| By Mark A. Colquitt, MD, FACS, FASMBS
The combination of obesity and Type 2 diabetes looms as the largest epidemic and public health issue in human history. Type 2 diabetes, also known as adult onset diabetes, accounts for 90 percent of all cases of diabetes. It is one of the fastest growing diseases today with nearly 300 million people affected worldwide and 450 million people forecast to have diabetes by 2030.
Individuals with diabetes also are at greater risk to develop heart and blood vessel disease, nerve damage, kidney damage, eye damage, foot damage, skin and mouth conditions, osteoporosis, Alzheimer's disease, and hearing problems.
Despite those grim statistics, there is good news.
Since I began performing bariatric surgery in 2002, I've seen that it helps resolve Type 2 diabetes. In fact, our patients are experiencing about a 90 percent resolution rate within weeks of surgery, if not sooner, independent of weight loss.
Gastric bypass, biliopancreatic diversion with duodenal switch, and laparoscopic sleeve gastrectomy are all effective in resolving diabetes. Gastric banding procedures do not resolve diabetes until the patient loses weight. Research is still ongoing as to different interactions, but it is believed that a metabolic or hormonal component resulting from bariatric surgery is the impetus behind diabetes resolution.
Now, the International Diabetes Federation (IDF), an umbrella organization of more than 200 national diabetes associations in more than 160 countries, has issued a position statement supporting bariatric surgery to treat Type 2 diabetes in obese patients. The IDF statement was generated as a result of key thought leaders and organizations collaborating over the past five years. It was written by 20 leading experts in diabetes and bariatric surgery.
Co-chairperson Professor Sir George Alberti, senior research investigator, Imperial College, London, said, "Bariatric intervention is a healthy 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."
The IDF statement is a game-changer because it formally recognizes surgery as a viable treatment option for diabetes and, for the first time, puts the role of bariatric interventions into a public health, clinical, and socio-economic perspective.
The following are a few IDF statement highlights:
Bariatric surgery is an appropriate treatment for obese people with Type 2 diabetes who are not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.
Bariatric surgery should be considered earlier in the treatment of eligible patients to help stem the serious complications that can result from diabetes.
Surgery should be an accepted option in people who have Type 2 diabetes and a body mass index (BMI) of 35 or more.
Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by an optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.
In Asian and some other ethnicities of increased risk, BMI action points may be lower (e.g., 27.5 to 32.5).
Societal prejudices about severe obesity should not act as a barrier to the provision of clinically effective and cost-effective treatment options.
Available evidence indicates that bariatric surgery for obese patients with Type 2 diabetes is cost-effective.
Now that we have an international statement supporting what we already know, it is important that we use it as a tool to educate insurance companies and primary care providers. There is still much work to be done, but this position statement gives us a worldwide statement supporting bariatric surgery as a viable, cost-effective method for the treatment of diabetes.
Mark A. Colquitt, MD, FACS, FASMBS, is medical director and a bariatric surgeon for Foothills Weight Loss Specialists, a division of Premier Surgical Associates and a Bariatric Surgery Center of Excellence. Colquitt is board certified by the American Board of Surgery. He is a fellow of the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery. He is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit http://www.foothillsweightloss.com.
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