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Bariatric surgery challenges the perception of type 2 diabetes as a chronic condition
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American Diabetes Association's 69th Scientific Sessions
A surgeon argued today that the criteria for bariatric surgery should be changed, allowing more overweight people to undergo the procedure.
Even though there is a 92% reduction in diabetes-specific mortality risk after gastric bypass, only a small percentage of patients who could benefit are eligible to undergo the procedure, Francesco A. Rubino, MD, said. Those with a BMI greater than 40 are eligible for the procedure; those with a BMI greater than 35 are eligible only if comorbidities are present. “These criteria should change,” he said.
Rubino, chief of gastrointestinal metabolic surgery at Weill Cornell Medical College and head of the Diabetes Surgery Center at New York Presbyterian/Weill Cornell Medical College, also argued that the success of gastric bypass surgery “challenges the idea that diabetes is chronic and irreversible.”
The outcomes of the surgical procedure suggest an intestinal contribution to diabetes pathophysiology. Diabetes may be a “dysfunction of the bowel,” he said.
Metabolic surgery
The concept of bariatric surgery is shifting to metabolic surgery, Rubino said. The procedure leads to a remission of type 2 diabetes, resolution of hypertension, improvement in hyperlipidemia, and a decrease in cardiovascular risk – in some cases lower than that of an age- and gender-matched population.
“It also results in remarkably improved long-term survival,” he said.
Taking on the perception that the surgery can be dangerous, Rubino said that the mortality rates associated with bariatric surgery are some of the lowest for all types of surgery. According to morbidity data from the Agency for Healthcare Research and Quality (AHRQ), the overall complication rate is 15%, with a 21% decline from 2002 to 2006.
Rubino referenced his article published in Diabetes Care in 2008, “Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis.” In that article, Rubino said that there seems to be a “role of the small bowel in the pathophysiology of diabetes.
“Recent experimental studies point toward the rearrangement of gastrointestinal anatomy as a primary mediator of surgical control of diabetes. Although the exact molecular explanation remains to be elucidated, these findings suggest the possibility that gastrointestinal bypass operations may tackle dysfunctional intestinal mechanisms responsible for abnormalities of glucose homeostasis,” Rubino said in his published article, which he summarized during his presentation.
“This hypothesis represents a new paradigm, which characterizes type 2 diabetes as an intestinal disease, potentially amenable to surgical treatment.”
It looks as though there may be a new era that is opening up. We will be awaiting new data.
Stefano Del Prato, PhD
University of Pisa, Italy
For more information:
- Rubino FA. Bariatric surgery and the treatment of obesity. Presented at: American Diabetes Association’s 69th Annual Scientific Sessions; June 5-9, 2009; New Orleans.
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