Diabetes Surgery: Caution or Stubbornness?

At the annual Scientific Sessions of the American Diabetes Association (ADA), we find ourselves wondering if resistance to diabetes surgery represents cautious wisdom or entrenched stubbornness. It’s a thin line.

Four bits of new data — all coming outside of the meeting — are begging the question.

1. Courcoulas et al conducted a randomized, controlled trial of gastric bypass versus gastric banding versus intensive lifestyle weight loss in 69 patients with BMI between 30 and 40. They found that bypass surgery was the most effective treatment, followed by gastric banding. Both were superior to intensive lifestyle management for weight loss.
    
2. Halperin et al conducted a feasibility trial for a randomized, controlled comparison of gastric bypass to intensive medical and weight management for diabetes in subjects with BMI between 30 and 42. Even in this small trial of 38 patients they found superior results in the gastric bypass group.
    
3. Sjöström et al published 15-year results from the landmark Swedish Obese Subjects trial showing that bariatric surgery led to more remission of diabetes and fewer complications than usual care.
    
4. CDC published new statistics showing that the number of American adults with diabetes is growing unabated at an alarming rate. It now affects 29 million adults. A quarter of them don’t even know they have it — which means that complications will mount.

 
Meanwhile, ADA guidelines say that bariatric surgery may be considered for patients with diabetes and a BMI of 35 or higher, particularly if the diabetes is difficult to control. And in practice, roughly 70% patients with severe obesity are led to believe that surgery is not appropriate for them.

Certainly, surgery is not a magic answer for diabetes and obesity. But it’s looking more and more like it could be superior for many more patients than what we’re doing now.

“Many are stubborn in pursuit of the path they have chosen, few in pursuit of the goal.” — Friedrich Nietzsche

Click here to read the study by Courcoulas et al, here to read the study by Halperin et al, here to read the study by Sjöström et al, and here to read more about the new CDC diabetes statistics.

Insulin Pen Needle, photograph © Aki Hänninen / flickr

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