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Sunday, February 18, 2018

Breakthrough in diabetes treatment: bariatric surgery


Doctors have long been talking about the epidemic of diabetes mellitus (DM) type 2 in the world. If 25 years ago the number of patients did not exceed 130 million; in 2015, there were 415 million, and by 2040 the total number of people suffering from diabetes in the world, can reach 642 million.

At risk for the development of the disease — first of all, people who are overweight. Numerous studies conducted in the world showed that with weight loss, first, sharply reduced the risk of developing type 2 diabetes, and patients — significantly improves the condition. That’s new for the treatment of such patients, “MK” told PhD, endocrinologist fsbi “SMRC endocrinology” of Ministry of health of Russia Ekaterina Shestakova.


photo: pixabay.com

– Ekaterina Alekseevna, what is the sharp increase in the prevalence of type 2 diabetes in recent years?

The increase in the number of patients with diabetes type 2 diabetes is caused, first of all, change the style of human life in the 20th-21st centuries. We all do less physical work, less walking, especially long distances. At the same time, the food became much more accessible. In this case, unfortunately, the less healthy the food is, the cheaper it costs and the more willing to buy it. Lack of exercise and junk food cause overweight is the main risk factor of diabetes type 2.

– Why type 2 diabetes often develops in people suffering from obesity?

– In the presence of overweight and obesity changes the sensitivity of cells to insulin. Insulin is a pancreatic hormone, its main function is to move glucose from the blood into muscle and fat tissue. Obesity develops resistance to this hormone (tissues no longer react to it), as a result, the glucose remains in the blood, which eventually leads to the development of diabetes.

– It is known that the disease is terrible, first of all, its complications. What complications occur most frequently, whether it is realistic to avoid them?

– Complications of diabetes are acute and chronic. And if the number of acute complications has been greatly reduced in our country thanks to the development of endocrinology services, chronic remain a major cause of morbidity and mortality of patients with this diagnosis.

So, a high level of glucose in the blood leads to progression of atherosclerosis, so patients with diabetes most often die from cardiovascular diseases (myocardial infarction, stroke). Besides diabetes, there are specific complications: kidney, eye and nerve fibers. It is fraught with renal insufficiency, blindness, the appearance of nonhealing wounds (primarily lower limb).

But complications can be avoided! The key is maintaining the target range of blood sugar levels. Patients often are mistaken when you think that it is possible to prevent health problems caused by diabetes, by conducting a variety of “droppers”. I repeat: to no complications arise, it is necessary to remove the cause of their development – high level of sugar.

– Are there any innovative methods of treatment of T2DM?

– The main treatment of diabetes mellitus type 2 is a medical. Now in the Arsenal of experts – several classes of drugs that have an effect including the resistance of cells to insulin. Compensation of type 2 diabetes are possible on the background of decreasing body weight by using drugs specifically designed to combat obesity. Several of them are now registered and used in our country.

Thus in any case we must not forget that to diabetes and obesity patients, often leads the wrong way of life, so the principles of good nutrition and increasing physical activity is necessary to speak always!

– Much talk today about the treatment of diabetes surgical methods. What scientific sources have confirmed the effectiveness of surgical treatment of diabetes?

– Evidence that diabetes mellitus can be treated by surgery came with the development of bariatric surgery – surgical techniques to treat obesity. With the development of bariatric surgery are medical professionals began to pay attention to the fact that after such operations diabetes “disappeared” for a long time. Thus arose the concept of “metabolic surgery” is a surgery aimed at treating the complications of obesity related metabolic disorders, primarily diabetes. In 2017, the studies were published STAMPEDE. For five years the doctors watched the patient after surgical treatment of diabetes. In the end, data were obtained that the operation is allowed-thirds of patients to refuse insulin, and another third were compensated without hypoglycemic therapy.

– How bariatric surgery affects metabolism?

– Bariatric interventions are of three types: restrictive, shunt and combined. Restrictive surgery aims at reducing the size of the stomach. They not only reduce the volume of food consumed, but also allow you to exclude the part of the body where the hormone responsible for appetite.

Shunt surgery, which are based on bypassing some of the small intestine, significantly reduces the suction surface of the gastrointestinal tract.

Also used combination (restrictive + shunt) surgeries, which result from both effects.

– Is it possible to conduct such operation for the prevention of diabetes?

In the case where the operation on the patient with obesity without diabetes, we have been able to achieve a significant reduction of body weight. The very reduction in weight and will be the prevention of diabetes in these patients.

– What is better: to treat T2DM conservative method or surgical?

– Treatment of a patient with overweight or obesity, diabetes, in any case, it should be comprehensive. After all, despite the effectiveness of the operation after the operation in some cases, failure to follow recommendations can cause relapses – a return to weight gain. Therefore, the competent support of a dietitian, endocrinologist is necessary for the patient’s whole life.

– Is there a need for incorporation of bariatric intervention into the MMI system?

I think that for some individuals, bariatric surgery is vital, for them, they should be free. In addition, this type of surgery is associated with the peculiarities of the postoperative management. So I think that it is important to establish specialized centers where they would run the whole range of such interventions and carried out multidisciplinary follow-up monitoring of patients.

– Whether there were still any new treatments for diabetes lately?

– Of course, drug treatments of diabetes are improving constantly. Over the last 10 years several new classes of drugs. Many of them concurrently with the treatment of diabetes can help to reduce body weight. In addition, medications are becoming safer, the range of side effects and contraindications narrowing. Much work is going on creation of new insulins: they are the most similar to that produced in a healthy person. Along with this, improved methods of insulin delivery: many children and adults are using insulin pumps, allowing the most comfortable to inject the drug and significantly reduce the number of injections. The progress is tremendous!

Whether the transplantation of pancreatic cells in the future treatment of diabetes?

– Very important question! I would like to warn that all studies of cellular technologies for the treatment of diabetes are still experimental. Now the effectiveness of such methods is not yet proven, not in some official recommendations for the treatment of diabetes. Therefore, we cannot neglect the standard treatment of diabetes and replace it with cellular technologies.

Science does not stand still, and perhaps such technology will be actively applied in the future.

Borden, Natalia Semenovna, bariatric surgeon

– In the world annually 500 – 600 thousand bariatric surgeries, of which 250 thousand – in the United States. In Russia – only 3-4 thousand, 70% of them – in Moscow. Of course, this is not enough. Patients with obesity and T2DM in our country more than a million, and many of them, surgical treatment is indicated. In Russia, bariatrics is not included in the system of mandatory medical insurance for such treatment, patients have to pay out of pocket. Although in the world (Georgia, Kazakhstan, Israel, America, some European countries) surgical treatment of obesity is to be paid through the insurance system. Experts estimate that the state’s cheaper to pay the costs associated with the operation, than for life to treat patients with obesity and diabetes, providing them with drugs, benefits by disability group. Therefore, in Russia it would be reasonable to include such a treatment in the MHI system. Now his paying patients only a few Russian regions.

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