On March 28, leading experts across multiple disciplines will convene at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes to review the latest research on bariatric surgery as a treatment option. The three-day meeting, hosted by NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City, will bring together physicians, scientists and policymakers representing 60 countries. The Congress director is Dr. Francesco Rubino, one of the world's leading authorities on bariatric surgery for diabetes.
Bariatric surgery, initially developed for the treatment of morbid obesity, can improve or normalize blood sugar levels, reduce or even eliminate the need for medication, and lower the risk of diabetes-related death. When specifically used to treat diabetes, bariatric surgery is known as "metabolic surgery" or "diabetes surgery," an emerging field that is continuing to gain recognition throughout the diabetes community.
Scientists are also probing the mechanisms behind the powerful anti-diabetic effects of bariatric procedures, particularly gastric bypass. Understanding how the surgery works could significantly advance the understanding of diabetes and open avenues for the development of novel drugs.
"The 2nd World Congress aims to raise awareness of gastrointestinal surgery for diabetes, not only as a valuable therapeutic option but also as a unique opportunity for research into the root causes of the disease. The lessons we are already learning from the study of metabolic surgery may profoundly change the way we think about diabetes and obesity," says Dr. Rubino, who serves as director of gastrointestinal metabolic surgery at NewYork-Presbyterian/Weill Cornell and associate professor of surgery at Weill Cornell Medical College.
"I want to thank all of the professional organizations that have endorsed this Congress and everyone who has supported our effort," he continues. "In particular, I'd like to thank the American Diabetes Association for partnering with us in this initiative and the International Diabetes Federation, which has chosen this Congress as the venue for announcing its new position statement on diabetes surgery."
IDF Statement
The International Diabetes Federation (IDF), an umbrella organization for more than 200 diabetes associations in more than 160 countries, will present its first position statement on metabolic surgery and gastrointestinal interventions for the treatment of diabetes. The IDF will urge the international community to give greater consideration to surgery as a legitimate treatment option for diabetes in appropriate candidates.
Today, an estimated 285 million people across the globe suffer from Type 2 diabetes. That number is expected to nearly double by 2030. Obesity and Type 2 diabetes used to be associated with affluent countries, but their most dramatic increases are occurring in the developing world -- especially the Middle East, sub-Saharan Africa and India. According to Dr. Paul Zimmet, director emeritus for the Baker Heart and Diabetes Institute at the International Diabetes Institute in Melbourne, Australia, who is also representing the IDF at the Congress, "While metabolic surgery is likely to be more immediately relevant for patients with diabetes in the wealthy countries of the North, diabetes specialists on every continent are eager to learn about this promising new treatment option."
The American Diabetes Association: Educational Partner
The American Diabetes Association has stepped forward as an educational partner with the World Congress, committing to raise awareness and sponsor research in order to answer many outstanding questions surrounding surgical intervention for Type 2 diabetes.
"The epidemic rise of Type 2 diabetes is clearly linked to rising rates of obesity, driven in turn by significant cultural, dietary, lifestyle and demographic changes. We need all the tools we can get to deal with the diabetes epidemic, and we see surgery as part of our toolkit," says Dr. Sue Kirkman, the association's senior vice president.
Nobel Laureates and Others to Address Major Research Issues
A major focus of the March 28 Congress will be research into topics related to the biologic processes behind Type 2 diabetes. Participating faculty include a long list of leading international experts across many scientific and medical disciplines. Notable on that list are Nobel laureates Michael S. Brown and Joseph L. Goldstein, who will deliver a keynote lecture on the role of the gastrointestinal hormone ghrelin in regulating key biochemical processes implicated in energy metabolism.
Following their lecture, a group of international scientists will discuss the GI tract more broadly as an important endocrine organ that may contribute to the development of diabetes through a mechanism that is still largely unknown. They will further probe the emergence of the gut as a target for surgery and other interventions in diabetes -- and as a potentially fruitful target for research.
More broadly, one of the main purposes of the 2nd World Congress is "to define which population might be appropriate for interventional strategies and when such strategies should be considered, and to establish clinical guidelines," says leading endocrinologist Dr. Harold Lebovitz, professor of medicine at SUNY Health Science Center in Brooklyn, N.Y.
Traditionally, only people with Type 2 diabetes and severe obesity -- a body mass index (BMI) of 35 or over -- have been considered eligible for metabolic surgery. However, what happens if a patient has a BMI of 34, uncontrolled blood sugar, and signs of serious diabetic complications? At the Congress, specialists will challenge the appropriateness of a BMI over 35 as a rigid cutoff.
Currently, a clinical trial is under way at NewYork-Presbyterian/Weill Cornell to test surgery as a means of controlling diabetes in patients who are overweight or mildly obese -- i.e., with a BMI between 26 and 34.
"Surgery is not right for every patient with Type 2 diabetes. The very success of the surgery in improving or even resolving the disease is what makes the need for new guidelines so urgent," says Dr. Lebovitz.
Cardiovascular Risk and Longevity
The connection between diabetes and heart disease is so strong that some consider diabetes a cardiovascular disease on its own. For a diabetes treatment to be successful, then, it must go beyond blood sugar regulation alone. "It must bring patients' physiology into long-term balance so as to significantly lower their risk of cardiovascular disease, the leading cause of death in the United States and worldwide," says Dr. Rubino.
New data on the long-term reduction of cardiovascular risk and overall survival after metabolic surgery will be presented at the Congress. In one presentation, Dr. Lars Sjöström, professor at the Institute of Medicine in Göteborg, Sweden, will provide an update from the Swedish Obesity Study (SOS) after 20 years since its inception. The longest study of its kind, SOS has compared more than 2,010 bariatric surgeries for weight loss to a similar number of patients undergoing conservative (lifestyle or medical) treatments. The results presented at the Congress will show that bariatric surgery outperformed non-surgical approaches with respect to long-term weight loss, control of high blood sugar, decrease in cardiovascular risk, and overall survival.
"The next step will be to design multicenter, randomized, controlled trials comparing patients grouped by body weight who are receiving gastric bypass for Type 2 diabetes with those being treated non-surgically," says Dr. David Cummings, a leading endocrinologist and professor of medicine at the University of Washington in Seattle. "We have been working with the NIH to design a study that will generate the volume and quality of data we need to move that agenda forward."
Cost-Effectiveness Research
Another focus of research to be presented at the Congress is the issue of cost effectiveness. Dr. Zimmet and colleagues, including Catherine Keating, from Deakin University in Melbourne, Australia; Dr. Frank Lefevre, from Northwestern University's Feinberg School of Medicine; and Dr. Sean Sullivan, from the University of Washington, will compare the cost of the surgery -- presumably a one-time intervention with periodic follow-up -- with the lifetime costs associated with medical management of the disease and its complications affecting the eyes, heart, kidneys and extremities. Long-term costs include outpatient care, prescription medications and diabetes-related hospitalizations and surgeries, including amputations.
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