New guidelines for the use of metabolic surgery as a diabetes treatment

In the first afternoon of the XXI Brazilian Bariatric Surgery Congress, happening in São Paulo, this year's participants were able to attend a panel with a new study presented by Dr. David Cummings. Dr. Cummings presented the results from the CROSSROAD trial, a randomized controlled trial that studied the different responses to surgical e non-surgical treatments for patients that suffer from T2DM with lower BMI, between 30 and 40.

Dr David Cummings

The group chosen for the surgical approach received the standard RYGB and medical care, as the non-surgical approach stuck to an intensive medical-lifestyle regiment of aerobic exercise, a low calorie & low-fat diet and state of the art diabetes medication. As shown by Dr. Cummings' results, the surgical approach surpassed the results of the intensive medical-lifestyle, with more than 60% of diabetes remission after a year, against 6% of the medical lifestyle approach.


Dr. Cummings also demonstrated that the results were similar and complementary with a more specific demographic - Asian Indians. According to the data, it has the highest incidence of diabetes per 1000 person-year. Using the same surgical and nonsurgical parameters of the CROSSROAD study but with patients BMIs between 25-40, the diabetes remission percentage reached 60% against 2,5%of the medical lifestyle approach, with the added benefits of improvement in HDL level, lowering of FPG and HbA1c and others for up to ten years.


This comparison made Dr. Cummings and his team come to the conclusion that the metabolic approach for T2DM patients with lower and higher BMIs are the same and the parameter might have to be changed for the medical recommendation of the procedure in patients that would clinically benefit from it.


In his second lecture of the day, Dr. Cummings debates if metabolic surgery could improve a diabetic patient situation by reducing adipose tissue and/or systemic inflammation.


For Dr. Cummings, the inflammation model used in the first research of this hypothesis can be flawed, as is supported mainly by data from mice and the correlations to humans can only be associational.


Adding his own research data, Dr. Cummings concluded that the surgery improved glucose homeostasis despite increased white adipose tissue inflammation, putting in question the rodent that used to support this hypothesis.