The International Diabetes Federation has recommended that bariatric surgery be considered as an early option for the treatment of obese patients with Type II diabetes. A panel of 20 medical and surgical specialists, concerned that obesity and diabetes is now a global public health issue, released a position statement recommending bariatric surgery as an acceptable treatment option for patients with Type II diabetes and a BMI >35kg/m2, and even in patient with a BMI > 30kg/m2 if there are cardiovascular co-morbidities or if diabetes is difficult to control medically. Since Asian patients have an increased risk for diabetes and heart disease, the panel recommended that a BMI >27.5kg/m2 should be the minimum criteria for patients of Asian origin. This consensus statement is based on previously reported studies demonstrating an improvement in blood sugar control in overweight adult and pediatric patients undergoing obesity surgery.
Dr. Bill’s comment’s (The Prescription Perspective)
The strong association between excess body fat and Type II Diabetes Mellitus has been very well documented. Hundreds of diabetics in the Prescription program have been able to reduce and/or discontinue their diabetes medication after significant weight loss. Excess body fat increases insulin resistance making the pancreas work progressively harder to control blood sugar. Eventually the insulin- producing pancreatic beta cells “burn out.” Type II diabetes is the result. Type II diabetes is also one component of the Metabolic Syndrome, a constellation of factors which increase overall cardiovascular risk. Metformin is a first line therapeutic drug since it improves insulin sensitivity.
Bariatric surgery in any form represents a drastic metabolic alteration for the patient. Even those who advocate bariatric surgery recognize that it has many long term complications including osteoporosis, nutritional deficiencies and other mechanical complications of the procedures. Nevertheless it can be a lifesaving “last resort” for the severely obese. We do not advocate bariatric surgery as a first line therapy for overweight patients, however. Improvement in diabetes following medical weight loss has been documented numerous times, achieving results similar to those seen with more drastic surgical approaches. It is not at all uncommon for patients with a BMI in the 30-35% range to achieve excellent results in a medical weight loss program rather than resorting to direct gastric intervention. Failures of bariatric surgery are almost always treated medically anyway. This consensus report recognizes, however, that an active intervention is required to “cure” diabetes in the obese. It is not enough to tell patients to change their lifestyle and eat less. Whether a surgical or medical approach is utilized, it is clear that good results can only be achieved with a well organized program featuring long term followup. If the study had used body fat percentage as a criterion for patient selection rather than BMI, it is quite likely that the results would have been even more dramatic.
Excess carbohydrate intake is the real culprit, however. A diet high in refined carbohydrates and simple sugars commonly seen in Western societies leads directly to fat accumulation and diabetes. Many diabetologists are now treating diabetes with low carbohydrate diets, eschewing medical therapy completely in many cases. The message is clear: Weight loss = less diabetes and improved cardiovascular health.