Reality Check – Is Surgery the right path to fight diabetes?

Reality Check – Is Surgery the right path to fight diabetes?

Last week researchers from Monash University in Australia published a study in the Journal of the American Medical Association which found that laparoscopic adjustable gastric banding (LAGB) was a successful therapy to induce the remission of type 2 diabetes. Investigators found that LAGB induced remission of type 2 diabetes in 73% of patients. Given the epidemic growth rate in both diabetes and obesity many hailed this news as a significant.

While the device used in the study was not disclosed analyst believe the device used was the Lap-Band® from Allergan (NYSE:AGN).

Before everyone goes out and loads up on shares of Allergan, consider the following:

1. 1. While Diabetic Investor is encouraged by these results it must be noted that this is not the first time a study has shown surgery to be an effective tool in fighting diabetes. That being said, this is still surgery and as we all know surgery no matter how simple is rather drastic step to take.
2. 2. Besides the inherent risk with any form of surgery consider the cost. According to the Allergan web site; “The cost of a LAP-BAND® System procedure will vary from state to state and even from city to city, and it is difficult to predict what your actual costs will be. The variations are often due to the type of health plan you have, whether the surgeon and hospital you choose is an in-network provider, and whether your procedure is performed as an in-patient (overnight stay) or out-patient (same day). Generally speaking the cost of the procedure (facility, surgeon, and anesthesiologist) can run from $12,000 to $25,000.

In addition to the surgery, you will need to be seen by your doctor for follow-up care and adjustments to the LAP-BAND® System so that you get the best results. The general procedure cost referenced above usually includes the cost of adjustments for the first year after surgery. After that, these follow-up visits will run from approximately $35.00 to $200.00 each, depending upon how long you are in the office for each follow-up visit.”
3. 3. Diabetic Investor understands that nearly two-thirds of patients with diabetes are not achieving control. However, spending $12,000 to $25,000 for surgery is just a little pricey. This cost is even more dramatic when one considers the surgery is reversible and no long term studies have been done showing that the remission is permanent. What happens if the patient has the device removed and regains the weight lost?
4. 4. With everyone complaining about the rising cost of healthcare the question needs to be asked; will insurance companies reimburse for this surgery when there are several cheaper effective treatment options available that do not carry the risk of surgery?

To Diabetic Investor the fact that surgery is even being considered as treatment option for type 2 diabetes is further evidence of the failure of how diabetes is being dealt with in this country. Surgery should be the last option only after all other options have failed.

And what does it say about our healthcare system when insurance companies are willing to pay $12,000 to $25,000 per case when they could spend the same amount of money and educate thousands of patients. To Diabetic Investor this is just like the many medical device companies who continue to pursue sophisticated technology and do nothing to educate the patient on the practical application of the technology. What good does it do the patient to have a glucose monitor that delivers fast test results, alternate site testing and has the ability to download results to their computer when they have absolutely no idea what the test results mean or what to do with all this data.

The same can said for the many medications currently available that effectively treat diabetes. It is a well known fact that poor therapy compliance is a leading factor as to why some patients are not achieving control. Just as patients are not educated on what their glucose levels mean, they have little, if any, education on why they should consistently take their medications.

Each day patients are bombarded with some new study that says don’t do this or that. Just this morning a study in Diabetes Care found a possible connection between caffeine and higher glucose levels in patients with type 2 diabetes. According to James Lane, a Duke medical psychologist who led the study stated, “Caffeine appears to disrupt glucose metabolism in a way that could be harmful to people with type 2 diabetes.”

These results appear to contradict previous research that indicated people who drank coffee had a reduced risk of type 2 diabetes, and those who drank the most coffee had the lowest risk. Dealing with diabetes is complicated enough and it doesn’t help matters when researchers who study the same thing come up from with two very different conclusions.

It would be wise before we start recommending the dramatic, risky and costly use of surgery as a treatment option for type 2 diabetes that everyone consider the most effective method for improving control is having an educated patient. To Diabetic Investor the use of surgery as a treatment option is like killing a mosquito using a bazooka.

Let’s get real here folks!

David Kliff
Diabetic Investor
847-634-4646 fax
224-715-3761 mobile