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Gastric bypass: Is it a diabetes fix?

Rating

4 Star

Gastric bypass: Is it a diabetes fix?

Our Review Summary

This was a well-written article about bariatric surgery and resultant effects on diabetes that would have been much stronger with a discussion of costs of treatment (bariatric surgery vs treatment with medications specifically for diabetes).  The discussion of possible mechanism of action was particularly well done.  A presentation of absolute reduction in diabetes after surgery would have strengthened the piece.

The story failed to adequately question whether these effects are generalizable to a different group of patients, namely those with diabetes who are not interest in weight loss.  While the story did mention the risk of death, it did not adequately explore the trade off between increased risk of dying in the near future with the risk of dying within 5 years. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no discussion about the costs for gastric bypass surgery.  It would have been helpful to compare typical costs of diabetic drugs over, say 10 years, with the cost of one-time surgery.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story did not discuss the absolute risk reduction of the complications of diabetes that may be obtained with gastric bypass surgery. 

While providing information about the resolution of diabetes in cohorts of individuals who had gastric bypass for the purpose of weight loss, it failed to fully explore the impact of having the surgery in the absence of a desire and willingness to work on weight loss.  

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story provided data for the risk of death and mentioned a number of other complications and side effects that are common.

Perhaps it was an oversight, but while including the back of the envelope calculation by Dr. Parnell and a colleague that 14,310 diabetes-related deaths might be prevented over five years if 1 million individuals with diabetes had gastric bypass surgery,  the story failed to mention the 5000 deaths in the short term from surgery that was mentioned in this same calculation.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story provides quite a bit of evidence about the AJM meta-analysis which is the best piece of evidence available about gastric bypass (in obese pts) and Type II diabetes.

Does the story commit disease-mongering?

Satisfactory

The story did not engage in disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes quotes from 3 clinicians with a variety of expertise about diabetes, weight loss surgery, and benefit analysis.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story was an exploration of the value in using gastric bypass surgery as a means of treating type II diabetes.  It did not describe the range of treatment currently in use though it did mention that medications are the other option for treating diabetes.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story did not specifically address how widely available is gastric bypass surgery for the specific purpose of treating type II diabetes. 

In addition, the story did not adequately cover the variability in treatment outcomes among institutions performing gastric bypass.  It could have informed readers about the availability of the Centers of Excellence for Bariatric Surgery.

 

Does the story establish the true novelty of the approach?

Satisfactory

The treatment is not new; the story discussed the benefit to an additional group of patients.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There’s no evidence that the story relied on a news release.

Total Score: 7 of 10 Satisfactory

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