Sunday, December 30, 2012

Bariatric Surgery Is Not Always a Cure for Type ll Diabetes

As we all know, bariatric surgery is increasingly being used to treat obesity. It is being used because the surgery is effective in combating the disease. Bariatric surgery has also been found to be beneficial in treating type 2 diabetes. But not all forms of the surgery are equally successful, and even the most effective bariatric surgical method may not resolve the disease long term for most persons with type 2 diabetes.

The three most common types of bariatric surgery are gastric bypass surgery, laparoscopic sleeve gastrectomy (LSG), and the lap band. While gastric bypass is the most studied form of the surgery, LSG and the lap band have both been considered, and investigated, as a surgical treatment for type 2 diabetes.

A study abstracted on Pubmed indicated that over a ten year period, only about a third of people with the disease experienced a durable remission. The study was conducted by the Group Health Research Institute located in Seattle, WA.  The study looked at "4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass." Two thirds of the subjects experienced remission, but for a third of these subjects the disease returned within five years of the surgery.

LSG (laparoscopic sleeve gastrectomy) is coming into its own as a viable form of bariatric surgery. And a recent study has shown that the surgery can resolve type 2 diabetes. "In 13 cases of type 2 diabetes mellitus, 7 patients (53.8%, 7/13) were weaned off hypoglycemic agents or insulin. In 11 cases of hypertension, 5 required no medications (45.5%, 5/11). The remission rate was both 100%." The researchers concluded that LSG "can cure or improve type 2 diabetes mellitus."

It should be noted, however, that the type 2 diabetes LSG group was small, and that the period following the LSG surgery was only a year. Looking at type 2 diabetes patients for a ten year period may give less positive results similar to those received from the gastric bypass study referenced above. So with respect to LSG, more researched is needed to determine if the surgery effectively treats type 2 diabetes.

And concerning the lap band, a recent study described on Pubmed showed that type 2 "Diabetes resolution, defined by HbA1c less than 6.5% and taking no medications, occurred in 14 (16%) [of the] cases..." This was a relatively small number of patients experiencing remission related to lab band surgery.

So based on the above mentioned studies, bariatric surgery is an option for the treatment of type 2 diabetes. However, in many cases, there is a good chance the surgery will not be a long term cure for the disease.  Further, results from the studies show why collaboration between overweight type 2 diabetes patients, non surgical weight loss professionals, and bariatric surgeons is important in deciding on the proper treatment for the patients.

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Monday, December 17, 2012

The Future Looks Bright for Qsymia and Belviq

Last month we said that the obesity drugs, Qsymia, made by Vivus, and Belviq, made by Arena,  recently received a lot of attention from those interested in weight loss drugs. We went on to say that while Belviq is not yet on the market, Qsymia has gotten off to a slow start, giving disappointing market results. But we indicated that Qsymia's market results would likely improve if Qsymia's benefits are found to outweigh its risks. We now believe that recent actions taken by the U.S. Government and by  health care industry leaders signal that these stakeholders believe that the drug's benefits do outweigh its risks. Therefore, we believe that both Qsymia and Belviq will likely experience bright futures.

CMS (Centers for Medicare & Medicaid Services), the organization responsible for Medicare and Medicaid, has declared that  it "will begin reimbursing primary care physicians and other qualified practitioners for administering face-to-face behavioral counseling to patients with a body mass index of 30 or more."

The  Affordable Care Act (The 2010 U.S. Health Care law) directs insurers (via U.S Preventive Services Task Force) to cover preventive measures and  intensive counseling for obesity, with no copay or co-insurance payments by the patient. The CMS action and the Health Care Law directive illuminate the importance the U.S government attaches to the treatment of obesity.

Aetna, the third largest health insurer, indicated on its website that "Among the medications that have been approved by the FDA for weight reduction which would be covered under its policy" are Qsymia and Belviq.  And Mayo Clinic reports on its website that Qsymia and Belviq are ‘prescription weight-loss medications your doctor may prescribe.’"

The actions at the federal level and those within the health care industry should give a boost to the future prospects of Qsymia and Belviq. In addition to the above mentioned actions, Vivus, the maker of Qsymia, is trying to accelerate Qsymia's future prospects. In a program called "Get Started!" Vivus is offering Qsymia "to qualified consumers on a free [14 day] trial basis."

So, there has been positive market movement with respect to Qsymia and Belviq. And that bodes well for the future of Qsymia, Belviq and possibly other obesity drugs. This positive movement will likely motivate medical weight loss providers to prescribe weight loss drugs as part of a patient's weight loss treatment.

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