International Diabetes Federation and bariatric surgery
The position statement from the International Diabetes Federation that bariatric (or as they refer to it – metabolic) surgery should be considered a standard treatment for Type 2 diabetes is both an acknowledgement of the powerful impact this form of treatment has on the condition but also a significant issue given the demographics of T2DM worldwide. Specifically, surgery is recommended as an option in patient whose BMI>40 regardless of glycaemic control or BMI 35-40 with hyperglycaemia but also considered in patients whose BMI is 30-35. These thresholds are reduced further in patients of S Asian origin. On top of this, they recommend that surgery should be performed in high volume centres with medical support for nutrient status and there is also reference to the multiple procedures currently available. Whilst the position statement has been ratified / endorsed by diabetes organisations from around the world (including Diabetes UK), given that >50% of patients with Type 2 diabetes in the UK are obese there is clearly a gap between demand and supply – only 18000 bariatric operations were performed between 2010-2013 (although the numbers are growing). Although the financial benefits of surgery are clear, in the time of NHS austerity, it is difficult to see how surgical numbers can match this gap – even though it is recommended by NICE. Furthermore, the UK is (supposedly) a rich country and it is hard to see how these recommendations can be adopted fully in other countries with significant diabetes morbidity. At the same time the IDF is an organisation which blocked the uptake of HbA1c as a diagnostic tool because of concerns over cost – clearly these concerns do not extend to surgery.
Dr Mark Freeman