Diabetes and Bariatric Surgery, Metabolism and Nutrition
Bariatric surgery can be considered one of the great advances that have emerged after the discovery of insulin for diabetes care. Since 15 years ago, when the first observational study of bariatric surgery was carried out, both it and clinical studies have clearly shown the beneficial effects of surgery.(50)
The study carried out by Hoerger, et al(51) shows that bariatric surgery for the management of diabetes is profitable when looking at the patient’s entire life.
However, from the payer’s point of view the cost occurs primarily during the first year after surgery, while the benefits occur over the course of life. Another difficult situation occurs with the certainty of the validity of the results obtained with surgery through the studies, the quality and the follow-up that could have been done with the patients.
Unfortunately, patient retention after surgery is inadequate and often very short, making it difficult to obtain accurate data. The retention standard accepted both in the publication of studies and in clinical practice is 50%, a figure that is well below the norm for clinical studies and other areas of medicine.
Another serious problem is the shortage of labor, since until now it is general surgeons who perform the procedure and it is known that by 2020, in the United States there will be a deficit of 1,875 general surgeons and therefore, surgeons who practice bariatric surgery.
This situation will make it increasingly more expensive and difficult to generalize the procedure, even without taking into account that obesity in adolescence is a new area where it is being explored and the benefits are also being seen.
However, for diabetes, bariatric surgery is an invasive medical technique and a high-tech treatment, which will require extensive research, which can be based on studies that present greater patient retention and long-term results; In this way, uncertainty would be reduced and the profitability model discussed would be confirmed.
Finally, despite the good results generated, it is unlikely that this mutilating and invasive procedure will be seen as the treatment of the future.(52, 53) It is necessary to continue with the common work of the various medical disciplines, of the establishment of public, governmental and business policies to counteract the obesity epidemic and its consequences.
For now, for the vast majority of patients, multidisciplinary programs remain in force (coming from work teams that include doctors, diabetes educators, nurses, psychologists and nutritionists) that benefit the prevention and treatment of diabetic patients and that avoid complications.
These same groups will be the ones that receive diabetic patients from bariatric surgery procedures in the near future for their management and control.
Conflict of interests
The author declares no conflict of interest in the preparation and publication of the article.
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