Bariatric Surgery Suffering from a Bad Rep

Internal Medicine World Report, Summer 2011, Volume 1, Issue 1

Bariatric Surgery Suffering from a Bad Rep

IDF calls for bariatric surgery for selected type 2 diabetes patients, in the face of evidence that physicians are not considering bariatric bypass even when it is appropriate to do so

By Kurt Ullman

A new position paper from the International Diabetes Federation (IDF) states that bariatric surgery should be considered as an integral part of treatment algorithms for treating type 2 diabetes mellitus (T2DM) in obese patients.

“The IDF realized that on one hand there was a growing interest in the field of bariatric surgery,” said Francesco Rubino, MD, associate professor of surgery at Weill Cornell Medical College in New York City who served as co-chair of the IDF Consensus Conference that developed the Statement. “On the other hand, there was also growing evidence that the surgery was not always appropriately used. Physicians were not even considering the option in patients who would make ideal candidates.”

To address these issues, the IDF brought together a task force composed of diabetologists, endocrinologists, surgeons, and public health experts. They were tasked with looking at the current available research and figuring out why, if the surgery had so many benefits, it was being so widely underutilized? “The conference came up with a recommendation that is in many ways ground-breaking,” said Dr. Rubino. “The IDF says surgery should be part of the regular diabetes treatment algorithm in selected patients.”

The Position Statement says that surgery is an appropriate treatment in T2DM for those with a body mass index (BMI) of 35 or more who are not able to achieve treatment targets with medical therapies. Those with a BMI between 30 and 35 should be eligible for bariatric intervention when conventional medical therapies fail and/or there are other cardiovascular risk factors present.

“This is a stronger recommendation than other current treatment guidelines that call these patients ‘potentially eligible’ for surgery,” said Dr. Rubino.

He noted that there is a social stigma and discrimination against obesity that negatively impacts the approach to treatment in these individuals. The conference members found evidence that, even in those patients where there is a general agreement that surgery is indicated under current guidelines, only around 1% have access to the surgery.

“This is clearly a treatment that improves diabetes, hyperlipidemia, hypertension, changes heart disease risk factors, and even decreases overall health care costs,” said Dr. Rubino. “Even so, only about 1% of the people who qualify get this treatment in the best case scenarios. When you look at these figures, there is definitely something broken.”

Although the Position Statement clearly called for bariatric surgery to be used as part of routine treatment in certain patients, there were no recommendations issued as to which type of surgery might be the best. The experts did call for more research on this aspect of treatment.

“The simple consideration that bariatric surgery be part of the algorithm, makes the whole of diabetes management different,” said Dr. Rubino. “Most diabetologists and other physicians do not even offer this to patients as an option.”

The consensus meeting was supported with an unrestricted educational grant from Allergan Inc, Ethicon, Ethicon Endo-Surgery, Inc, and MetaCure Inc.

Source:International Diabetes Federation. Bariatric Surgical and Procedural Interventions in the Treatment of Obese Patients with Type 2 Diabetes: A position statement from the International Diabetes Federation Taskforce on Epidemiology and Prevention. 2011.

http://www.idf.org/webdata/docs/IDF-Position-Statement-Bariatric-Surgery.pdf