The Headline:
An expert has said that “fat children should be given gastric bands to tackle diabetes” according to The Daily Telegraph. The newspaper says paediatrician Professor Julian Shield believes that the NHS needs to take more radical measures to prevent serious damage to the health of obese children with ‘weight-related diabetes’.
NHS Choices says that:
This case series study has followed-up children diagnosed with type 2 diabetes in the UK, and reports on the characteristics of the patients one year after diagnosis. According to the researchers, the study highlights shortcomings in the way that paediatric diabetes clinics in the UK managed the participating children’s diabetes.
The researchers have commented on the findings of their study, saying that “given the increasing prevalence of type 2 diabetes in paediatric practice, these poor weight-management figures and evidence of poor metabolic control indicate an urgent need to develop specific strategies to deal with this relatively new patient group”. The researchers say these strategies should feature “culturally sensitive lifestyle and behaviour changes as the cornerstone of therapy”.
This is an important study in that it demonstrates current practice in the way children with type 2 diabetes are managed by this group of paediatric consultants. There are two separate but related issues raised by this study. Firstly, whether children are receiving appropriate clinical treatments in accordance with national treatment guidelines. Secondly, whether treatment with these recommended patient management approaches are effective in this population.
This second question can only be addressed by comparative studies, and one recent systematic review of appropriate literature suggests that a combined behavioural and lifestyle intervention can lead to significant weight reduction in children and adolescents with type 2 diabetes. However, in this widely reported research, there was insufficient information collected at the beginning of this study to determine whether the children were receiving a comprehensive lifestyle intervention.
Overall, this study was not set up to compare one treatment approach with another. It certainly did not compare children managed with gastric bands to those who were not, as might be understood from some of the news headlines. The researchers say that their study indicates that most patients require medication-based therapies from diagnosis, presumably implying that they are not receiving them.
Most of the newspapers focus on gastric banding, quoting the lead researcher as saying that gastric banding “should be considered for the most severe cases”. However, weight-loss surgery in a child or adolescent would only be considered, with great caution, as a last resort when all other therapeutic options have failed. Current NICE guidance for the management of obesity in children advises that surgical intervention is not generally recommended for children or young people, and would only be considered under exceptional circumstances when they have reached, or almost reached, physiological maturity.
Links to the Headlines:
Fat children should have gastric bands to prevent weight-related diabetes, says expert. Daily Mail, March 2 2009
Fat children should be given gastric bands to tackle diabetes, says expert. The Daily Telegraph, March 2 2009
Children with diabetes 'need more NHS help'. The Guardian, March 2 2009
Links to the Science:
Shield JPH, Lynn R, Wan KC, et al. Management and 1 year outcome for UK children with type 2 diabetes. Arch. Dis. Child. 2009;94;206-209
