Dear Colleagues and Friends,
The previous three editions of the World Congress on Interventional Therapies for Type 2 Diabetes (WCITD) – in New York City 2008, 2011, and London 2015 – have established this series as a prestigious, multidisciplinary forum entirely focused on bariatric/metabolic surgery and novel GI-based interventions for type 2 diabetes (T2D), as well as roles of the gastrointestinal tract in metabolic regulation.
In 2015, the 2nd Diabetes Surgery Summit (DSS-II), held in conjunction with the 3rd WCITD, developed global clinical guidelines for surgical treatment of diabetes, published in Diabetes Care in June 2016 and now formally endorsed by more than 50 major medical and surgical organizations from around the world, including the American Diabetes Association (ADA). These guidelines recommend that gastrointestinal operations originally intended for weight loss ("bariatric surgery") be used as standard treatment options for patients with T2D and obesity – including those with only mild obesity – a practice referred to as metabolic surgery. This development is based on a large body of biological and clinical evidence, including numerous randomized clinical trials, controlled long-term clinical observations with hard outcomes, mechanistic studies, and economic analyses.
In addition to providing an effective treatment option for millions of patients with T2D, metabolic surgery provides an unprecedented opportunity to advance diabetes research at large. In fact, studying how surgery works may inform the design of novel pharmaceutical and less invasive, device-based interventions for diabetes. Furthermore, the evidence that surgery commonly promotes remission of a disease long considered irreversible could strengthen searches for the elusive causes of diabetes, thereby reinvigorating hopes to find a cure.
Capitalizing on these insights and opportunities, however, will require a shift in mindsets across the broad spectrum of clinical care, research, and policy.
In fact, despite compelling scientific evidence and broadening professional consensus favoring metabolic surgery, only 0.1-2% of surgical candidates worldwide currently have access to this approach. Furthermore, diseases such as diabetes and obesity continue to receive far less research funding than do other diseases, relative to their prevalence and the costs they impose upon society.
Barriers to advancing both care and research in the field are likely multi-factorial, including insufficient awareness among healthcare providers, inadequate insurance coverage, and misconceptions about surgery, obesity, and diabetes.
To tackle these issues, the 4th World Congress on Interventional Therapies for Type 2 Diabetes will take place in New York City on April 8-10, 2019.
A specific goal of this edition of the WCITD will be to engage a group of leading experts and stakeholders in developing a roadmap of policy initiatives to ensure implementation of current guidelines on surgical treatment of T2D.
We will also seek to develop an agenda of policy and educational initiatives to reduce the impact of stigma and end discrimination against people with diabetes and obesity, in order to facilitate access to care and funding of research.
On behalf of the organizing committee and myself, I eagerly look forward to welcoming you to New York for an exciting event expressly designed to change policies, practices, and the way we think about diabetes and obesity.
Prof. Francesco Rubino, MD
Chair, Bariatric and Metabolic Surgery
King's College London