Bariatric surgery option for diabetics

medical matters

January 05, 2007|By Judy Foreman | Judy Foreman,Sun Columnist

Should I consider bariatric surgery to control Type 2 diabetes?

Yes, if you are significantly obese and have tried and failed to lose weight through diet and exercise. Obesity is a major contributor to Type 2 diabetes, in which the hormone insulin becomes less effective at its job, escorting sugar into cells; weight loss is the best way to control diabetes.

For people who can't lose enough weight through diet and exercise, bariatric surgery is an increasingly popular option; the number of such surgeries has quadrupled since 2000, reaching 177,600 this year, according to the American Society for Bariatric Surgery.

There are two main methods. One involves the stomach being "banded" to constrict its size. The other, a more involved but more effective approach called gastric bypass, divides the stomach in two so that most food bypasses the larger section and goes straight to the small intestine. By making it difficult for the patient to consume much food, both procedures lead to weight loss.

In 2004, a major study called the Swedish Obese Subjects Study showed that, after 10 years, diabetes disappeared in 36 percent of patients who had the surgery, compared with 13 percent who did not.

"The improvement of diabetes control is unquestionable," said Dr. Martin Abrahamson, medical director at the Joslin Diabetes Center in Boston. "It occurs following bariatric surgery in 80 percent of patients."

With the banding approach, American patients typically lose 40 percent to 45 percent of their excess weight; with bypass, they lose 70 percent," said Dr. Edward C. Mun, director of bariatric surgery at Faulkner Hospital in Boston.

The procedures are not without risks. The incidence of death after banding surgery is about one in 1,000 patients, Mun said. After gastric bypass, it's three in 1,000. The major risks are bleeding, infection, blood clots and leakage of intestinal fluids into the abdomen.

If you are overweight and have Type 2 diabetes and can lose sufficient weight with diet and exercise, go for it. If you can't, and your BMI, or body mass index, is 35 or higher, talk to your doctor about surgery.

For help calculating your BMI, go to nhlbisupport.com/bmi/.

When should you consider having your child's tonsils removed?

Historically, children had their tonsils removed to reduce the frequency and severity of colds and strep throat. (The tonsils, and the nearby adenoids, all part of the immune system, catch and harbor germs, so removing them can reduce infections.)

Doctors still take out kids' tonsils for recurrent throat infections, though many parents these days opt for antibiotics instead. Today, most of the country's nearly 600,000 tonsillectomies in children are done to correct breathing problems that can disrupt sleep and even lead to trouble paying attention and concentrating in school, said Dr. Dwight Jones, a pediatric otolaryngologist at Children's Hospital in Boston.

"What happens in many children is that the tonsils get to be large - disproportionate to the mouth and throat - so when the child goes to sleep and the tongue falls back in the mouth, you get obstructive sleep apnea," Jones said.

Apnea is the cessation of breathing during sleep. The result is often loud snoring, restless sleep and hyperactivity and sleepiness the next day. Some research even links sleep-disordered breathing with ADHD, attention deficit hyperactivity disorder. Bedwetting, for unclear reasons, has also been linked to sleep apnea.

When the tonsils are removed, 83 percent of children with sleep apnea get better, meaning there is no more snoring, no labored breathing or pauses between breaths, said Dr. Stacey Ishman, an assistant professor of pediatric otolaryngology at the Johns Hopkins Children's Center. School performance also improves.

Removing tonsils is also getting easier than it used to be. In the past, doctors used scalpels to remove tissue, which led to considerable bleeding.

The excessive bleeding improved when they switched to electrocautery or "hot" probes that used electricity to zap blood vessels so blood did not leak out. But this often burned the throat, leading to more post-operative pain.

The latest approach is coblation, which uses high-frequency radio waves to sculpt away tonsils from the underlying muscles. With this technique, bleeding is minimal and so is post-op pain, because the tissue is not burned.

Bottom line for parents? If your child snores or has labored breathing at night - and has trouble staying awake and paying attention in school - see a pediatric otolaryngologist.

Send your questions to foreman@baltsun.com.

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