April 25, 2011

Bariatric Surgery to Tackle Global Diabetes and Obesity Crisis

Print More

On March 28–30, 2011, New York-Presbyterian Hospital and Weill Cornell Medical College hosted the 2nd World Congress on Interventional Therapies for Type two Diabetes. Leading researchers and experts from many countries and disciplines came together to raise awareness bariatric surgery’s potential and formulate a map for important research and health policy priorities.

At the world congress, International Diabetes Federation (IDF) decided on including Bariatric surgery in the armamentarium of patient care for controlling and treating type 2 diabetes and obesity across the world. The director of the Congress was Dr. Francesco Rubino, director of Gastrointestinal Metabolic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center.

Obesity and type two diabetes are among the major public health risks in the 21st century. With lifestyles becoming more sedentary and increasing popularity of high calories processed food, the International Diabetes Federation (IDF) predicts 438 million diabetic people by 2030 worldwide. Type two diabetes begins with insufficient insulin production in the body and goes on to cause both vascular damage and metabolic dysfunction. It could lead to diseases as varied as cardiovascular, cerebovascular, neuropathy, hyperglycaemia or retinopathy.  There is an urgent need for a powerful therapy in addition the current methods of medical and behavioral strategies of treating the disease. Most of the approaches are time consuming measures like lifestyle changes that do not live up to the targets set by clinicians.

Bariatric surgery fills this void. Bariatric surgery is a set of surgical procedures that result in significant sustained weight loss in a patient. Although, weigh loss is the main result, it has many other benefits that were discussed in the 2nd World Congress to make it part of the legitimate treatment for type two diabetes.

“Surgery will play a larger role in the management of diabetes in years to come”, said Dr. Aronne, clinical professor of medicine, Weill-Cornell Medical College and director of Comprehensive Weight Control Program. Researchers presented   data on bariatric surgery that confirmed its role in lowering stroke and heart attack in diabetic patient. Twenty years of data was presented by Swedish Obese Subjects Study that has compared 2,010 weight loss bariatric surgeries on patients.

These showed the successful results of bariatric surgery in terms of controlling high blood sugar, weight loss, cardiovascular dysfunction and improving survival rate. Medication could also be reduced or completely removed in some cases. Advances in the medical aspect of the treatment were also presented in this forum. FDA has approved 10 classes of pharmaceutical agents for better disease management

Dr. Aronne added,” The meeting was important as a validation of the concept that intestinal hormones called incretins play a critical role in blood sugar regulation. There was growing support for the concept that an “anti-incretin”, some mechanism or hormone which worsens blood sugar by blocking the effect of these hormones exists, and that gastric bypass surgery reverses this effect.”

Moreover, studies were presented that showed an increase in mortality rates and decrease in incidence of cancer among women after the surgery. Analysis of data from UK, USA, Australia and some European countries demonstrated the cost effectiveness and overall cheaper health expenditure with bariatric surgery for type two diabetic patients, according to an Australian researcher.

“One of the ongoing feasibility studies – Surgery or Lifestyle With Intensive Medical Management in the Treatment of Type 2 Diabetes (SLIMM-T2D), has shown the gut to be an entero-endocrine organ that regulates hunger and satiety, and other metabolic processes. Perhaps one day we can use less invasive practices and new pharmacologic agents or combinations to be able to better control diabetes and weight related health issues”, said Harvard Medical School and Section Head of Clinical Research at Joslin Diabetes Center Prof. Allison Goldfine.

New research avenues have opened for using bariatric surgery as a tool for better understanding the causes of the disease. IDF has pushed for legitimately using the surgery option for diabetes treatment in appropriate patients. The American Diabetes Association supports the use of surgical interventions and committed to raise awareness and provide funding in this field. The 2nd World Congress has been instrumental in building a strong consensus on the effectiveness of bariatric surgery among surgeons, diabetologists, researchers, endocrinologists and public health experts.

Original Author: Poornima Gadamsetty