Doctors today called for surgery to become a standard treatment for diabetes in what was hailed as the biggest global advance since the discovery of insulin a century ago.
The demand from experts in the UK, USA, China and India came after clinical trials found that gastric-bypass surgery put type-2 diabetes into remission for at least five years in half of patients.
They said surgery was a life-saving option for patients unable to control their diabetes through diet and medication and could help to reduce the £10 billion annual cost to the NHS – a tenth of its total budget – of managing the obesity-fuelled epidemic.
Professor Francesco Rubino, of King’s College London, who led the research, told the Standard: “Surgery introduces a new type of outcome that was not even considered possible in diabetes before.
“With surgery, for the first time at least some patients can experience and enjoy remission of the disease that can last quite long. This is probably the most radical change ever since the discovery of insulin.
“The evidence is now robust that says this should be offered to patients. It doesn’t mean a cure for diabetes for everybody but it does show very clearly that diabetes is not invincible.”
Gastric-bypass surgery, which removes part of the stomach or re-routes the small intestine, is already offered as a treatment for obesity. Today’s call would designate bariatric surgery as a treatment option for diabetes.
It would be considered for type-2 diabetics with a BMI (body mass index) of 40 and above (morbidly obese), regardless of their blood glucose control, and those with a BMI of 30 and above (obese) whose blood glucose levels are inadequately controlled by lifestyle and medication. Thresholds for Asian people with type-2 diabetes would be lower as they develop diabetes at lower BMI rates.
Simon O’Neill, of charity Diabetes UK, said: “We strongly support the call for obesity surgery to be fully recognised as an active treatment option for type-2 diabetes alongside established forms of type-2 diabetes treatments, such as lifestyle changes, and blood glucose lowering medications.”
Professor Rubino, also a consultant surgeon at King’s College Hospital, said 11 clinical trials had shown that the role of the gut was key to finding a cure for diabetes. Many of the patients on trials had seen their blood glucose levels fall so low that they no longer required medication.
He said: “I think this will create fresh impetus to the search for a cure for diabetes. In the 20th century we have always been saying we can live with diabetes. In the 21st century, as we face an epidemic of diabetes, we have to find a solution. We have to prevent it. We have to treat it and potentially cure it. What surgery offers is an insight into potentially vulnerable targets to address diabetes.”
The joint statement, from Diabetes UK, the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, and Diabetes India, was published today in the journal Diabetes Care. Professor Rubino has written an accompanying article in Nature.