Canadian Journal of Diabetes
Canadian Journal of Diabetes is Canada’s only diabetes-oriented, peer-reviewed, interdisciplinary journal for diabetes healthcare professionals.
Published quarterly (February, April, June, August, October and December), Canadian Journal of Diabetes contains original articles, resource reviews, a journal watch, shorter articles such as Perspectives in Practice and Diabetes and Society, and news from the Clinical and Scientific Section and the Diabetes Educators Section of the Canadian Diabetes Association.
Canadian Journal of Diabetes is distributed as a benefit of membership to all members of the Professional Sections of Canadian Diabetes Association.
Is Surgery an Option in the Treatment of Type 2 Diabetes?
David C.W. Lau MD PhD FRCPC
Metabolic (Bariatric) Surgery in Canada: a new concept
Nicolas V. Christou MD PhD FRCSC FACS
Weighing the Clinical Benefits and Economic Impact of Bariatric Surgery in Morbidly Obese Patients with Diabetes
Diabetes mellitus imposes a large economic burden on individuals and national healthcare systems worldwide. People with type 2 diabetes incur medical costs 2 to 3 times higher than individuals without diabetes. Treatment of type 2 diabetes with conventional lifestyle modification programs and antihyperglycemic medications often fails to achieve long-term weight loss and adequate glycemic control in obese patients. Bariatric surgery is an intensive and highly effective treatment for obesity. It has considerable accompanying beneficial effects on diabetes and other obesity-related comorbidities. We review the literature and summarize key findings about the clinical benefits and cost-effectiveness of bariatric surgery, as well as its use as a treatment for morbidly obese patients with type 2 diabetes. We update our earlier analysis reporting the return on investment (ROI) associated with bariatric surgery for type 2 diabetes patients with body mass index ≥35 kg/m2.
Pierre Y. Cremieux PhD, Sara Eapen PhD, Stephen W. Trask BA, Arindam Ghosh PhD
Use of Metabolic Surgery for the Treatment of Type 2 Diabetes
Diabetes currently affects more than 220 million people worldwide. This number has increased from 171 million, reported in 2000, and the World Health Organization (WHO) projects this number will reach 366 million by 2030. One of the most significant contributors to the increased prevalence of diabetes is the epidemic of obesity. According to the International Obesity Task Force and the 2002 WHO World Health Report, ~58% of diabetes globally can be attributed to a body mass index (BMI) >21 kg/m². Increasing use of bariatric surgery for the treatment of patients with type 2 diabetes and morbid obesity has been associated with significant improvement and even remission of diabetes in post-surgical patients. This, in turn, has led to significant research into the physiological pathways involved. The current guidelines for bariatric surgery limit its use to patients with diabetes or comorbidities whose BMI is ≥35 kg/m²; however, recent studies suggest these guidelines may need to be adjusted to include patients with type 2 diabetes who have a lower BMI.
Mehran Anvari MB BS PhD FRCSC FACS
Biliopancreatic Diversion with Duodenal Switch in the Treatment of Diabetes: An Argument that a Chance to Cut is a Chance to Cure
Diabetes is an increasing global health problem. Current medical strategies have had limited effect in controlling and curtailing the complications of the disease. Morbidly obese patients with type 2 diabetes are at particular risk of the cardiovascular complications of diabetes. Bariatric surgery in these patients has been shown to induce glycemic control and even obviate the need for chronic medical therapy. Of all the bariatric procedures, biliopancreatic diversion with duodenal switch is the most effective in inducing diabetes remission. The mechanism for this is likely multifactorial and not limited to weight loss alone. Understanding how this and other bariatric procedures affect diabetes may help to elucidate a new paradigm in treating both obese and nonobese patients with diabetes.
Mustafa Hussain MD, Alfons Pomp MD
Secretion and Function of Gastrointestinal Hormones after Bariatric Surgery: Their Role in Type 2 Diabetes
Bariatric surgical procedures were designed primarily to promote weight loss in morbidly obese individuals. There is increasing evidence that, apart from producing durable weight loss, bariatric surgery powerfully ameliorates type 2 diabetes in the majority of morbidly obese individuals. Its role is also being investigated in less obese patients, with generally favourable short-term results. While massive weight loss undoubtedly plays an important role in consolidating the long-term anti-diabetic impact of bariatric surgery, the role of the altered hormonal gut milieu is now known to be integral to improved glucose homeostasis. Changes in levels of glucagon-like peptide 1 (GLP-1), gastric inhibitory peptide, peptide YY (PYY) and ghrelin have been described following metabolic surgery. The various surgical procedures differ in their respective abilities to modulate gut hormones, depending on whether they involve intestinal diversion or are purely restrictive. The postprandial GLP-1 response to an oral glucose tolerance test or mixed test meal is augmented following gastric bypass surgery or biliopancreatic diversion, while no change is observed after gastric banding. Increased PYY levels have been reported following gastric bypass. Levels of ghrelin, an orexigenic hormone, do not rise following weight loss due to gastric bypass, although this is not reported consistently in all studies. In this paper, the authors review the current evidence regarding the use of metabolic surgery to treat type 2 diabetes, focusing on published data from animal and human studies regarding gut hormone secretion and function following bariatric surgery.
Alpana Shukla MD, Francesco Rubino MD
Access to Bariatric (Metabolic) Surgery in Canada
Severe obesity is reaching epidemic proportions throughout the world including Canada. The nonsurgical treatment of severe obesity is a life-long struggle, associated with high recidivism and suffering. Bariatric surgery is the only treatment modality that produces significant, sustained, long-term weight loss in patients with severe obesity. This is accompanied by substantial improvements in obesity associated diseases, particularly, Type 2 diabetes mellitus, hypertension, hyperlipidemia and sleep apnea which results in an overall reduction in mortality risk. In addition bariatric-metabolic surgery is very cost-effective. Despite these clear benefits bariatric-metabolic surgery is difficult to access in Canada with tremendous regional and provincial variation in bariatric-metabolic capacity in Canada resulting in extremely long waits for the surgery (up to 5 years). Provincial strategies such as those adopted by the Province of Ontario where the money follows the patient, i.e. the money given to the health care center is specifically marked for bariatric-metabolic surgery and the post-operative care services required, should be adopted by the remainder of Provinces and Territories across Canada.
Nicolas V. Christou MD PhD FRCSC FACS
Is it Time to Seriously Target Obesity to Prevent and Control Diabetes?
The prevalence of both type 2 diabetes and obesity has increased markedly worldwide during the last century and continues to do so. Considerable evidence now supports the notion that reducing body weight via lifestyle, medical and/or surgical interventions can significantly reduce the risk of type 2 diabetes and its complications. There is also accumulating evidence that surgical interventions for obesity can be remarkably cost-effective in treating type 2 diabetes in obese individuals. However, efforts to prevent and better treat obesity lag far behind current efforts to address the everincreasing cost of the diabetes epidemic to Canadians. This paper, based on a presentation given at the First Canadian Summit on Metabolic Surgery for Type II Diabetes, May 6–7, 2010, Montreal, Quebec, discusses the potential role of lifestyle, and medical and surgical interventions for obesity in diabetes management.
Arya M. Sharma MD PhD FRCPC, Raj Padwal MD FRCPC, Shahzeer Karmali MD FRCSC, Daniel W. Birch MD FRCSC
2nd National Obesity Summit Abstracts
Oral Presentations 139 Poster Presentations 165
Canadian Obesity Network
Canadian Journal of Diabetes May 2011 - Full Issue
Production of materials has been made possible through a financial contribution from the Public Health Agency of Canada.
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