8 May 2020

Two pandemics clashing - COVID-19 and 'Diabesity'

Professor Paul Zimmet argues that bariatric
surgery should not be classed as elective
The COVID-19 pandemic has seen elective surgery postponed worldwide.  Experts from the multidisciplinary Diabetes Surgery Summit (DSS) are concerned for patients with the greatest need for bariatric and metabolic surgery (such as gastric bypass), as delaying treatment could put them at a greater risk of complications from their disease as well as from COVID-19.

Recommendations published today in The Lancet Diabetes & Endocrinology, led by world-leading authority, Professor Francesco Rubino from King’s College London, outline the surgical candidates at greatest risk of morbidity and mortality from type 2 diabetes or from severe obesity, where this surgery may be life-saving.

Metabolic or bariatric surgery has been used for decades to treat severe obesity and can deliver immediate and life-saving improvements for diabetes patients who could not be adequately controlled with lifestyle and oral therapies or with insulin. Dramatic remission of their diabetes can be achieved along with significant weight loss and other health benefits.

However, due to the nature of bariatric surgery, it is not classified as an emergency and currently remains an elective procedure. This paradox has experts concerned, given the progressive nature of obesity and diabetes and demonstrated potential of the procedure to obtain remission of diabetes and lessen the risk of other diabetes-related complications including heart disease. 

Prolonged wait times and surgery delay can increase the risks for patients with acute conditions posing an immediate threat to life, organs, or limbs and this may be occurring now due to the COVID-19 pandemic.

Monash University diabetes and obesity experts, Professors Paul Zimmet and John Dixon say the new recommendations encompass non-surgical interventions to improve metabolic and weight control for patients awaiting surgery, telemedicine protocols for post-operative surveillance and the use of appropriate criteria to triage surgical candidates during the current period of limited elective surgery capacity.

“At this historic moment, we are seeing a clash of two huge global pandemics - those of diabetes and COVID-19,” Professor Zimmet said.

“The numbers of both have continued to escalate. The “Diabesity” (diabetes and obesity) epidemic has been strongly correlated with sedentary lifestyle. While this situation is compounded during the COVID-19 pandemic, it is an essential and needed component of our government’s successful, strong and necessary attack on this dangerous viral epidemic.

“Furthermore, as we move forward into the recovery phase, we need to recognise the importance of turning our attention to diabetes and obesity as major drivers of our national chronic disease burden.”

Professor Rubino, chair of bariatric and metabolic surgery at King’s College London and a consultant surgeon at King’s College Hospital, said, “In times of limited resources, patients with greatest risk of harm from untreated disease should be identified and prioritised for timely access to the treatment they need. The misconception that bariatric surgery is a ‘last resort’, widespread stigma of obesity and inadequate criteria for patients’ selection can penalize candidates for surgical treatment of diabetes and obesity.”

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