Prof Rudolf Weiner, MD - "Treating and Curing Diabetes"

Transcript

Roberta Speyer:  Hi, I am Roberta Speyer and I am reporting for OBGYN.net. I have the pleasure today to be talking today to Professor Rudolph Weiner and I am here at his hospital in Frankfurt, which is Sachsenhausen Hospital. It is a very famous hospital, and Dr Weiner is the Chief of Surgery. We are going to discuss a topic that is very interesting to everyone and on the rise, which is diabetes, and some new treatment options for how to handle and manage diabetes.

Professor Rudolph Weiner:  Diabetes is an upcoming disease and in the United States for example, 18 million suffer from diabetes. Diabetes the disease is followed by overweight and obesity, and this is the main cause. In all countries all over the world obesity becomes more and more the first leading disease. This causes a lot of people to suffer now from diabetes. We know now for two decades that we have some surgical options to treat diabetes, we can achieve remission of diabetes for long periods of time for type 2 diabetes. This is very important because you can cure diabetes as a surgeon.

Roberta Speyer:  You can cure it? That is an incredible thing to say. What does that mean, because I do not think that people think you can cure diabetes and that you can only manage it.

Professor Rudolph Weiner:  If I talk with a diabetes doctor he will say we can never cure it because it is a chronic illness, the correct word is remission. Remission means free of symptoms, normal glucose metabolism, and free of treatment. If the diabetes has not existed for more than 15 years then we can have a real remission for a long period.

Roberta Speyer:  So, being that the disease becomes asymptomatic, or you are in remission, then in essence it becomes a cure for the person who is experiencing it. What are you doing to get these kinds of results? This is done surgically; this is not a medication, correct?

Professor Rudolph Weiner:  Correct. This is surgery but the type of surgery changes and the risk of the surgeon _________ because all the procedures can be done with minimal invasiveness by laparoscopy. Also new techniques and some procedures are now under development to perform the procedures by endoscopy, which means there is no surgery and no general anesthesia. This is a real improvement and a new development that we have seen in the last few years.

Roberta Speyer:  What we are talking about essentially is what people think of as weight loss surgery but you are applying the weight loss surgery and saying that it is more than just something that is done for cosmetics. It is actually indicated in type 2 diabetes and can indeed put these people into remission. And in most cases if they have had it for less than 15 years it can totally take the symptoms away.

Professor Rudolph Weiner:  Yes that is correct. To ________ with weight loss or overweight, it is a risk factor. The risk for early death increases with weight, and you will develop a lot of diseases, metabolic diseases; you can have hypertension, sleep apnea and also cancer, a high risk for cancer. But the metabolic diseases can be treated, not only by weight loss; there are some other effects that can be achieved with these types of surgery. Now there are some types where you can perform the surgery also in patients who are not really obese and we have no weight loss or a very small weight loss but you can improve remarkably the diabetes. There are some changes we learned from the first surgeries we started, with bypass surgery and with doing a switch and its sleeve gastrectomy, and now we have some other types, gastric stimulation is under investigation. There is interest in transposition surgeries, and you can achieve also the same effects on diabetes with these types of surgery without weight loss.

Roberta Speyer:  This would apply to people that did not really need surgery for weight loss but still needed to get the metabolic syndrome benefits that the surgeries have to offer.

Professor Rudolph Weiner:  Correct. If somebody is really obese or super obese, then you need both, weight loss and improvement of the co-morbidities. If somebody is just overweight you can perform a bypass with a BMI maybe of 29 or 30, if someone is overweight by 40 lbs. But, if he has diabetes then you can perform a type of surgery whereby you can bring the diabetes to remission.

Roberta Speyer:  That is incredible. When you talk about the endoscopic approach and some of the things that are being investigated now, what time frame do you see from now and the end of 2009? When do you think we are going to start seeing these types of procedures available?

Professor Rudolph Weiner:  The endoscopic procedures are just under trial. For example, gastric pacing can also be done by endoscopic placement of the leads, and maybe we will have these surgeries in 2010 or 2011. These are surgeries you can perform in a patient with a low BMI who are overweight but not obese, and you can have a treatment to prevent any treatment with insulin. If you start with insulin therapy you will gain weight. And if you become more and more overweight, then you need more insulin, and the life expectancy is really short.

Roberta Speyer:  So, a vicious cycle. I was a very heavy girl. I weighed close to 300 lbs and it was really a life-changing event for me. I was lucky; I had not developed diabetes or metabolic syndrome at that time. But coming back and finding out that there are these new applications and new procedures going on, I think it is really important because so many times people attach a stigma to these types of surgeries, and almost look down on people that want to investigate them or find out more about them. I really think that you sharing this information, and with more people looking into this, and more doctors studying it, the more we are going to realize that there is really a lot to offer here.

Professor Rudolph Weiner:  The American Society for Bariatric Surgery changed their name four years ago, they have changed their name to American Society for Bariatric Surgery and Metabolic Disorders, and they developed a fact sheet describing all the effects on diabetes and all the benefits from this type of surgery. This fact sheet is very interesting and hopefully more doctors will recognize these advantages.

Roberta Speyer:  We can probably find that fact sheet and link to it on our website to the association's website, and we will do that.

I want to thank you very much for taking the time to share this new research with our viewers. The professor has to catch a flight to Berlin so we have to go now. Thank you everyone and we are going to keep an eye on this topic as it develops in the future. Thank you professor.

Professor Rudolph Weiner:  Thank you very much Roberta.