|
 A joint statement from a 45-strong group said on Tuesday that
bariatric, or metabolic, surgery could have a significant benefit
for hundreds of thousands of patients worldwide, which they said
represented one of the biggest shifts in diabetes treatment
guidelines since the advent of insulin.
The new guidelines say surgery to reduce the stomach and induce
weight loss should be recommended to treat all diabetes patients
whose body mass index (BMI) is 40 or over, regardless of their blood
glucose control, as well as those with a BMI of 30 and over whose
blood sugar levels are not being controlled by lifestyle changes or
medication.
Francesco Rubin, a professor and chair of metabolic and bariatric
surgery at King's College London and one of the authors of the new
guidelines, said many countries across the world are in the midst of
"an epidemic of diabetes".
Rubino said patients should be offered a range of options, including
lifestyle changes, medications and surgery.
"For some, surgery may be the best choice," he told a briefing in
London.
Type 2 diabetes is characterised by insulin resistance, which many
can manage with medication and diet. But the disease is often
life-long and a major cause of blindness, kidney failure, heart
attacks, stroke and lower limb amputation.
A recent World Health Organisation study found that the number of
adults with diabetes has quadrupled in the past four decades to 422
million. International Diabetes Federation (IDF) estimates that by
2040 this will rise to 642 million.
"Surgery represents a radical departure from conventional approaches
to diabetes," Rubino said.
The guidelines, published in the journal Diabetes Care, were
endorsed by 45 international organisations, diabetes specialists and
researchers, including the IDF, the American Diabetes Association,
the Chinese Diabetes Society and Diabetes India.
The guidelines are based on a substantial body of evidence,
including 11 randomised trials, showing that in most cases surgery
can lead to reductions in blood glucose levels below the Type 2
diabetes diagnosis threshold or to a substantial improvement in
blood glucose levels.
[to top of second column] |
In many cases this would lead to patients being able to give up or
significantly reduce their diabetes medications.
Novo Nordisk, Sanofi and Eli Lilly are the world's leading suppliers
of insulin and other diabetes drugs.
Nick Finer, a University College London honorary professor and
senior scientist with Novo Nordisk, said the guidelines recognised
evidence that shows surgery "achieves excellent blood glucose
control and reduces cardiovascular risk factors".
"Sadly in England less than 1 percent of people who might benefit
are offered surgery and at a high level there is still a refusal to
respond to the evidence," he said.
Philip Schauer, director of the Cleveland Clinic's bariatric and
metabolic centre in the United States, said the new guidelines were
unlikely to trigger an immediate "avalanche" of surgery but should
mean doctors will recommend it more often.
As well as helping patients lose weight - reducing diabetes by
lowering insulin resistance, surgery also has other effects on
insulin production, he said.
(Additional reporting by Andrew Seaman in New York; Editing by Jane
Merriman and Alexander Smith)
[© 2016 Thomson Reuters. All rights
reserved.] Copyright 2016 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
