Type 2 Diabetes: When medications are riskier than surgery

By nature, we seek lower risk approaches to every problem, from crossing a stream to treating disease. In medicine, there is a longstanding and well-founded wariness of surgery: choose it when you have to, but not when there is another choice. Even within the Hippocratic oath, there appears a prohibition on surgically treating kidney stones that makes urologists cringe, because today it is the safest, and most life-saving approach.

In type 2 diabetes, physicians have historically used a combination of diet, exercise, and medications to control the disease. But increasingly, large studies are demonstrating that this approach leaves people with a false sense of safety while the disease progressively damages the retinas, kidneys, toes, and heart, and shortens life expectancy by over eight years. Meanwhile, metabolic surgery has become one of the safest procedures performed in the country, requiring around 45 minutes and 4 band-aids to completely reverse the diabetes in over half of people suffering with the disease. And the risk and invasiveness today is less than an appendectomy.

In recent, large studies, metabolic surgery proves safer and more effective in treating type 2 diabetes. For example in Fisher’s 2018 paper published in the Journal of the American Medical Association, over 20,000 patients were studied, and far more people died when treated with the approach of even the newest medications when compared to metabolic surgery (also known as bariatric surgery) for type 2 diabetes. At the 7 year follow-up mark, the medications method resulted in a 300% higher mortality risk. 

Historically, we have digested new data fairly quickly across medical disciplines and accepted surgery as the best therapy when the risk-benefit analysis favors the approach. 

But the adoption of metabolic surgery to treat diabetes is progressing at a much slower rate. To be sure, it is a recommended therapy by the American Diabetes Association and nearly every medical advisory body in the world whose mission is to protect human health and not to simply sell pharmaceuticals. But of the eligible 30 million Americans with type 2 diabetes today, and the additional 80 million with pre-diabetes, somewhere under 1% of individuals are availing themselves of a procedure that is irrefutably safer than the medications, drops the risk of amputations and kidney failure, and adds years of life.

In heart disease, a collaboration began between cardiologists and surgeons that continues to this day. There is a general consensus around who should have open heart surgery, one that evolves with the data.

But few such collaborations exist in most places among the surgeons who perform metabolic surgery and the endocrinologists who manage the same disease with medications. Perhaps such collaborations will be the model of the future for treating type 2 diabetes, with a combination of metabolic surgery and newly evolving medications that together can deliver a complete remission of the disease, rather than simply aiming to keep the blood sugar under control.

The data are compelling that such an approach, with metabolic surgery as its cornerstone, would provide the lowest risk approach of all, reducing the terrible toll that type 2 diabetes is taking on the health of those we love.

Author: Dr. Kent C. Sasse is the author of The Type II Diabetes Cure: The expert guide to reversing your diabetes and living a longer, healthier life. Dr. Sasse is one of the United States’ leading authorities on Type 2 Diabetes, working with those whose pre-diabetes or Type 2 onset is a result of obesity. He the founder of the Obesity Prevention Foundation, a not-for-profit organization dedicated to the prevention of obesity and excessive weight gain in children and adolescents. At the moment, 1-in-3 Americans are obese and either has type 2 diabetes or is in a state of pre-diabetes. It is on track to be a $1 trillion annual industry by 2026.  BUG