, Head of Obesity and Bariatric Services at University College London Hospital Trust, who was involved in developing the guidance, said: “We know that surgery can make a real difference for people with recently diagnosed Type 2 diabetes, so the guideline now recommends that if someone is diagnosed with Type 2 diabetes and their BMI is 35 or over then they should be offered an early, rapid assessment for weight loss surgery. 

The earlier you have the surgery in your diabetes course, then the more likely you are to have remission

“If we look at the latest report of bariatric surgery done in the UK, there were 4,000 patients with Type 2 diabetes who had surgery. Of them, 65 per cent were no longer on any diabetes medications 2 years later.

“The health benefits of weight loss surgery are so great that it should be considered as part of the treatment for obese diabetics. The earlier you have the surgery in your diabetes course, then the more likely you are to have remission or a really good improvement.”

Last year, 6,500 weight loss procedures were performed in the UK, with gastric bypass and sleeve gastrectomy the most common types of surgical intervention. Both work on the principle of surgically altering the digestive system so it takes less food and makes the patient feel fuller quicker after eating.

It is estimated that an additional 5,000 weight loss surgeries will be carried out each year if the guidance is fully implemented.

NICE recommends that doctors consider surgery for people of Asian family origin who have recent-onset Type 2 diabetes at a lower BMI than other populations, as the point at which the level of body fat becomes a health risk varies between ethnic groups. Asian people are known to be particularly vulnerable to the complications of diabetes.

Professor Alex Blakemore, representing patients and carers on the group that developed the guideline, has had the surgery: “Surgery isn’t a magic spell or an easy option, it helps you lose weight, but it doesn’t happen overnight and there is still a lot of work to do, it requires changing your lifestyle.

“One of the most surprising effects for me was the rapid effect it has on diabetes, some of which happens immediately, before weight loss. On the day that I had my own surgery, another woman had her operation too. She had diabetes and was on insulin and already had severe complications including constant pain from nerve damage. Four days later she went home without her insulin and within six weeks she was off her other medication too. That all happened before weight loss. Sadly, although her diabetes went into remission the complications remained, if she had had surgery earlier, this could have been prevented.

“The updated guideline puts a lot of emphasis on follow up after surgery, ensuring that people have support to help improve their diets, be more active and make lifestyle changes to ensure they lose the weight and keep it off.”

Recommendations include:

Very-low-calorie diets:

  • Do not routinely use very-low-calorie diets (800 kcal/day or less) to manage obesity (defined as BMI over 30).
  • Only consider very-low-calorie diets, as part of a multicomponent weight management strategy, for people who are obese and who have a clinically-assessed need to rapidly lose weight (for example, people who need joint replacement surgery or who are seeking fertility services). Ensure that: the diet is nutritionally complete; the diet is followed for a maximum of 12 weeks (continuously or intermittently); the person following the diet is given ongoing clinical support.
Bariatric surgery for people with recent-onset Type 2 diabetes:

  • Offer an expedited assessment for bariatric surgery to people with a BMI of 35 or over who have recent-onset Type 2 diabetes as long as they are also receiving or will receive assessment in a tier three service (or equivalent).
  • Consider an assessment for bariatric surgery for people with a BMI of 30–34.9 who have recent-onset Type 2 diabetes as long as they are also receiving or will receive assessment in a tier three service (or equivalent).
  • Consider an assessment for bariatric surgery for people of Asian family origin who have recent-onset Type 2 diabetes at a lower BMI than other populations (see recommendation 1.2.8) as long as they are also receiving or will receive assessment in a tier three service (or equivalent).
Follow-up careOffer people who have had bariatric surgery a follow-up care package for a minimum of 2 years within the bariatric service. This should include:

  • Monitoring nutritional intake (including protein and vitamins) and mineral deficiencies
  • Monitoring for comorbidities
  • Medication review
  • Dietary and nutritional assessment, advice and support
  • Physical activity advice and support
  • Psychological support tailored to the individual
  • Information about professionally-led or peer-support groups

 

The public health aspects of NICE’s original obesity guideline are not addressed in this update, but some sections are in the process of being updated by the Centre for Public Health at NICE.

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