According to the World Health Organization (WHO), more than 16 million adult Brazilians suffer from diabetes. This disease kills 72,000 people a year in the South American country. WHO points out that 422 million adults around the world lived with diabetes in 2014, a number four times higher than in 1980. In the same period, the prevalence of the disease almost doubled from 4.7% to 8.5% of the adult population, reflecting an increase in associated risk factors, such as overweight, obesity and physical inactivity.
In recent years, metabolic surgery has emerged as an option to control type 2 diabetes. The procedure was one of the subjects discussed by a group of members from the Brazilian Diabetes Society during the second day of the XVIII Brazilian Congress of Bariatric and Metabolic Surgery, in Florianópolis. Doctor Alexander Miras, Clinical Professor in Metabolic Medicine at the Imperial College in London, was one of the highlights of the program, as a guest speaker.
Miras, who is an endocrinologist, confesses that he became interested in metabolic surgery after seeing the good results obtained by this technique in cases of diabetes, something he could not achieve with clinical treatments. As surgical procedures such as by-pass and sleeve gastrectomy evolved, he noted its positive effects on diabetics, making him dedicate himself to the subject.
The weight regain after bariatric surgeries was also one of the subjects approached by Miras. According to him, it is normal for patients to regain a certain amount of weight after the first year of surgery. He argues that this fact doesn’t mean that the procedure has failed or that the patient is doing something wrong. “If the trajectory of the weight regain is incredibly fast, then you start being worried about something being wrong. Otherwise, you have to consider a certain weight gain as acceptable”, he said.
Relationship between weight relapse after bariatric surgery and recurrence of diabetes
In an interview after his talk at the event, Miras talked about the relationship between weight regain after bariatric surgery and the recurrence of diabetes. According to him, this is a very difficult subject to be answered because the researches about it presents contradictory results. Some studies say that patients whose glycemic control worsens after surgery usually gain weight. Other researches point out that there is no relationship between the two facts. “I would say that the truth is somewhere in the middle. That means that in some patients where the driver of the diabetes is weight, if they do experience weight regain, there might be indeed a relationship between the two”, he says.
Miras explains that in patients whose main driver of diabetes is not weight, but other problems (such as insulin secretion or insulin sensitivity), weight regain may not the principal factor for the return of the disease. “So you need to treat those two groups of patients differently. In the treatment for the first group, whose weight regain is the driver of the diabetes recurrence, the focus should be on weight loss. For the other group of patients, it should focus on whatever part of the physiological mechanism is driving the worsening of glycemic control”, he concludes.
The doctor also took the opportunity to talk about his impressions of the congress. “I was very surprised by the number of participants from Brazil and other countries. The importance of this event is that people come to get updated on the latest evidences for the treatment of obesity and diabetes. That is very important for trainees and even more for senior doctors. They can keep up to date with the latest evidences when it comes to treating their patients. The main benefit of this type of congress is to share new scientific and clinical knowledge”, concludes Miras.
The XVIII Brazilian Congress of Bariatric and Metabolic Surgery goes on until Saturday (07), in Centrosul, in Florianópolis. The event is promoted by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM).