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More type 2 diabetics 'may get surgery' under updated guidelines

Hundreds of thousands more patients with type 2 diabetes could in future be offered weight-loss surgery by the health service.

New draft guidance from the National Institute of Health and Care Excellence suggests that obese people with diabetes should be assessed for bariatric surgery − having a gastric band fitted to reduce the size of the stomach or a gastric bypass, where the digestive system is re-routed past most of the stomach.

At present weight loss surgery is given to NHS patients who are morbidly obese with a body mass index (BMI) score of over 40 or to those who have a BMI over 35 and who have another serious health condition − such as type 2 diabetes.

“People who are obese and have been recently diagnosed with type 2 diabetes may benefit from weight loss surgery”

Mark Baker

But NICE is now suggesting people with a BMI score of 30 to 35 should be considered for an assessment for weight-loss operations if they have been diagnosed within the last 10 years. This could mean hundreds of thousands more patients could be considered for treatment.

Data from the National Diabetes Audit show around 71% of people with type 2 diabetes were diagnosed in the last decade. And around half (47%) of those with the condition have a BMI over 30. If these figures were extrapolated this could mean that as many as 800,000 could be considered for this type of surgery on the NHS.

“Bariatric surgery should only be considered as a last resort”

Simon O’Neill

The draft NICE guideline also recommends that people who have undergone bariatric surgery on the NHS should have a “follow up care package” for at least two years after their operation.

“Obesity rates have nearly doubled over the last 10 years and continue to rise, making obesity and overweight a major issue for the health service in the UK,” said Professor Mark Baker, director of the Centre for Clinical Practice at NICE.

“Since the publication of the existing guidance in 2006, more information has become available on how best to tackle the issue,” he said. “Updated evidence suggests people who are obese and have been recently diagnosed with type 2 diabetes may benefit from weight loss surgery.

“More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes related illness; in some cases surgery can even reverse the diagnosis,” he added.

Mark Baker

Mark Baker

Simon O’Neill, director of health intelligence at charity Diabetes UK, said: “Although studies have shown that bariatric surgery can help with weight loss and have a positive effect on blood glucose levels, it must be remembered that any surgery carries serious risks.

“Bariatric surgery should only be considered as a last resort if serious attempts to lose weight have been unsuccessful and if the person is obese,” he said.

“Bariatric surgery can lead to dramatic weight loss, which in turn may result in a reduction in people taking their type 2 diabetes medication and even in some people needing no medication at all. This does not mean, however, that type 2 diabetes has been cured,” he added.

The draft NICE guidance on obesity, which updates guidance published in 2006, also states that clinicians should be “selective” about recommending very-low calorie diets to obese people trying to lose weight.

Professor Baker added: “Very-low-calorie diets have grown in popularity in recent years, so we now have more evidence to consider how well they work, if the weight loss can be sustained and the safety concerns, than we did in 2006.

“The new draft guidance now recommends that they should not be used routinely for people who are obese, only those who have who have a clinical need to lose weight quickly, such as before joint replacement surgery.”

The draft guideline has been issued for consultation until 8 August. The final guidance is due to be published in November.

 

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