Surgery News - November 2008 - (Page 16)

16 GENERAL SURGERY SURGERY NEWS • N O V E M B E R 2 0 0 8 Merits of Bariatric Surgery for Type 2 Diabetes Debated BY NANCY WALSH Else vier Global Medical Ne ws N E W Y O R K — Consensus on the role of bariatric surgery for patients with type 2 diabetes remains elusive, with advocates citing high rates of diabetes resolution and improved survival, and opponents, while acknowledging potential benefits, urging caution until more long-term data are available. In 1991, the National Institutes of Health’s (NIH) guidelines recommended considering bariatric surgery for patients whose body mass index (BMI) is greater than 40 kg/m2—or greater than 35 in those with coexisting illnesses such as diabetes. Data from the Agency for Healthcare Research and Quality showed a 79% reduction in mortality during hospitalization between 1998 and 2004 following bariatric surgery, Dr. Bruce Wolfe said at a congress on interventional therapies for type 2 diabetes. Twelve-month data from the American Society for Metabolic and Bariatric Surgery (ASMBS) now show that after 66,000 procedures, the 30-day mortality rate is 0.3%, the readmission rate is 5%, and the reoperation rate is 2.4%, said Dr. Wolfe, professor of surgery at Oregon Health and Science University, Portland. Experts disagree, however, about whether enough evidence exists to specifically recommend bariatric surgery for diabetic patients whose BMIs are in the 30s. “We are seeing a lot of complications now in patients who had their surgery 2 or 3 years ago—bone problems, anemia, nutritional abnormalities, and hypo- reduced minimum investment WE SHRUNK THE MINIMUM The suggested minimum investment to participate in SDIF has been reduced to $10,000. For those who ﬁnd it appropriate to participate in an automatic investment plan1, the minimum initial investment is $5,000 assuming an automatic investment plan of at least $100 per month is implemented; waivers of the minimum are possible. The minimum investment has been modiﬁed for Medical Student Members ($500), Resident Members ($1,000), and Associate Fellows ($2,500) of the College. For more information about SDIF or regarding the waived minimum, please contact Savi Pai, 312/202-5056 or spai@facs. org, or Tom Kiley, 312/202-5019 or tkiley@facs.org. Both are available to discuss speciﬁc details regarding SDIF. You may also visit the Web site at www.surgeonsfund.com or call 800/208-6070. An investor should consider the investment objectives, risks, and charges and expenses of SDIF carefully before investing. SDIF’s prospectus contains this and other information about SDIF and should be read before investing. SDIF’s prospectus may be obtained by downloading it from SDIF’s Web site at www.surgeonsfund.com or by calling 800/208-6070. ¹A program of regular investing does not ensure a proﬁt or protect against depreciation in a declining market. Because a consistent investing program involves continuous investment in securities regardless of ﬂuctuating prices, you should consider your ﬁnancial ability to continue to purchase through periods of various price levels. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246. The phone number is 513/587-3400. glycemia,” said Dr. Xavier Pi-Sunyer, professor of medicine, Columbia University Medical Center, and chief, division of endocrinology, diabetes, and nutrition, St. Luke’s–Roosevelt Hospital Center, both in New York. Patients have experienced significant hypoglycemia that resulted in seizures and even automobile accidents, and approximately 100 patients have had to undergo pancreatectomy, according to Dr. Allison Goldfine of Harvard Medical School and head of the clinical research section, Joslin Diabetes Center, both in Boston. Moreover, medical therapy today is often successful; 55% of patients are able to achieve a hemoglobin A1c of 7% or less, according to Dr. Richard Hellman of the University of Missouri–Kansas City. Surgeons have a different viewpoint. “I don’t have any doubt that patients with BMIs of 40 and 50 have much to gain from surgery, to which there is a 90% good response,” said Dr. Mario Morino, professor of general surgery, University of Turin (Italy). “At my center we have a yearlong waiting list.” Authorities on diabetes, obesity, and bariatric surgery met in Rome in 2007 to review available evidence, identify indications and contraindications, and begin to establish regulatory and scientific oversight for bariatric surgery, specifically for type 2 diabetes. With 52 voting faculty (weighted toward nonsurgeons to avoid potential conflicts of interest), the conference produced several consensus statements, said Dr. David Cummings of the division of metabolism, endocrinology, and nutrition, and deputy director of the diabetes endocrinology research unit, at the University of Washington, Seattle. The question “Should gastrointestinal surgery be considered for patients with type 2 diabetes who are appropriate surgical candidates with BMIs over 35 who are inadequately controlled on medical therapy?” received 100% agreement that the answer was yes, Dr. Cummings said. When asked whether any type of gastrointestinal surgery would be appropriate for inadequately controlled patients with BMIs between 30 and 35, 82% agreed. When asked whether gastric bypass might be appropriate in this patient group, 73% agreed. Consensus was not reached on the use of other procedures, such as biliopancreatic diversion, duodenal switch, and sleeve gastrectomy. After the Rome consensus document was presented to the world congress participants, Dr. Philip Schauer, an ACS Fellow and director of the Cleveland Clinic Bariatric and Metabolic Institute, asked for comments and endorsement from representatives of interested organizations. “We would like to see more long-term data, but I’m positive we will be able to endorse it,” said Dr. Caroline Apovian of Boston University, speaking on behalf of the Obesity Society. “We enthusiastically endorse all the elements of the document relating to research, and to collaborative efforts to advance the knowledge for surgical intervention in type 2 diabetes,” said Dr. JefContinued on following page http://www.surgeonsfund.com http://www.surgeonsfund.com http://www.surgeonsfund.com

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Surgery News - November 2008 Contents News:�Without a Stitch The 20/20 Vision:�Med School Mix News From the College:�New President General Surgery: Diabetes Debate

Surgery News - November 2008

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