Why is metabolic surgery the most viable option compared to other diabetes treatments?
– Metabolic surgery is the most radical departure from mainstream approaches to the management of diabetes since the introduction of insulin in the 1920s. They are based on findings from a large body of work, including 11 randomized clinical trials conducted over the past decade.
– International Diabetes Federation in 2016 recommends that surgery be considered early in the management of disease in obese patients, and not only as a last resort.
– Why 3E? – efficacy, efficiency, cost effective
– DM disease itself- natural progression- Type 2 diabetes is a progressive disease, characterized by continuing deterioration of insulin secretion over time. This leads to increasing need for medication, while persistent or worsening glycemic control may increase the risk of developing diabetes complications (i.e. heart attacks and strokes, kidney failure, eye disease and blindness etc). Less than 50% have good control of DM despite multiple medication
– Metabolic surgery- Bariatric surgery, however, results in dramatic improvement of type 2 diabetes, hypertension, dyslipidemia, and reduction of overall mortality.
– Success rate Effect- STAMPEDE trial, which included 140 patients with a BMI of 27 to 43 kg/m2 and reported 12-month HbA1c levels of 6.0% or less in around 40% of patients who underwent surgery (gastric bypass or sleeve gastrectomy), compared with 12% of those who received medical therapy.
– Besides providing excellent control of diabetes and weight loss, metabolic surgery has several additional benefits, including improvement of hyperlipidemia, hypertension and sleep apnea.
– the incidence of cancer is reduced in obese patients who have had bariatric surgery. Most importantly, several reports have consistently shown that in patients with diabetes and severe obesity, surgery increases long-term survival.
– Timing- shorter duration of DM < 8yrs, not on insulin, preserve pancreatic function- metabolic surgery give maximal benefit for DM remission.
– Significant weight loss through lifestyle modification and medical methods is modest at best and is rarely sustained in obese, and particularly severely obese people.
– Medical options for controlling blood glucose levels are also unfortunately less effective in severely obese people.
– A number of medications used for treating type 2 diabetes, including insulin, can result in weight gain/ side effect.
– However, rates of diabetes are rising rapidly in low- and middle-income countries, where surgery is not likely to be available for most patients. But if handled the right way, the inclusion of surgery as an option could influence diabetes care as a whole
– Several economic analyses suggest that the costs of surgery (roughly US$20,000–25,000 per procedure in the United States) may be recouped within 2 years through reduced spending on medication and care.