By Owen Haskins (photograph featuring Professor Michel Gagner)
Bariatric or metabolic surgery should be performed as a mass treatment as a means of treating millions of patients with diabetes and other metabolic disease, according to eminent bariatric surgeon, Professor Michel Gagner, Professor of surgery, Herbert Wertheim School of Medicine, FIU Senior consultant, Hôpital du Sacre Coeur, Montreal. In a clinical editorial entitled, ‘Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus’, accompanying the publication of a trial assessing lifestyle invention vs. bariatric surgery published in JAMA Surgery, he writes: “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with T2DM and start a mass treatment, similar to what was done with coronary artery bypass surgery more than 50 years ago.”
In his editorial, he argues that thus far, surgery is the only known effective treatment for resolving or preventing T2DM. He cites the outcomes from studies that clearly show the beneficial effects bariatric/metabolic surgery has T2DM in terms of controlling, resolving or preventing T2DM. For example, 15 year outcomes from the Swedish Obesity Study reported a greater prevalence of T2DM in non-surgical patients (28.4 per 1,000) compared to the surgical group (6.8 per 1,000), and that the effect of surgery was influence by the presence of impaired fasting glucose (p=0.002) but not by BMI (p=0.54).
In comparison, studies that have examined the efficacy of lifestyle intervention have failed to show any benefit with regards to controlling, resolving or preventing T2DM. The Look AHEAD study, which was stopped early on the basis of a futility analysis, did show some improvements in weight loss and reductions in glycated haemoglobin A1C, nevertheless it failed to show any cardiovascular benefit. Likewise the TODAY study also failed to show any benefit of lifestyle intervention in adolescents with recent-onset of T2DM.