A growing number of medical experts are now endorsing the idea that
diabetes surgery should be offered to treat
Type 2 diabetes. The surgical techniques used for weight loss have largely concerned either
gastric banding or gastric bypass. Morbidly obese patients were traditionally considered for such surgery.
More recently a number of medical organizations have endorsed the use of
surgery in the
mildly obese to moderately obese diabetic population. The reason for this shift in emphasis is the realization that surgery not only treats
diabetes effectively but in many cases puts the
diabetes into remission.
The rates of morbidity and mortality directly related to bariatric surgery have reduced considerably in recent years such that the risks are now equivalent to having keyhole surgery to remove the gallbladder (laparoscopic cholecystectomy). As such recommending surgery for people with diabetes when they have a BMI over 35 is becoming much more widely accepted. For those with a BMI of less than 35 the guidelines are less clear. Surgery is performed in this situation in many parts of the world although long-term risk/benefit analysis still needs to be established.
As clinical research continues to pick up momentum in this area so do the number of different surgical techniques offered to patients. In addition to standard gastric banding and bypass there are also new emerging procedures such as sleeve gastrectomy, and duodenal-jejunal bypass. These operations are also showing promising results for the treatment of diabetes. Recent clinical studies are indicating that approximately 80% of patients improve or resolve their type 2 diabetes after bariatric surgery.
So what for the future? The main conclusion is that we need more research. We need to know more about the longer term effects of gastric surgery, we need to know if the so called 'remission' of diabetes by these procedures stand the test of time and are not just short term benefits.
Finally we need to know more about what type of surgical procedure might be optimum. To answer many of these questions an international group of experts met in Rome in March 2007 in order to review the scientific evidence and to develop a Diabetes Surgery Summit Position Statement. The findings and recommendations can be found on www.asmbs.org. This is the website for the American Society for Metabolic and Bariatric Surgery (ASMBS).