BY Dr. Mario del Pino and Diana F. Ramirez | Special to The Monitor
Doctors were not expecting that gastric bypass could eliminate diabetes. In 1982, the early days of bariatric surgery, diabetic morbidly obese patients didn’t need insulin only days after being operated.
“Who would have thought it? Surgery is a treatment for diabetes,” was the title of a landmark article published by Dr. Walter Pories in 1995. He showed that 80 percent of diabetic morbidly patients returned to normal glucose levels after having the gastric bypass operation.
Then in 2003 a group of the University of Pittsburgh, not only corroborated those results, they went further. They revealed that patients who did not fully respond, were older and had suffered diabetes for a longer time, suggesting that the operation would have a stronger effect if done earlier.
Metabolic operations (gastric bypass, sleeve gastrectomy) produce more than just a return to normal glucose levels, they reduce your all-cause mortality (from 4.5 percent to 1 percent per year), reduce cardiovascular events (strokes and heart attacks), reduce cancer mortality and improve or resolve hypertension, hypercholesterolemia, gastroesophageal reflux disease, sleep apnea, etc. No other therapies have achieved such results.
So why is that important for our community here in the RGV?
Type 2 diabetes mellitus is a very common disease among us in our predominantly Mexican-American population and the prevalence of obesity in the Hispanic adults in the RGV is 35 percent higher than the rest of the state. The obesity rate is
53 percent in Cameron County while the morbid obesity rate is 10 percent. The diabetes prevalence is 27 percent (1/3 is unaware of their diagnosis, half of them are not taking any medications) and the pre-diabetes prevalence is 32 percent. In 5 years 1/3 of pre-diabetics become diabetics. Diabetes mortality among border Hispanics is 2 to 3 times the mortality for non-Hispanic whites. No wonder why our healthcare utilization rate is among the highest in the entire country.
Every day I see patients in my office who are good candidates for metabolic surgery but their primary care physicians never mentioned surgery as an option or never referred them for a surgical consultation. Some even recommend against metabolic surgery, stating that it is too drastic, too risky or has no role in the treatment of diabetes or severe obesity. Today, with the addition of laparoscopic techniques, surgery is much safer than 20 years ago, with complication and mortality rates comparable to less than a gallbladder surgery.
The major Medical Professional Associations, including the American College of Cardiology, the American Heart Association, the Obesity Society, the American Association of Clinical Endocrinology and the American College of Endocrinologists have agreed that metabolic surgery for patients with Type 2 diabetes mellitus should be recommended for subjects with BMI greater than 40 regardless of glucose control and BMI greater than 35 with inadequately controlled glucose levels.
All healthcare providers involved in the care of diabetes and obese patients should take note and implement these guidelines in their practice. The goal of any patient with Type 2 diabetes should be able to achieve normal glucose levels and discontinue all diabetes medications. Pharmaceutical treatment of Type 2 diabetes is not necessarily the answer and usually results in disease progression, extensive morbidity and increased mortality. Metabolic surgery is the only available treatment that has resulted in a substantial number of patients achieving normal and durable glucose levels without antidiabetic medications.
With physician, nurse practitioner, physician assistant in the frontline in the war against the diabetes and obesity epidemic in our community, that means we need to update their training and do a better job at it. Diabetes should not be a hopeless disease in 2018. All of us involved in healthcare must know and pass the message to patients and the public.
The Rio Grande Valley Diabetes Association is a local non-profit organization whose mission is dedicated to the prevention of diabetes and its complications through educational services, early detection and awareness. The RGVDA’s focus is to bring attention on a growing health epidemic that affects one out of every four people in Hidalgo Country, making it one of the worst afflicted areas in the country.
Type 2 diabetes is preventable and also manageable through a healthy regimen of exercise and dieting. The RGVDA offers free monthly cooking classes on the second Tuesday of the month in Edinburg. For more information, call your RGVDA office at (956)782-1900.
>> 2 pouches (2.6 oz. each)
>> 4 oz. tortilla chips (any type)
>> 1/2 tomato, diced
>> 1 cup shredded lettuce
>> 1 cup shredded cheddar cheese
>> 1/4 cup sliced black olives
>> 1/2 cup guacamole (optional)
>> 1/4 cup light sour cream (optional)
>> Preheat broiler. Place tortilla chips on a flat cookie sheet and cover with cheese. Place under broiler until cheese has just melted and tortilla chips are slightly browned.
>> Remove from oven and move tortilla chips to a serving platter.
>> Top with tuna, lettuce, tomatoes and olives.
>> Serve with sour cream and guacamole as desired.
Calories 280 per serving
Saturated Fat 16g
Trans Fat 0g
Total Carbohydrate 21g
Dietary Fiber 2g
Total sugar 1g
Mario del Pino is the director of the metabolic surgery program at Rio Grande Regional Hospital. Diana F. Ramirez is the CEO for the RGVDA. The Rio Grande Valley Diabetes provides monthly to help educate the public about the prevention.