Published on 2 July 2020

Effect of “two pandemics clashing” as potentially life-saving treatments put on hold.

People with type 2 diabetes and obesity who are in need of potentially life-saving weight loss surgery could be at a greater risk due to having treatment delayed as a result of the Covid-19 pandemic.

Operations around the world have been postponed during the pandemic to allow hospitals to treat people in a safe environment as possible and reduce the risk of further infection.

However, a team of 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).

The researchers said that delaying treatment for obese people, many of whom with type 2 diabetes, could put them at a greater risk of complications from the condition in addition to Covid-19 – in what they have described as “two pandemics clashing”.

In a recently published report in The Lancet Diabetes & Endocrinology, led by Professor Francesco Rubino from King’s College London, recommendations were outlined for the surgical candidates at greatest risk from type 2 diabetes or from severe obesity, where this surgery may be life-saving.

Metabolic or bariatric weight loss surgery has been used for decades and can deliver immediate and life-saving improvements for people with type 2 diabetes and obesity where lifestyle changes and additional treatments including insulin were not effective.

The results of the surgery can lead to remission of diabetes in addition to significant weight loss and other health benefits.

However, bariatric surgery is not classified as an emergency treatment and currently remains an elective procedure.

Experts have expressed concern that given the progressive nature of obesity and type 2 diabetes and potential to put the condition into remission, that not receiving the treatment could increase the risk of developing additional diabetes-related complications including heart disease.

An image of the Covid-19 molecule.

Waiting for surgery could lead to additional health complications 

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 happening now due to the Covid-19 pandemic.

Professors Paul Zimmet and John Dixon, experts in diabetes and obesity at Monash University in Australia, said the new recommendations included non-surgical interventions that could improve metabolic and weight control for patients awaiting surgery, during the current period of limited elective surgery capacity. Professor Zimmet said: “At this historic moment, we are seeing a clash of two huge global pandemics - those of [type 2] diabetes and Covid-19.

“The numbers of both have continued to escalate. The “diabesity” (diabetes and obesity) epidemic has been strongly correlated with sedentary [inactive] 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 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 penalise candidates for surgical treatment of diabetes and obesity.”

Read the report in The Lancet Diabetes & Endocrinology
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