Letter from the Editor, #698

This week we have an article on how gastric bypass and other laparoscopic procedures can cause remission in diabetes and improve cardiovascular outcomes. While I am glad that this study shows the value of these procedures, it points to a bigger problem that we have with our diabetes patients. The lack of responsibility for taking care of themselves is the reason so many of them need surgery to begin with.

As an educator and someone who made the commitment to lose a great deal of weight and keep it off I know that it is not easy to do, but it can be done. But now these surgical procedures are advertised on billboards from Maine to California and patients are calling to see how large their BMI has to be in order to qualify. Insurance companies are spending millions for these surgeries and yet won’t spend a few dollars for diabetes education or nutritional counseling to help prevent the need for these surgeries.

In addition to taking the incentive away from patients to care for themselves we are forgetting about the complications that patients often get by not taking care of their diabetes for years until surgery occurs. Complications like retinopathy, kidney failure and peripheral neuropathy occur regardless of surgery. All of these problems could have been reduced if rather than waiting on the surgery our patients had been actively managing their diabetes with food choices, medications and exercise.

When peripheral neuropathy occurs it makes it even harder to exercise giving our patients another reason to just wait for the surgery and with that in mind I asked Dr. Sheri Colberg to help us to work with those patients.

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Dave Joffe, Editor-in-chief