Consensus From Diabetes Organizations Worldwide

Jun 16, 2016

Consensus From Diabetes Organizations Worldwide



Signaling a major shift in official policy and recommendations, over forty international professional organizations, diabetes clinicians and researchers are suggesting that popular metabolic surgery procedures such as gastric bypass and the vertical sleeve gastrectomy should be considered as a treatment option for people with diabetes, including people who are mildly obese and whom fail to respond to conventional treatment i.e. low BMI bariatric surgery.

Published in the June 2016 issue of “Diabetes Care”, a major diabetes journal, these new guidelines are based on the results of multiple verified clinical studies which validate the hypothesis that metabolic surgery is beneficial for certain people with diabetes and can yield significantly improved outcomes. Further establishing validation of these studies is that they are not conducted by surgeons, but rather third-party organizations! These are not self-serving valuations!

This is a very important milestone since until as late as 2010, the very same major diabetes medical societies would not even mention surgery in their published guidelines. During my own tenure as chief of bariatric surgery at UCLA, I faced the same resistance amongst the medical and endocrinology faculty. They would always chime up together saying “Diet and exercise are the only way to go, plus insulin”!! I would hear it over and over, with no justification.

In contrast, bariatric surgical journals have consistently documented the effectiveness of stapled operations such as the gastric bypass, duodenal switch, and the sleeve gastrectomy for their penchant for ‘curing’ diabetes… dating all the way back to the 1990’s. Many people who undergo metabolic surgery experience major improvements in blood sugar control, as well as a reduction in cardiovascular risk factors. This makes these surgeries a highly effective treatment for type 2 diabetes and a highly effective means of diabetes prevention. The authors admit that despite continuing advances in diabetes pharmacotherapy, fewer than half of adults with diabetes attain therapeutic goals designed to reduce long-term risks and complications from medicine alone. Lifestyle interventions alone offer disappointing results in the long term as well, as we all know from multiple failed attempts. Metabolic surgery, on the other hand, has been shown to “improve glucose homeostasis more effectively than any known pharmaceutical or behavioral approach”.

Finally, according to the new guidelines, bariatric surgery should also be considered for patients with diabetes, who have a BMI between 30 and 34kg/m2 i.e. low BMI metabolic surgery. Bariatric surgery literature has clearly demonstrated the effectiveness of the gastric bypass and sleeve gastrectomy in this category of patients whom until now were not ‘officially’ considered to be candidates. We surgeons see this in our practices very often.

The full articles, consensus statement and commentary is published online here.

If your body mass index is over 30 and you suffer from diabetes, prediabetes, or other obesity related co-morbidities such as high blood pressure, elevations in cholesterol or triglycerides, and sleep apnea, you should look more closely at the vertical sleeve gastrectomy or the Roux en-Y gastric bypass.

Many of our medical colleagues’ mindsets about bariatric surgery is stuck in the 80’s and 90’s and hence, they often suffer from extreme hesitation to refer patients earlier in their timetables for surgery…when it will have the most benefit.

However how surgery is now performed and prescribed is very different than it used to be. Bariatric surgery no longer presents and inherent risk and has now become as risky as routine gallbladder or appendix surgery and much less dangerous than other abdominal operations.

If you want to learn more about vertical sleeve gastrectomy or the other operations and their typical preoperative requirements, postoperative recovery, risks and benefits, and many other similar questions, please attend one of our free information seminars or the patient support meetings where you’ll hear first hand about gastric sleeve and gastric bypass patients’ success stories. You will find their respective schedules on our website’s calendar of events.

University Bariatrics