Type 2 diabetics face three-year wait for gastric surgery

Gastric surgery should be routinely available to people with type 2 diabetes, international experts say, but anyone wanting it in Ireland will have to wait three years.

New guidelines agreed by international diabetes organisations state that bariatric surgery should be recommended to treat people with type 2 diabetes who are obese or morbidly obese.

Consultant endocrinologist and diabetes expert, Dr Francis Finucane, said he would be offering bariatric surgery to more patients with type 2 diabetes on the basis of the new guidelines.

He was concerned, however, that people in Ireland deciding to have the surgery would have to wait three years because of the time it took to join a lifestyle programme and see a psychologist.

“The current situation is disgraceful — people waiting for the surgery are at risk of dying. Bariatric surgery is the only intervention in obesity shown to prolong life,” said Dr Finucane.

The guidelines are based on a wide body of evidence, including 11 randomised trials, showing that in most cases surgery can improve glucose levels, reducing the need for medication. Economic studies also show that the treatment can be cost effective.

There are about 190,000 people with diabetes in Ireland and 160,000 have type 2 diabetes. However, some people who are not overweight can develop type 2 diabetes, a disorder characterised by high blood sugar levels because insulin is not working adequately in the body.

Dr Finucane, who established a regional bariatric service for patients with severe and complicated obesity at Galway University Hospital in 2010, said the biggest driver of type 2 diabetes was excess body weight.

In a joint statement published in the latest edition of the journal Diabetes Care, 45 international organisations doctors and researchers in diabetes say that obesity surgery should be a treatment option for people with diabetes.

Surgery should be recommended to treat people with type 2 diabetes who have a body mass index (BMI) of 40 and over, regardless of the blood glucose control as well as people with a BMI of 30 or over, whose blood glucose levels are inadequately controlled by lifestyle changes and medication.

Dr Finucane said the new guidelines would encourage more patients to consider bariatric surgery but the main problem for those wanting it was access.

Bariatric surgery was part of a process of care and there were long waiting lists. “I think in the future we will look back and recognise that we did a great disservice to these people,” he said.

Galway University Hospital allowed 100 people to be put through the bariatric programme. “We need to put 400 through the programme every year but the hospital is saying, sorry, we can’t pay for that.”

He said the surgery, which can include gastric bypass and band, was now well established and safe. It was also cost effective and in some studies it had also been shown to result in cost savings.

“Demand for resources for bariatric care is going to increase at a time when we are already beyond breaking point. ”


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