Issue link: https://viewer.e-digitaledition.com/i/727041
DIABETES AND OBESITY are considered to be the twin epidemics of the 21st cen- tury in the United States. According to the Centers for Disease Control and Prevention, 9.3% of the population has diabetes; 34.9% suffer with obesity. Among those with severe/morbid obe- sity, the prevalence of diabetes is more than 25%. Adrian G. Dan, MD, is Co-Director of Summa Health's Bariatric Care Center where he sees the toll obesity takes on those who seek his help. A board-certified general surgeon with fellowship training in advanced laparoscopic and bariatric surgery, he also sees the positive out- comes surgery has on obesity. In fact, he considers surgery to be the most e…ective weapon against severe obesity that is refractory to medical therapy — mainly diet and exercise. "The e…ects of metabolic and bariatric procedures have been well studied and proven to be the most e…ective therapy for obesity and associated conditions such as diabetes mellitus," Dr. Dan explains. "The focus is now shifting to the use of these operations in patients with type 2 diabetes who have lower BMIs than what has been traditionally indicated." According to the American Society for Metabolic and Bariatric Surgery (ASMBS), indications for bariatric surgery in the U.S. typically include a BMI≥40. For those with type 2 diabetes and at least one other obesity-related co-morbidity, the BMI traditionally has been ≥35. New guidelines now recommend surgery for patients with diabetes who have a BMI>30. According to Dr. Dan, these guidelines are for patients with poorly controlled diabetes despite optimal medical therapy. "These guidelines evolved from the second Diabetes Surgery Summit (DSS-2) held in London last year," he explains. "The summit [which Dr. Dan attended] was historic in that its focus was on revising outdated guidelines for the use of metabolic procedures in the treatment of metabolic conditions such as diabetes. The new guidelines, which have now been endorsed by 45 professional associations including the American Diabetes Association and the ASMBS, were based upon evidence which included several randomized controlled trials that clearly showed the e…ectiveness of surgical therapy." According to the ASMBS, bariatric surgeries performed in more than 135,000 patients were found to improve type 2 diabetes in nearly 90% of patients by lowering blood sugar, reducing the dosage and type of medication required, and improving diabetes-related health problems. In 78%, surgery resulted in remission of type 2 diabetes by reducing blood sugar levels to normal levels and eliminating the need for diabetes medications. "The most commonly performed procedures shown to be use- ful include the laparoscopic Roux-en-Y gastric bypass and the laparoscopic sleeve gastrectomy," says Dr. Dan. "The full potential of using such procedures to alleviate metabolic conditions like type 2 diabetes is yet to be exploited." In August 2016, Surgical Clinics of North America (volume 96, issue 4) was published. "Metabolic and Bariatric Surgery" is the topic of this 345-page issue, to which 40 physicians and surgeons from across the U.S., Canada and the United Kingdom contributed. Dr. Dan is the editor. "For the first time in the 96-year history of Surgical Clinics, the focus is metabolic surgery," he says. "For so many years we have focused on the reduction of weight with surgical interventions of the GI tract. But now we're shifting that focus to the resolution of conditions, like type 2 diabetes and other metabolic conditions, through surgery." To contact Dr. Adrian Dan, email dana@summahealth.org. To learn more about Summa Health's Bariatric Care Center, visit www.summahealth.org/weightloss or call 330-375-6590. ■ Adrian G. Dan, MD, FACS, FASMBS, is Co-Director of Summa Health's Bariatric Care Center, Director of the Advanced Laparoscopy and Bariatric Fellowship, Attending Surgeon, and Chief of the Division of Robotic General Surgery at Summa Health in Akron, Ohio. He is also Assistant Professor of Surgery at Northeastern Ohio Medical University in Rootstown, Ohio. PHOTO COURTESY OF SUMMA HEALTH, AKRON, OHIO Metabolic Surgery for Diabetes 1 1 M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n S E P T E M B E R / O C T O B E R 2 016 P R O f i l e 1 1