To the Editor: Given the increasing evidence that bariatric surgery may result in major improvement in diabetes control, a survival advantage, and a potential for cost-effectiveness, Drs Purnell and Flum1 asked in their Commentary why surgery has not yet become the standard of care for obese diabetic patients. Their lucid analysis of opportunities and challenges in diabetes surgery highlighted the importance of a constructive dialogue between clinicians and policy makers on this subject. Particularly timely is their call for practical solutions that reconcile an individual's right to a potentially life-saving treatment with the fact that the up-front costs of increasing the number of procedures may be unaffordable at a time of limited resources.
Rubino F. Access to Bariatric Surgery and Patients With Diabetes. JAMA. 2009;302(10):1055-1057. doi:10.1001/jama.2009.1288