New advice supports surgery to treat type 2 diabetes in obese
paitients
29 March 2011
Bariatric surgery should be considered earlier in the
treatment of eligible patients to help stem the serious complications
that can result from diabetes, according to an International Diabetes
Federation (IDF) position statement presented by leading experts at the
2nd World Congress on Interventional Therapies for Type 2 Diabetes in
New York.
The statement was written by 20 leading experts in diabetes and
bariatric surgery who have made a series of recommendations on the
use of weight-loss surgery as a cost-effective treatment option for
severely obese people with type 2 diabetes.
The combination of obesity and type 2 diabetes is looming as the
biggest epidemic and public health issue in human history. Type 2
diabetes is one of the fastest growing diseases today with close to
300 million people affected worldwide and 450 million people
forecast to have diabetes by 2030.
According to the statement there is increasing evidence that the
health of obese people with type 2 diabetes, including their glucose
control and other obesity-related comorbidities (conditions), can
benefit substantially from bariatric surgery under certain
circumstances.
The IDF's Taskforce on Epidemiology and Prevention of Diabetes
convened the expert group with specific goals to:
- develop practical recommendations for clinicians on patient
selection and management;
- identify barriers to surgical access;
- suggest health policies that ensure equitable access
to surgery; and
- identify priorities for research.
Co-chairperson Professor Sir George Alberti, Senior Research
Investigator, Imperial College, London, said, "Bariatric
intervention is a health and cost-effective therapy for type 2
diabetes and obesity with an acceptable safety profile. Bariatric
surgery for severely obese people with type 2 diabetes should be
considered much earlier in management rather than held back as a
last resort. It should be incorporated into type 2 diabetes
treatment protocols."
He also pointed out that the cut-points for action may be lower
in Asian populations because of their increased risk of diabetes and
heart disease.
Professor Paul Zimmet AO, Director Emeritus, Baker IDI Heart and
Diabetes Institute, Melbourne, and co-chairperson, said, "Bariatric
surgery is a treatment that can be recommended for people with type
2 diabetes and obesity not achieving recommended treatment targets
with existing medical therapies, especially when there are other
major co-morbidities such as hypertension, high cholesterol or sleep
apnoea.
"Surgery should be an accepted option in people who have type 2
diabetes and a body mass index (BMI) of 35 or more. The procedures
must be performed within accepted guidelines and require appropriate
multidisciplinary assessment prior to surgery and on-going care as
well."
Professor Francesco Rubino, Chief of the Gastrointestinal
Metabolic Surgery Program at NewYork-Presbyterian Hospital/Weill
Cornell Medical Center and Director of the 2nd World Congress on
Interventional Therapies for Type 2 Diabetes, said, "This is the
first time the International Diabetes Federation or any major
international organisation has made recommendations on this rapidly
developing area of therapy.
"It did so because of the urgent need for worldwide expert
guidance on the use of bariatric surgery because of the increasing
usage. We note the need to establish appropriate measures in
education and selection of patients and safe and standardized
surgical procedures. Long-term follow-up after surgery is
essential."
Professor John Dixon, Head of Obesity Research Unit, Department
of General Practice, Monash University, Melbourne, said: "It is very
important for health authorities and policy makers to understand
that almost all severely obese patients cannot achieve and maintain
significant weight loss. They should be treated where appropriate
with bariatric surgery, which can lead to remission of diabetes in
up to 80% of patients. National guidelines and registers for
bariatric surgery need to be developed and implemented for people
with type 2 diabetes."
The expert group warns the situation in low- and middle-income
nations presents special problems because severe obesity is
increasing at an alarming rate. As health care resources are
limited, bariatric surgery should only be performed where the health
budget can afford it, and when the expertise is available for both
the surgery and the long-term follow-up.