Is Diabetes a Surgical Disease?Friday, May 7, 2010
Yesterday, I chaired and spoke at the opening session of the 1st Canadian National Summit on Metabolic Surgery, currently being held in Montreal, Quebec.
I reminded the audience that diabetes currently affects more than 3 million Canadians, a number that is expected to reach 3.7 million by 2020 as we continue to see the impact of the obesity epidemic.
According to the Canadian Diabetes Association, diabetes is a contributing factor in the deaths of approximately 41,500 Canadians each year, and despite all ongoing efforts only around 50% of known patients with diabetes are at the recommended target for glucose control.
As highlighted by the conference Chair Nikolas Christou in his introductory remarks, the remarkable remission rates of diabetes and other metabolic problems with bariatric surgery has spawned an increasing interest in looking at surgical options for the treatment of type 2 diabetes, even in patients who may not meet the current criteria for bariatric surgery.
Henry Buchwald, one of the early pioneers of bariatric surgery, from the University of Minnesota, reminded us of his previous meta-analysis of 136 studies involving 22,094 patient undergoing bariatric surgery, showing an almost 80% resolution rate of type 2 diabetes in bariatric patients.
In a more recent subsequent analyses, of 621 studies with 135,000 patients, Buchwald showed that resolution of diabetes ranges from around 60% with gastric banding to over 95% with biliopancreatic diversions at one year.
Thus, although there remains a dearth of long term data, there is little doubt that the vast majority of diabetic patients undergoing bariatric surgery will experience a marked improvement if not complete remission of their diabetes.
Currently, several large randomised controlled trials of bariatric surgery for the treatment of diabetes are underway and the results can be expected in the coming years.
Nevertheless, from everything I heard at this meeting, I can only imagine that barring a major breakthrough in conservative treatment of type 2 diabetes, surgical treatment of diabetes may soon be upon us as a viable alternative to lifelong medications or injections.
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Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, & Schoelles K (2004). Bariatric surgery: a systematic review and meta-analysis. JAMA : the journal of the American Medical Association, 292 (14), 1724-37 PMID: 15479938
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, & Sledge I (2009). Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. The American journal of medicine, 122 (3), 248-25600000 PMID: 19272486
Thursday, May 13, 2010
As a person with type 2 diabetes and a BMI of around 40, I would be a candidate for bariatric surgery, but my quality of life would most likely decrease, not increase with surgery. I don’t doubt that for some, surgery is a best-of-the-worst option and restores quality of life, but for me, I wouldn’t want to be told (which I have been) that my diabetes would be cured by surgery. The risks of it far outweigh the potential good of it for me.
Type 2 diabetes is a very manageable condition, whereas some of the permanent, lifelong consequences of surgery can be very difficult to manage. Surgery as a general prescription for people with high BMIs and type 2 diabetes is hard for me to swallow from a quality of life perspective.