BY MARIO del PINO and DIANA F. RAMIREZ
Doctors were not expecting that gastric bypass could eradicate diabetes in some patients. In 1982 — the early days of bariatric surgery — the medical profession watched hopefully as diabetic morbidly obese patients stopped using insulin in a matter of 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 that shocked the medical world. 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 with 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 had 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, hyper-cholesterolemia, gastroesophageal reflux disease, sleep apnea, etc. No other therapies have achieved such results.
Why is that important for our community in the Rio Grande Valley?
Type 2 diabetes is very common among our predominantly Mexican-American population and the prevalence of obesity in the Hispanic adults in the Valley is higher than the 35 percent prevalence of obesity in the state of Texas. Data by Dr. Joseph B. McCormick from the University of Texas School of Public Health’s regional campus in Brownsville has revealed the magnitude of the obesity and diabetes epidemic in the Cameron County Hispanic adult population. The obesity rate is 53 percent. The morbid obesity rate is 10 percent. The diabetes prevalence is 27 percent (one-third of the population is unaware of their diagnosis and half are not taking any medications) while the pre-diabetes prevalence is 32 percent. In 5 years one-third of pre-diabetics become diabetics. Diabetes mortality among border Hispanics is two to three times the mortality for non-Hispanic whites.
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 physicians 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 or less than a gallbladder surgery.
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 should be recommended for subjects with a Body Mass Index, or 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 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 provides month articles to The Monitor to help educate the public about the prevention and control of diabetes. The RGVDA 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 affected areas in the country. Type 2 diabetes is preventable and also manageable through a healthy regimen of exercise and dieting.
Del Pino, M.D., is the director of the metabolic surgery program at Rio Grande Regional Hospital and Diana F. Ramirez is the CEO of the Rio Grande Valley Diabetes Association.