Diabetes surgery and new interventional treatments offer new hope to patients with type 2 diabetes

NEW YORK (August 4, 2008) — The 1st World Congress on Interventional Therapies for Type 2 Diabetes will bring together leading experts in diabetes, endocrinology, surgery and public health to discuss the role of surgery and novel interventional therapies in the treatment of type 2 diabetes. The World Congress has been formed to address this emerging approach to diabetes and its implications for health care systems and patient care.

Led by Congress Director Dr. Francesco Rubino, surgeon-scientist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Congress includes a faculty of more than 80 international leaders in endocrinology, surgery, and basic sciences, as well as public health specialists, insurers and top health authorities from the United States and worldwide. Dr. Rubino cited his reasons behind organizing the Congress this year, saying, “The epidemic growth of type 2 diabetes has created a race against time to find new approaches to treat and understand the disease. Diabetes surgery and other novel interventional techniques are not only a promising therapeutic option for selected patients with type 2 diabetes but also an unprecedented opportunity to shed light on the origin of the disease. To ensure a timely, scientific and safe development of this emerging discipline it is necessary to balance enthusiasm with caution. This is possible only with the immediate attention and responsible, urgent actions from the global diabetes community.”

A growing body of evidence shows that bariatric surgery can improve type 2 diabetes, often resulting in normalization of blood glucose levels, discontinuation of diabetes-related medications, and reduction of diabetes-specific mortality. Experimental studies show that surgical control of type 2 diabetes is not only a secondary effect of weight loss, but also occurs as a consequence of the re-arrangement of gastrointestinal anatomy and the resulting hormonal changes. Not surprisingly, the interest for diabetes surgery is growing both in the scientific community and among the public at large.

As with any medical innovation, however, there are both opportunities and challenges. Although animal studies and early reports from clinical trials suggest that mildly obese or overweight patients with diabetes might benefit from diabetes surgery, long-term data in these patients are still limited and more studies are necessary to identify the ideal candidates. In spite of the limited evidence, diabetes surgery is already being utilized throughout the world, even in non-obese patients. “Implementation of widely accepted, international recommendations to avoid an inappropriate use of surgery and ensure respect of safety standards has become top priority,” says Dr Rubino.

Despite the increasing evidence that bariatric surgery achieves long-term control of type 2 diabetes in patients who are severely obese (BMI over 35), only a few of these patients actually have access to this type of treatment. “While these procedures may be life-saving, less than 2 percent of those patients already eligible under current NIH recommendations are offered a surgical option in the U.S.,” says Dr. Philip Schauer, past president of the American Society for Metabolic and Bariatric Surgery, Congress faculty member and surgeon at Cleveland Clinic. “This may be because of limited awareness among primary care physicians, surgeons and diabetes specialists, and insufficient insurance coverage.”

Last year an International Consensus Conference (Diabetes Surgery Summit) was held in Rome, Italy, where international scientific authorities established a set of recommendations and called for a multidisciplinary effort to prioritize research in this emerging field.

To continue the multidisciplinary dialogue and translate scientific findings into policy changes, the 1st World Congress will bring together, for the first time, clinicians, scientists and policy makers. Together, they will craft an agenda of health policy initiatives in order to ensure access to approved treatments and prioritize further research in this field.

The Congress has received endorsements from the International Diabetes Federation (IDF) through its Taskforce on Epidemiology and Prevention, the European Association for the Study of Diabetes (EASD), the American Association of Clinical Endocrinologists (AACE), Diabetes-U.K., the American Society for Metabolic and Bariatric Surgery (ASMBS), the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) and many other prestigious organizations from Latin America, Europe, Asia and the United States.

“It is very timely and appropriate that major scientific organizations start to carefully evaluate available evidence and to encourage initiatives such as the World Congress that promote a rigorous, multidisciplinary approach to this field,” says Professor Sir George Alberti, diabetologist at the Imperial College in London, U.K., and Congress faculty member. “There are opportunities and risks that cannot be ignored, and both need to be adequately addressed.”

The emerging field of diabetes surgery is receiving increasing attention worldwide not only for its clinical implications but also for bringing about an entirely new way to look at diabetes. Dr. David Cummings, endocrinologist at the University of Washington and Congress faculty member, states, “The insights already beginning to be gained by studying surgical interventions may be the most profound since the discovery of insulin.”

“Surgery has arrived like a comet across the firmament of diabetes and obesity — unexpected, brilliant, with great promise for the future. Teams of talented researchers are moving ahead to define the role of surgery in the treatment of both of these scourges,” says Dr. Jesse Roth, Congress faculty member, researcher, and diabetologist at the Feinstein Institute for Medical Research and the Albert Einstein College of Medicine of Yeshiva University in New York.

Diabetes surgery might also be a way to reduce health care spending across private and public health sectors. At the 1st World Congress, cost-effectiveness analysis and public health implications of diabetes surgery will be discussed for the first time with policy makers and top health authorities from the U.S., U.K. and worldwide.

“Diabetes is growing at epidemic rates worldwide and places a severe burden on the economy and society,” says Dr. Paul Zimmet, Congress faculty member, diabetologist and director emeritus and director of International Research, Baker IDI Heart and Diabetes Institute in Melbourne, Australia. “However, issues may be very different in developed versus developing regions of the world. Organizing a World Congress to discuss the potential role of an emerging and yet-controversial approach to diabetes is very appropriate, and there are both global and regional perspectives that must be considered.”

Diabetes affects an estimated 24 million Americans and 246 million people worldwide, a number that is expected to grow to 380 million by 2025. According to the American Diabetes Association (ADA), the disease could lower the average life expectancy of Americans for the first time in more than a century. Costs to treat diabetes are skyrocketing as well. According to a recent study commissioned by the ADA, diabetes costs Americans $174 billion annually, an increase of 32 percent since 2002. Health experts predict that one of every three children born after the year 2000 will have diabetes in their lifetime. In some communities like New York City, that number is one of every two in certain ethnic groups. Even with good medical management, diabetes often leads to cardiovascular disease, kidney failure, and premature death.

When Denise Minks was diagnosed with type 2 diabetes in 1993, she knew nothing about the disease and received little advice except to watch what she ate.

Since then, Minks, 39, has developed serious wounds on her feet that have kept her bedridden for most of the last year and put her at the brink of losing both of her big toes to amputation.

The problem, which is common to diabetics, has opened her eyes to the magnitude of the disease.

Diabetes “is serious and you have to take care of yourself,” says Minks, one of 318,000 Kentucky adults with diabetes. “You have to find out what diabetes is and how it works.”

Though diabetes often is called a silent killer, more people are aware that they have the condition than in the past. The percentage of people with diabetes who don’t know they have it has decreased from 30 percent to 25 percent in recent years, according to federal officials.

But a lack of understanding about the disease persists, hindering people from taking steps to safeguard themselves from complications.

Some people think “you can ignore it, and it won’t hurt you” or that “you can just go to the doctor occasionally if you have diabetes and they will take care of it for you,” says Dr. Vasti Broadstone, medical director of the Joslin Diabetes Center at Floyd Memorial Hospital in New Albany, Ind. But if you’re a diabetic, “you have to get involved. You can’t just be passive.”

The disease is “deadly if it’s uncontrolled,” says Broadstone, an endocrinologist. “It is a big deal, and it’s costly, and it’s a lot cheaper to prevent it.”