Surgery as a Treatment For Diabesity

As the obesity epidemic grows, so does the spread of Type 2 diabetes, frequently appearing as a secondary condition to obesity. Obesity is directly correlated with Type 2 Diabetes Mellitus.
This growing number of patients present with a condition becoming commonly known as diabesity, the combination of diabetes and obesity. It is a growing global epidemic yet prevention and treatment appear to be ineffective and insufficient to date. Year after year, we see a dramatic increase of a disease that was once rare.

The treatment of type 2 diabetes mellitus (T2DM) has primarily been the domain of internal medicine, consisting of dietary adjustments, blood sugar-lowering drugs and possibly insulin injections.
But lately, bariatric procedures traditionally used to treat obesity, have demonstrated that surgical solutions may be a good option to treat Diabesity.

Surgical solutions for obesity are also known as “bariatric surgeries“. Several years ago, when data demonstrated that some of these procedures can significantly improve glycemic status even before significant weight loss is achieved, the term “metabolic surgeries” was coined.
Surgery has been added to the T2DM treatment guidelines of both the American Diabetes Association (ADA) and the International Diabetes Federation (IDF).

What Types of Surgeries Are Available Today for treating Diabesity?

Surgical options can be divided into two classes: Restrictive and Malabsorptive.
Restrictive surgeries such as gastric bands, gastric balloons and sleeve gastrectomy, reduce the amount of food that can be consumed per meal by reducing stomach volume or stomach entry capacity. Some of these procedures are reversible. However patients can learn to circumvent these procedures and weight regain often reoccurs within a few years. With these procedures, patients many times experience nausea and vomiting (due to reduced stomach volume) and other complications such as hemorrhaging, pain and discomfort and a need for reoperations. The decision to perform such surgery is a significant one, given the risks and drawbacks.

Malabsorptive surgeries – such as the Roux-en-Y Gastric Bypass (RYGB) and Biliopancreatic Diversion (BPD), consist of bypassing a portion of the small intestine thereby reducing the magnitude of nutrient absorption. This does usually lead to considerable weight loss. However, these surgeries are irreversible. Furthermore, they can cause severe Gastrointestinal effects (diarrhea, bloating) and there is a high risk of vitamin and mineral deficiencies (requiring patients to take supplements for the rest of their lives). These procedures are major abdominal surgeries and hold the risk of hemorrhaging, adhesions and infection.
Malabsorptive bariatric surgeries have been shown to improve/remit diabetes in ~85% of patients independent of weight loss. Sometimes this can occur as soon as 5 days after surgery. So in cases where less extreme alternatives are ineffective, the promise of such surgeries can be critical to the morbidly obese diabetic.
The majority of these procedures are approved only for morbidly obese patients, namely patients with a BMI of over 35 kg/m2.

A New Discipline: Interventional Diabetology
A new discipline has emerged over the past few years, with a paradigm of offering a reversible, minimally invasive surgical solution which would be suitable not only for the morbidly obese population, but for lower BMI patients as well. The rise of this new paradigm called “Interventional Diabetology” is somewhat reminiscent of the emergence of “Interventional Cardiology” in the last two decades, where minimally invasive or even percutaneous procedures have largely replaced open heart surgery which was the standard of care in the 1980s.

Emerging reversible treatments for Type 2 diabetes, like MetaCure’s Diamond System, drive the acceptance of the Interventional Diabetology paradigm. The Diamond System provides an alternative to treatments that patients are often concerned about starting – such as insulin injections or more invasive surgical procedures like the bariatric surgeries mentioned previously. It is also approved for patients with a BMI of 30 kg/m2 and above. So for instance, if you are a 1.70m diabetic weighing 86.5 kg or above you are eligible for DIAMOND treatment. Interventional Diabetology may significantly reduce the compliance challenges that diabetes patients face and offer a solution for underserved diabetic populations, such as those diabetics who failed with medication treatment and who are ineligible for full blown metabolic surgery.

The DIAMOND System is the first dedicated Interventional Diabetology System approved for clinical use in Europe.

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