Bariatric Surgery Recommended for Treatment of Type 2 Diabetes

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 a metabolic or hormonal component resulting from bariatric surgery is the believed to be 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.

IDF statement highlights:

  • An estimated 285 million people worldwide are affected by diabetes. This number is expected to grow by 54 percent to 438 million by 2030.
  • 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.
  • 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.

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.

Now that we have an international statement supporting what we already know, it’s 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 an effective, cost-effective method for the treatment of diabetes.

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