Diabetes Surgery: A New Approach to an Old Disease
- Francesco Rubino, MD,
- Tracy-Ann Moo, MD,
- Daniel J. Rosen, MD,
- Greg F. Dakin, MD and
- Alfons Pomp, MD
- From the Department of Surgery, Sanford I. Weill Medical College of Cornell University, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
- Corresponding author: Francesco Rubino, frr2007{at}med.cornell.edu.
Since its earliest description several thousand years ago, diabetes has remained a chronic progressive disease (1). The disease now affects ∼200 million people worldwide, and diabetes-related death is expected to increase by >50% in the next 10 years (2). The situation is only getting worse. The prevalence of diabetes among the elderly has increased 63% in the 10 years 1994–2004 (3). This increasing prevalence is a testament to improvement in managing diabetes-related complications, as well as our global “modernization” and the accompanying metabolic derangements. Diabetes is now ranked as the sixth leading cause of death by disease in the U.S. (4). In many places, it ranks far higher. The economic burden in 2007 alone exceeded $174 billion (5).
Diet modification and oral hypoglycemic medications have proven inadequate, whereas insulin therapy only solves the problem temporarily. In the U.K. Prospective Diabetes Study, diabetic patients were treated with diet modification, metformin, sulfonylurea, or insulin. Consistent with the progressive nature of diabetes, monotherapy was abandoned in 75% of the patients studied in a follow-up of 9 years (6). Even with the newest pharmaco-therapies, patients continue to develop macro- and microvascular complications. Diabetes is associated with increased cardiac- and stroke-related deaths, kidney failure, blindness, and 60% of nontrauma lower-limb amputations (4). In cardiac surgery, diabetes as a preoperative risk factor confers greater morbidity than a previous myocardial infarction (7,8).
While these numbers show that diabetes will be the global health crisis of the next generation, its true pathophysiology has yet to be delineated. Alternative treatments targeting different models of this disease require careful and responsible examination. A large body of evidence now demonstrates surgery for type 2 diabetes can achieve up to complete disease remission, a goal almost unheard of in current diabetes care. Evidence collected over decades of bariatric …
