'Thousands miss out' on surgery for type-2 diabetes
Thousands of people with type-2 diabetes in the UK are missing out on obesity surgery that would slash blood sugars and even lead to remission in some cases, a team of experts say.
Leading surgeon Prof Francesco Rubino described the gut operation as "the closest thing to a cure" available.
UK guidelines already recommend the surgery for some patients.
But experts argue the guidance needs to be expanded and made more prominent, as most doctors do not offer it.
About three million people in the UK have type-2 diabetes, which can lead to serious complications, including kidney failure, blindness and heart disease.
The team predict up to 100,000 obese diabetic patients - including those who are only mildly obese and have already tried medication and lifestyle changes - could benefit from the surgery, which involves removing part of the stomach or re-routing the gut.
But they estimate fewer than 6,000 bariatric operations were carried out for type-2 diabetes last year.
They looked at a growing body of evidence that suggests the treatment - traditionally used for weight-loss - not only reduces weight but also alters gut hormones and the lining of the gut to get blood sugars under control.
This reduces the need for daily drugs or insulin injections and leads to a period of remission in more than a third of cases, experts say.
'I lost three stone'
Anne Mulvaney, aged 51, from London, said the surgery had given her a lifeline.
She was diagnosed with type 2 diabetes four years ago and her weight climbed to 19 stone (120 kg).
She tried to lose weight but she says it was nearly impossible. She was offered surgery in March, when taking anti-diabetic medication every day.
Three months later she is now 15.6 stone (99kg) and though not yet what doctors would consider an ideal weight, she no longer has to take drugs to keep her blood sugar under control.
She said: "Before the operation I no energy and was thirsty all the time.
"Now I have lots of energy, don't crave sugar anymore and can exercise without getting breathless as quickly.
"But it is not a quick fix. You have to be dedicated and make changes. The whole process, including seeing a psychologist, took about two years.
"It feels a bit like a corset that gets tight when you have a spoonful too much.
"I don't eat as much as I used to now - but I don't get hungry.
"I definitely don't regret it - it has given me a new lease of life."
Scientists argue the operations - which cost about £6,000 in established centres - would pay for themselves within two years, by cutting the cost of drugs and the expense of treating diabetic complications.
They say the National Institute for Health and Care Excellence (NICE) needs to make this option explicit in their diabetes guidance and to expand it to ensure long-term diabetics on the cusp of obesity are also considered.
Prof Rubino, co-author of the report and a surgeon at King's College London, said: "Surgery represents a radical departure from conventional approaches to diabetes.
"The new guidelines effectively introduce, both conceptually and practically, one of the biggest changes for diabetes care in modern times."
Meanwhile Prof Mark Baker, at NICE, said the paper appeared to be broadly in line with the updated NICE guideline on obesity.
But Simon O'Neill at charity Diabetes UK, said: "Many people who stand to benefit from this potentially life-saving treatment are missing out due to needless barriers to obesity surgery services.
"Even people who meet the criteria for the surgery are made to wait too long."
In a joint statement, endorsed by 45 international organisations and published in the journal Diabetes Care, experts put out a global call for surgery to be seen as a standard part of diabetes treatment in certain cases.
The guidelines emerged at a summit organised by charity Diabetes UK, the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society and Diabetes India.