Last night on ABC news, former director of the CDC and current ABC pontificator, Dr. Richard Besser reported that gastric bypass surgery reverses Type 2 Diabetes forever.
This morning on Good Morning America, the story replayed and then in commentary, to Robin Roberts and George Stephanopoulos, Dr. Besser bemoaned how health care insurance won’t pay for bariatric surgery. It is, after all, clearly a cure for Type 2 Diabetes.
He doesn’t credit his source for this revelation. His story begins, “Doctors have discovered something incredible. . .” Ah, those ambiguous “doctors.” And they all agree, eh? Mmm. As a hedge he slips in the modifier “may”: “Gastric bypass surgery may actually reverse type 2 diabetes almost instantly.” (What does that “may” modify — “almost instantly” or that surgery reverses diabetes?) He goes on to interview Dr. Phil Schauer, the Director of the Bariatric and Metabolic Institute for the Cleveland Clinic (no vested interest there) who tells us that the cure is not only instant, but permanent. “Before they leave the hospital, they will NEVER use insulin again.” Hmmmm. This is a miracle, indeed.
Dr. Besser goes on to explain that “how the procedure normalizes blood sugar remains unclear.” Then he speculates vaguely with Dr. Schauer about “incretins” and then “humanizes” the report (as journalists are supposed to do) with the story of Katy Wiley, and actual patient who once was a fat, diabetic train wreck and now claims to be “healthy, healthy, healthy!”
Diane Sawyer doesn’t tell us what Dr. Besser’s report is based on. She introduces it as important medical news springing from “something making headlines today.” I would guess that Dr. Besser is probably hanging his story on the statement issued by the International Diabetes Federation (IDF) yesterday at the Second World Conference on Interventional Therapies for Type 2 Diabetes in NYC. Here’s a two-page executive summary. The recommendation for surgery as treatment begins at subpoint 1.5:
“In addition to behavioural and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalising blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.”
The statement goes on to downplay the risks of bariatric surgery and promote the value of offering it to all diabetic people with a BMI exceeding 35 and to some whose BMI is between 30 and 35.
Whoa! Wasn’t it just last year at this time that the American Association of Clinical Endocrinologists (AACE) met and heard an important paper on how Bariatric Surgery may only mask the symptoms of Type 2 Diabetes? A case report by Medical Doctors Anna Marina and Dace Trence of the University of Washington, Seattle, summarized in this news release, throws a lot of cold water on the idea that incretins are the miracle workers that Dr. Besser and Dr. Schauer portray. Moreover, typical fasting blood glucose measurements cannot tell the whole story. Blood glucose, after eating, in surgical survivors vascillates to dangerous extremes. While their’s was only a case study, n = 1, Marina and Trence posited that a popular meta-analysis study that declared bariatric surgery a “cure” for diabetes was flawed and premature, and contradicted by other, empirical, studies.
So, that was a year ago. Is the AACE baby now gone with the IDF bathwater? Is the optimistic Richard Besser correct that we now have the cure to Type 2 diabetes?
If we don’t have a cure, but merely a mask, what will be the human consequences?
The final two points in the IDF document may reveal the doubts of these surgery optimists:
- A national registry of persons who have undergone bariatric surgery should be established in order to ensure quality patient care and to monitor both short- and long-term outcomes.
- In order to optimise the future use of bariatric surgery as a therapeutic modality for type 2 diabetes further research is required.
I turn to you, my dear readers. What do you make of this battle? Especially those of you managing Type 2 diabetes. Is the medical evidence compelling enough to lure you onto the table, under the knife? Is gastric bypass safer than managing your diabetes other ways? Katy Wiley is “healthy, healthy, healthy,” afterall, and I’m just a commentator from the sidelines. Are the scientists of the IDF (as well as Richard Besser and Phil Schauer) more credible than those of the AACE (including Marina and Trence)? Whom will you entrust with your life?