Bariatric surgery gaining acceptance as alternate treatment for diabetes

The Bariatric & Metabolic Institute at Arkansas Heart Hospital in Little Rock just celebrated its inaugural year of operation completing roughly 200 surgical procedures designed to help diabetics like Todd Thompson of Russellville do a better job controlling blood sugar, high blood pressure and rising cholesterol.

The 43-year-old firefighter and paramedic told Talk Business & Politics he was headed down the wrong path with his pre-surgery blood sugar reading 204 despite taking multiple insulin shots and additional meds by mouth each day. At 5’7” and 228 pounds, Thompson said he was also taking two medications for high blood pressure and a statin to try and lower his LDL cholesterol. Every month he spent around $200 out of pocket for insulin and other meds with insurance picking up the other 80% of the costs.

Thompson said he began to research bariatric surgery — gastric sleeve — a procedure to help him gain better control of his blood sugar. He said Type 1 and Type 2 Diabetes run in his immediate family. He began taking insulin six years ago as a Type 2 Diabetic.

“My insurance would not pay for the procedure unless I used the doctor they recommended. That doctor didn’t look at the surgery as a treatment for diabetes and that was what I was after, much more so than the weight loss,” Thompson said.

MORE THAN JUST COSMETIC
He then met Dr. Samuel Bledsoe, a surgeon at the Bariatric & Metabolic Institute, with the primary goal of getting his blood sugar under control. Thompson had a body mass index at 35 which put at the “obese” level, not “morbidly obese”, but his insulin usage was heavy and Bledsoe said this made him a good candidate for the gastric sleeve procedure.

“We felt this patient (Thompson) could benefit from the surgery which would help him gain better control of his blood sugar. We did not expect that he would no longer need insulin once the surgery was complete. But that’s happened,” Bledsoe told Talk Business & Politics.

He said when Thompson’s Oct. 19 surgery was complete his gastric tract began to process sugar and proteins differently because the liver and pancreas reactions changed with the reduction in the size of the stomach. Bledsoe said four months post surgery, Thompson is no longer a diabetic and he has needed no insulin. Bledsoe said the Institute has seen 80% of the diabetics having bariatric surgery completely cured of diabetes. He said 100% have seen improvements in the disease and need less insulin.

Institute President Dr. Bruce Murphy said he spent 30 years as a cardiologist and his attitudes about bariatric surgery have changed in recent years.

“When I was I practicing, this surgery was seen primarily as cosmetic for weight-loss and nothing could be further than the truth. We know that diets don’t work for morbidly obese people over the long run. Two to four years post some weight loss via dieting fat people are still fat. There has been no cure for diabetes either. But we see bariatric surgery today doing just that in some patients and reducing the insulin requirements in others,” Murphy said.

He said when the Institute opened in January 2017, one of the targets for surgery were those patients who sought better control of their diabetes. There are 750,000 adults in Arkansas who qualify as being overweight or obese. Arkansas has the third highest obesity rate in the nation at 35.7% and 13.5% of adults are diabetic, the fourth highest rate in the nation.

Hypertension (high blood pressure) is also a problem with 39.3% of the state’s population. Recent guidelines defining high blood pressure where lowered and that is taking the percentage of adults with hypertension upward. Obesity-related cancers numbers 47,390 in 2010 and are expected to reach 116,050 by 2030, according to state health officials.

Bledsoe said Type 2 Diabetes can shorten a patient’s lifespan by 10 to 15 years, which is equal to that of a lifetime smoker. He said the average annual costs to treat diabetes is roughly $8,000 per case and that doesn’t include hospitalizations or complications from diabetic ulcers that often claim the limbs of diabetics from poor circulation and wounds that will not heal. Because of the success in reducing blood sugar, Bledsoe said bariatric surgery is now the treatment protocol for diabetic people with body mass indexes over 40, or about 100 pounds overweight.

SURGERY COST, LIFESTYLE CHANGE
Bledsoe said insurance companies have been slow to recognize bariatric surgery as a treatment for diabetes but he’s hopeful a move toward more outcome-based reimbursement in the healthcare sector will change that. He said there is no question insurers would save money over time if they paid for the surgery.

He said the cash costs for gastric sleeve or gastric bypass range from $15,000 to $20,000. With the costs to treat diabetes at $8,000 annually on average, he said in three years insurance companies would see savings. Over time, those savings could be as large as $325 billion annually, the estimate the U.S. spent in 2014 treating diabetes and other obesity-related health complaints, according to the Word Obesity Federation.

Thompson said the surgery allows him to more aggressively do his physically demanding job.

“The joke around the fire station is that I am happy to be less of a man today. I told my wife recently this is the first time in many years that I have the energy to be happy. Coming off of insulin has been liberating for me and this surgery changed my relationship with food. I used to be like Mikey, eating everything nobody else would touch.” Thompson said.

He said his energy level has improved enough to allow him to train for a half marathon in April, just four months after his surgery. Thompson said he’s always been active, but the diabetes weighed him down in recent years. He last ran a half marathon in 2013 and was taking insulin at the time. Today his blood sugar is lower than he ever got while taking medication.

“I was tied to an injection pen and taking other meds by mouth each day. I was hungry all the time and had no energy. I bought gym memberships, tried running and swimming, bought Nutrisystem plans, Plexus and Advocare as well as Atkins for Diabetics. I stayed hungry and was prone to muscle injury. The surgery is only thing that has worked for me and I would do it again in a heartbeat,” Thompson said.

He said eating protein in small portions and drinking plenty of water is going to be his meal plan for now on, abandoning old habits like grabbing the Doritos and Diet DP.

“I looked at this surgery for the long haul and worked with the dietician at the Institute to understand how my diet would change. I am not hungry today for the first time in years. I feel like I finally have control over my body and I feel like I am going to see my daughters, 12 and 6, and my 10-year-old son, each graduate and get married someday and that’s priceless,” he said.