Call for Gastric Surgery to be Standard Diabetes Treatment
By Kate Kelland
(Reuters Life) People with diabetes should be offered gastric surgery as a standard treatment option which could help control it for years without medication, the world's leading diabetes groups said.
A joint statement from a 45-strong group said on Tuesday that bariatric, or metabolic, surgery could have a significant benefit for hundreds of thousands of patients worldwide, which they said represented one of the biggest shifts in diabetes treatment guidelines since the advent of insulin.
The new guidelines say surgery to reduce the stomach and induce weight loss should be recommended to treat all diabetes patients whose body mass index (BMI) is 40 or over, regardless of their blood glucose control, as well as those with a BMI of 30 and over whose blood sugar levels are not being controlled by lifestyle changes or medication.
Francesco Rubin, a professor and chair of metabolic and bariatric surgery at King's College London and one of the authors of the new guidelines, said many countries across the world are in the midst of "an epidemic of diabetes".
Rubino said patients should be offered a range of options, including lifestyle changes, medications and surgery.
"For some, surgery may be the best choice," he told a briefing in London.
Type 2 diabetes is characterised by insulin resistance, which many can manage with medication and diet. But the disease is often life-long and a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
A recent World Health Organisation study found that the number of adults with diabetes has quadrupled in the past four decades to 422 million. International Diabetes Federation (IDF) estimates that by 2040 this will rise to 642 million.
"Surgery represents a radical departure from conventional approaches to diabetes," Rubino said.
The guidelines, published in the journal Diabetes Care, were endorsed by 45 international organisations, diabetes specialists and researchers, including the IDF, the American Diabetes Association, the Chinese Diabetes Society and Diabetes India.
The guidelines are based on a substantial body of evidence, including 11 randomised trials, showing that in most cases surgery can lead to reductions in blood glucose levels below the Type 2 diabetes diagnosis threshold or to a substantial improvement in blood glucose levels.
In many cases this would lead to patients being able to give up or significantly reduce their diabetes medications.
Novo Nordisk, Sanofi and Eli Lilly are the world's leading suppliers of insulin and other diabetes drugs.
Nick Finer, a University College London honorary professor and senior scientist with Novo Nordisk, said the guidelines recognised evidence that shows surgery "achieves excellent blood glucose control and reduces cardiovascular risk factors".
"Sadly in England less than 1 percent of people who might benefit are offered surgery and at a high level there is still a refusal to respond to the evidence," he said.
Philip Schauer, director of the Cleveland Clinic's bariatric and metabolic centre in the United States, said the new guidelines were unlikely to trigger an immediate "avalanche" of surgery but should mean doctors will recommend it more often.
As well as helping patients lose weight - reducing diabetes by lowering insulin resistance, surgery also has other effects on insulin production, he said.
(Additional reporting by Andrew Seaman in New York; Editing by Jane Merriman and Alexander Smith)
