Not of the clearest messages that have been given in the National Diabetes Congress held these days in Seville is that diabetes is not operated or has for now cure.The Spanish Diabetes Society (SED) Organizer of the Congress, denounces the advertising claims of surgical clinics that erroneously claim that "diabetes is operated and heals along with their complications."
It is true that bariatric or metabolic surgery (techniques that regulate intake and appetite and modify food absorption, such as gastric band, gastric ball or gastric bypass), has meant a great advance in the treatment of obesity andits complications, and, among them, especially type 2 diabetes. The standardization of laparoscopic surgery and mixed techniques with a very small morbidity and mortality has substantially changed the indications and management of the process.
According to Dr. Clotilde Vázquez, head of the Endocrinology and Nutrition Service of the Ramón y Cajal hospital in Madrid, “in the case of people with obese type 2 diabetes, good results in terms of weight loss and, above all, improvementMetabolic are spectacular.In fact, the indications of the ADA (American Diabetes Association), when the body mass index is greater than 35 (which is equivalent to grade 2 obesity), are based on a very good degree of scientific evidence ”.
From the results obtained with the different techniques of surgery in type 2 diabetes associated with obesity, the optimism of being before a powerful, efficient procedure, which, as long as it is well indicated, and accompanied by specific dietary-therapeutic measures, specific measures,Get results in the short and medium term higher than changes in lifestyle and classic drugs, including insulin.
Diabetes is not operated
However, surgery is a risk with risk, which requires subsequent follow -ups, dramatically modifies food tolerance and almost always requires a subsequent pharmacological treatment.Disadvantages, all of them, minors compared to potential benefits, but cannot be ignored.In short, diabetes is not operated.Surgical procedures constitute an effective and cost/effective treatment measure in cases where excess fat plays an important role.
Diabetes is not operated
"But we must not forget," explains Dr. Vázquez, "that the existence of very effective drugs in the treatment of obesity and diabetes together allows spectacular achievements without surgery.And above all, in diabetic patients with normal or lightweight weight, the results of medium and long term surgery are uncertain and insufficient. ”
Conclusions
1. The first and most important is that type 2 diabetes is not cured, and the remission of diabetes is not achieved in 100% of cases with bariatric surgery (or metabolic surgery).This is very important, because many advertising claims are being seen in recent months announcing the healing of diabetes with this surgery and patients may believe that the results are guaranteed in all cases, which is not true at all.Therefore diabetes is not operated.
2. Type 2 diabetes can go into remission with surgery, but it is very important to individualize the cases, the type and duration of diabetes and the patient's surgical risk, as well as advise well about the type of surgery.
3. It seems clear that the lower the evolution of diabetes, and minors are the complications of it, the greater the remission rate seems.
Uncertainty about its long -term results
There are still many areas ofUncertainty: The most important are time to advise surgery and the type of surgical technique that must be performed.Nor do we know how long the remission will be maintained once it is achieved, that is, what happens at 10 or 15 years after surgery: Does diabetes recurrence again?We know that from the two years of performing obesity surgery, weight begins to recover, and it is known that in some patients in which this weight recovery is striking over the years, diabetes may appear again, althoughIt is usually of less intensity and is usually controlled better and with less medication than before surgery.In any case, we do not know in a precise way the long -term results and more studies are needed, although it has been demonstrated in recent years that the surgical treatment of type 2 diabetes that is accompanied by obesity is much more effective than themedical treatment.
Given the contribution of this surgery as an effective alternative treatment in type 2 diabetes, the main scientific societies -Spanish Diabetes Society (SED), Spanish Society of Obesity Surgery and Metabolic Diseases (DRY);Spanish Society of Endocrinology and Nutrition (SEEN), and Spanish Society for the Study of Obesity (SEEDO)- involved in the management of obesity and diabetes have developed a positioning document in relation to metabolic surgery in type 2 diabetesRecently presented, whose objective is to define in which patients it would be advisable to do this intervention, what their indications are and explain the referral criteria.
Thirst recommendations
It is very important to advise patients with obesity and diabetes who are interested in metabolic surgery as a treatment that come to centers that have multidisciplinary obesity surgery units and have extensive experience in the surgical and medical management of these patients,so that they can receive the best possible and individualized attention, weighing not only the surgery pros but also cons (surgical risk, long -term complications).
“It is necessary that they leave already, and once and for all, sensational holders on the healing of diabetes with metabolic surgery, which are used as an advertising claim.Patients with type 2 diabetes have the right to be well informed about metabolic surgery and access this type of therapy with total guarantee and rigor, since it has proven to be very effective in achieving the complete or partial remission of diabetes, although notHe is exempt from risks and short, medium and long term complications, ”concludes Dr. Clotilde Vázquez.