LINKED to modern lifestyle, type 2 diabetes is one of the big health threats of the 21st century. At least 415 million people have the disease worldwide, twice as many as 20 years ago, with 650 million predicted by 2040. Finding the best strategies to prevent and treat it is now a race against time.
That鈥檚 why 45 major health organisations, including the American Diabetes Association, International Diabetes Federation, Diabetes UK, the Chinese Diabetes Society and Diabetes India, have called this week for surgery to be formally recognised as a standard treatment for the first time.
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This means procedures originally designed to induce weight loss 鈥� like gastric bypass 鈥� should be offered more widely as a specific treatment for type 2 diabetes, including in mildly obese people who fail to respond to conventional therapies. Many more could benefit from surgery.
Numerous clinical trials have shown that it achieves than the alternatives. Although type 2 diabetes is generally considered a progressive disorder, the evidence is that surgery can bring long-lasting remission聽鈥� unusual with conventional care. Surgery is cost effective too.
In comparison, conventional therapy聽鈥� via diet, exercise and insulin tablets or injections聽鈥� too often fails to fully control blood glucose levels, raising the risk of complications such as kidney failure, blindness, nerve damage, amputations, heart attacks and strokes. The last two claim the lives of half of those with diabetes.
Surgery, implicitly focused on a聽single organ, may seem an odd solution for a disease associated with metabolic defects involving the pancreas, liver, brain, muscle and fat tissue. But experiments show that altering the anatomy of聽the stomach and intestine can directly influence the regulation of glucose metabolism. It appears that changes in gut hormones, bile acids and gut flora play a part. Better understanding how surgery works may also help identify the causes of diabetes, providing opportunities to find novel ways of preventing or even curing it.
We are not saying surgery is a panacea. It is not suitable for all patients, and high upfront costs will limit its use. While the operations are as safe as routine gall-bladder surgery, there will be聽a need for lifelong nutritional supplements afterwards.
There will no doubt be a wider debate about extending surgery for a condition linked to lifestyle. But making it a standard option would represent one of the most significant changes in treating diabetes since the discovery of insulin in 1921, and bring fresh impetus to the fight against a worsening epidemic.
Diabetes Care
This article will appear in print under the headline 鈥淐ut to the chase鈥�
