How can we define diabetes remission? Is bariatric surgery a viable option to treat diabetes? What steps can clinicians take to combat obesity and diabetes stigma?
At the 4th World Congress on Interventional Therapies for Type 2 Diabetes (WCITD), held April 8 to 10, 2019, in New York City, surgeons, endocrinologists, researchers, and several stakeholders in the field came together to discuss these questions as well as other important topics in diabetes and obesity care.
Day 1: Bariatric Surgery in Diabetes
In an executive recommendation based on data from 12 randomized controlled trials, a consensus panel at WCITD 2019 stated that “metabolic surgery is an evidence-based treatment option in appropriate candidates with obesity and type 2 diabetes, as recommended by [Diabetes Surgery Summit II] guidelines, [American Diabetes Association (ADA)] Standards of Care, and the 2019 ADA-[European Association for the Study of Diabetes] Statement on Management of Hyperglycemia.”1
Day 2: Defining Diabetes Remission
It has been 10 years since the ADA has attempted to define a “cure” for diabetes.2 At WCITD 2019, William Cefalu, MD, Chief Scientific, Medical, and Mission Officer at the ADA, addressed the need for updated definitions. According to a presentation on classifications of “remission,” “response,” and “cure” in oncology from William Oh, MD, Chief of the Division of Hematology and Medical Oncology at the Mount Sinai Health System and Deputy Director of the Tisch Cancer Institute, the benefits of clear definitions are significant: improved communication among clinicians, enhanced parameters for research, lower healthcare costs, and hope provided to patients.3
In an expert panel discussion, the following points were generally agreed upon for future classifications of diabetes remission:
· The term “cure” should be used with caution, as even long-term remission of diabetes does not necessarily mean the patient is free from complications, and saying a patient is cured may discourage continued follow-up.
· Hemoglobin A1c (HbA1c) is best for measuring diagnosis or remission of diabetes, except in resource-constrained populations, for which measurement of fasting plasma glucose may be more appropriate.
· In oncology, disease remission almost always means free from all medication use; however, whether metformin is an exception in diabetes remission must be considered.