Issue link: https://viewer.e-digitaledition.com/i/1472735
increasingly safe surgical treatments of diabesity. The most common surgeries are the following: + Sleeve gastrectomy + Roux-en-Y gastric bypass + Bi liopa ncreatic diversion (duode- nal switch) + Single-anastomosis duodenal ileos- tomy with sleeve gastrectomy (SADI-S) SURGERY COMPARED TO TRADITIONAL APPROACHES Metabolic/bariatric surgery is the most effective treatment for patients with diabesity. For patients with controlled diabetes, remission following surgery is more likely, with 97% of people with d iet- cont rol led d i a bet es a ch iev i n g remission, along with 87% of those on oral medications. Earlier surgical treatment improves outcomes of patients with dia- betes and obesity, particularly in patients who have had diabetes for five years or less, according to Dr. Atwa. The STAMPEDE trial demonstrated the superiority of surgery over traditional medical management of diabetes at five years in patients with advanced diabetes. " W hen t hey compa red surger y to medications, they found that the medical therapy group had to increase medica- tions and the surgica l group was able to cut down or eliminate medication," Dr. Atwa says. Of course, success va ries between individual cases. Factors that impact the success of metabolic surgery for diabetes and obesity include age, percentage of excess weight lost, HbA1c levels, insu- lin use prior to surger y a nd duration of diabetes. (See table below for more detail about factors that impact which patients will still need diabetes medicine after treatment.) LOW-RISK SURGERY TO REDUCE FUTURE HIGHER-RISK SURGERIES Met a b ol ic/ ba r i at r ic s u r g ic a l t e ch- niques have advanced significantly over the past couple of decades, resulting in a n impressive safety prof ile. For exa m- ple, the rate of complications following Roux-en-Y gastric bypass is 3.4%, lower tha n severa l other lapa roscopic proce- dures including appendectomy (4.5%) a nd cholec y s t ec t omy (3 .7%). W hen compared to surgeries for common com- plications of diabesity, such as coronary a r ter y by pa ss g ra f t su rger y (46.6%) a nd infra ing uina l by pass (23.6%), the safety of metabolic/bariatric surger y is markedly superior. Of 28 obser vationa l studies, a ll showed reduced mor ta lit y follow ing surger y, w ith a n avera ge of 45% risk reduction. DESTIGMATIZING METABOLIC BARIATRIC SURGERY For a lot of people, inability to achieve a norma l BMI is not due to lack of effort. Some people have a genetic predisposi- tion to obesity; despite trying numerous diets, they have difficulty losing weight by conventional means. The extra weight obese patients carry also makes exercise difficult and can contribute to significant joint pain. "Metabolic bariatric surgery should not be viewed as ta king the easy way out," Dr. Atwa says. "Instead, choosing surgery is taking the healthy way out." There is a huge opportunity to help patients with diabesity, as currently only 1% of patients who qualify for metabolic/ bariatric surgery have had the procedure. With his multidisciplinar y team and compassionate approach to diabesity, Dr. At wa hopes to positively impact more patients and help them live longer, healthier, happier lives. For patients with diabesity, early referral is key to glycemic control or diabetes remission. An hour of surgery can lead to a lifetime of health. In addition, primary care physicians and endocrinologists may find diabetes and associated comorbidities much easier to manage when they can confidently recommend bariatric surgery as a safe and effective treatment for their patients. "We have an extremely safe track record and we support each patient fully through- out the weight loss journey," Dr. Atwa says. "Our patients love us." ■ Please visit JourneyToTheNewYou.com to learn more about the services offered at Long Island Laparoscopic Doctors. To Refer or Not to Refer? E SCA PEDIA BE TE S.ORG CA N A SSIST in risk stratification for patients or clinicians. By factoring in certain biometric data, such as age, comorbidities, medications, blood pressure and lab values, this tool estimates the risk of developing certain complications of diabetes and how that risk could change with metabolic bariatric surgery. This may aid in decision-making for those considering consultation for surgery. Rates of Diabetes Medication Use at Five Years Treatment No Medications at Start of Trial Oral Medications at Start of Trial Insulin at Start of Trial Medical 2% 58% 40% Gastric Bypass 45% 43% 12% Sleeve 28% 65% 11% M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 1 5