Drug
therapies and bariatric surgery should play a more prominent role in prevention
of type 2 diabetes, according to draft
updates to national guidelines
The
National Evidence Based Guidelines for the Management of Type 2 Diabetes (link) released for comment by Diabetes Australia alsorecommend that risk assessment for diabetes
should begin at age 40 (and at age 18 in Aboriginal and Torres Strait Islanders).
This is earlier than the previous recommended starting age for screening of 45 (and
35 years), but is in line with the new Medicare item number for diabetes risk
assessment (713).
The
new item, released on July 1 is claimable by GPs who review patients aged 40 to
49 years inclusive at high risk of developing type 2 diabetes as determined
using the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) (link).
This
risk assessment tool unsurprisingly, is also recommended in the new draft
guidelines, but its use is not deemed necessary in certain patients with known
risk factors such as a history of gestational diabetes or on antipsychotic
medication.
And
while still emphasising the importance of lifestyle modification in the
prevention of type 2 diabetes, the new guidelines recognise the effectiveness
of various pharmacological interventions such as metformin and orlistat (Xenical)
and suggest they ‘could also be considered in people at high risk’.
In
addition, the revised guidelines state “bariatric surgery can be considered in
selected morbidly obese individuals at high risk of type 2 diabetes.”
Submissions
can be made to Diabetes Australia
(link) before 15 September.
Whilst weight gain and diabetes are certainly risks to patients on antipsychotic medication, I have serious concerns about the use of bariatric surgery in this group. I don't believe that we have the long term data on the effects on nutrient absorption caused by the altered flow dynamics ( note the reported cases of Wernicke's encephalopathy already) to ascertain potential psychiatric side effects, and absorption of medications may well also be altered. In addition, the vomiting associated with banding may reactivate symptoms of eating disorders in patients. I note one particular patient who was psychiatrically stable on medications for several years prior to her lap banding. Since the surgery, this patient has had multiple prolonged psychiatric hospital admissions, and remains severely depressed. Her eating pattern is severely disrupted and she is no longer able to care for her child. We may have improved the blood sugar and weight gain, but quality of life has certainly deteriorated. Leanne Barron
Latest Comments
Posted by Leanne Barron 19/08/2008 8:09:55 PM
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