Surgery Can Resolve Diabetes
Emerging data suggest that bariatric surgery results in substantial improvements in glycemia, blood pressure, and cholesterol; weight loss is durable; survival may be improved; and surgical risks are low.
The Great Debate: Medicine or Surgery: Type 2 Diabetes: A Surgical Disease?
Type 2 Diabetes: A Surgical Disease?
The ongoing diabetes epidemic, the impressive effectiveness of bariatric surgical procedures in treating type 2 diabetic patients, and the lines of evidence suggesting weight-independent effects of these procedures on glycemia, considered together, have resulted in substantial enthusiasm in the surgical community for lowering the minimal BMI criteria for bariatric surgical candidates with type 2 diabetes. This would in effect be the first step in making type 2 diabetes a surgically treated disease, and this proposal has been the subject of two recent international consensus conferences.
A growing number of investigators have initiated efforts to provide level 1 data relevant to determining optimal treatment regimens for type 2 diabetes given the current equipoise for the clinician to recommend surgical or medical interventions. There are currently 11 studies registered on Clinicaltrials.gov comparing various bariatric and medical interventions (Table 1) (clinicaltrials.gov, accessed 20 September 2010). The National Institute of Diabetes and Digestive and Kidney Diseases has funded four prospective pilot and feasibility trials in the past year, possibly in consideration of a larger nationally based outcome trial to follow. With the societal imperative to provide optimal care for the growing population of patients with diabetes, the intense scientific focus on medical and surgical option effectiveness, and such a rapid expansion of clinical trials on the matter, a number of relevant issues are brought to bear by those designing, conducting, reviewing, and ultimately interpreting such trials.