Is the IDF throwing in the towel?
This morning the International Diabetes Federation announced a new position that supports surgery as accepted method for treating Type 2 diabetes. According to a press release from the IDF; “Bariatric surgery should be considered earlier in the treatment of eligible patients to help stem the serious complications that can result from diabetes according to an International Diabetes Federation1 (IDF) position statement presented by leading experts at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes in New York.”
During the presentation that went along with the press release the IDF had a series of slides entitled “Management Algorithm for Metabolic Control in Type 2 Diabetes” which outlined how patients with Type 2 diabetes should be treated and where in this management algorithm surgery fits in. What Diabetic Investor found strange was the absence of GLP-1 therapy in this algorithm. Equally strange, which is beginning to be redundant here, was the presence of glitazone as an option.
Now before we go further here it’s important to recognize that Diabetic Investor completely understands the correlation between obesity and diabetes. Furthermore, it is also true that bariatric surgery has proven to be an effective treatment option. Still one has to wonder, even with all the study data, if there are no other less invasive options for treating type 2 diabetes. The reality is while bariatric surgery can be an effective tool it is still surgery which by itself brings with it a whole new set of risks and costs.
Diabetic Investor could understand surgery as last resort when all other options have failed and we can also understand using surgery for morbidly obese patients, but looking over the guidelines issued by the IDF Diabetic Investor came away with the impression that the IDF is being overly aggressive and they are ignoring alternate treatment options, in particular GLP-1 therapy.
Would it not be more appropriate to add GLP-1 therapy earlier to the treatment algorithm? Is it not true that GLP-1 therapy has proven that it can control glucose levels and promote weight loss? Is it not also true that patients can self-administer GLP-1 therapy and there is no risk of surgical complications? Although GLP-1 therapy may carry a higher long term cost than the one time cost of surgery, would it not be safer to move a patient to GLP-1 therapy and if that does not work then move to surgery?
This is not the first time we have seen healthcare professionals recommend surgery as treatment option for type 2 diabetes. However this is the first to our knowledge that a respected governing body, which the IDF is, actively endorses surgery as a treatment option. A position we could understand better if they had considered all available options in their treatment algorithm, an algorithm which excludes GLP-1’s yet includes glitazone. Diabetic Investor does see a place for surgery yet we believe it should only be used as a last resort or if mitigating circumstances make other options less palatable. In our opinion this endorsement by the IDF is an overly aggressive step and does not consider other safer and effective therapy options.
