By: Patrick Totty
Fifty science and medical diabetes experts, representing 22 international organizations*, have issued a consensus statement that calls for bariatric surgery to be used as a treatment for type 2 diabetes. The statement, published online November 23 in the Annals of Surgery, is seen by attendees at the recent Diabetes Surgery Summit in Rome as the precursor to the establishment of a new medical discipline, “diabetes surgery.”
Bariatric, or gastric bypass, surgery uses surgical stapling of the upper stomach or encirclement by an adjustable sleeve to control the hunger pangs and food consumption of morbidly obese people. “Morbidly obese” is defined as having a body mass index of 35 or more, which is roughly equivalent to being overweight by a factor of at least 40 percent. (For example, if a person’s normal weight should be 150 pounds, a BMI of 35 would indicate a weight of at least 210 pounds.
In many cases, patients undergoing bariatric surgery have also been people with type 2 diabetes. In a high percentage of instances, their diabetes symptoms have been either radically reduced in intensity or even eliminated, sometimes within a week of having the surgery. This side effect, which scientists cannot fully explain, has led to the creation of a new set of terms to describe the degrees of “remission” among type 2s who have had the surgery (see “Remissions,” Not “Cures” on this website).
It has also led to calls for a change in the criteria by which patients become eligible for the surgery. Currently, no one may undergo the surgery specifically to relieve or abate diabetes symptoms. The attendees at the Diabetes Surgery Summit would like to change those criteria in two ways: first, allow the surgery to be done to address type 2 diabetes as its main purpose, and second, lower the BMI required for the surgery below its current 35 kg/m² threshold. The consensus statement says that this threshold, equivalent to a BMI of 30 to 35, may be appropriate not only for type 2s, but also for people with “mild to moderate obesity.”
Standing in the way of lowering the BMI requirement are the parameters for bariatric surgery issued by the National Institutes of Health in 1991. The NIH has responded to the consensus document with a call for research into the effects of bariatric surgery that specifically focuses on type 2 or milder forms of obesity. It has issued several formal Requests for Application for projects that will study those questions.
Diabetes Health also recently commented on the appearance of newspaper ads that, while they mention the current use of bariatric surgery as a radical weight control measure, also mention its beneficial effects on type 2. The consensus document from Rome is one more step along a road that could see bariatric surgery join the arsenal of weapons available to fight diabetes.
*Attendees included representatives from the American Diabetes Association, the American Society for Metabolic and Bariatric Surgery, Diabetes United Kingdom, The Obesity Society and the European Association for the Study of Diabetes.