2nd World Congress on Interventional Therapies for Type 2 Diabetes
March 28-30, 2011 Hilton New York • New York, NY • USA
Congress Director Francesco Rubino, MD
Congress Program www.wcidt.org
Hosted By
Welcome to the 2nd World Congress on Interventional therapies for Type 2 diabetes
Dear Colleagues and Friends,
Several gastrointestinal (GI) operations originally designed to treat morbid obesity also cause dramatic improvement or even remission of type 2 diabetes. The mechanisms by which surgery controls hyperglycemia remain elusive. Increasing evidence suggests that weight-independent mechanisms may play a role in the surgical control of diabetes. This knowledge challenges current paradigms of disease pathogenesis and points to the gastrointestinal tract as a potential target for the development of less invasive interventional therapies and novel pharmaceuticals.
Previously, the Diabetes Surgery Summit (Rome 2007) and the 1st World Congress on Interventional Therapies for Type 2 Diabetes (New York 2008), have raised attention about the role of gastrointestinal surgery for the treatment of diabetes: opportunities and limitations of this emerging field are now the matter of a growing debate.
The debate continues with the 2nd World Congress on Interventional Therapies for Type 2 Diabetes. A multidisciplinary group of clinicians, scientists and policy makers will address barriers that still prevent access to surgical treatment of diabetes in eligible patients and develop an agenda of research priorities to improve patients selection and elucidate mechanisms of diabetes control.
A stellar Faculty of leading international scientists will also discuss how the lessons learned from study of gastrointestinal interventions may improve understanding of diabetes and provide a lead for future treatments of curative intent.
On behalf of the organizing committee and myself, I welcome you to this exciting, multidisciplinary event.
Francesco Rubino, MD Congress Director
1 2nd World Congress on Interventional Therapies for Type 2 Diabetes
EDUCATIONAL PARTNER
American Diabetes Association
ENDORSING SOCIETIES The 2nd World Congress on Interventional Therapies for Type 2 Diabetes is endorsed by the following organizations.
™ 100 SW 75th Street Suite 201 Gainesville, FL 32607
American Association of American Association of American Gastroenterological American Society for Metabolic Clinical Endocrinologists Endocrine Surgeons Association and Bariatric Surgery
Asociacion De Cirugia Bariatrica Y Metabolica De Guatemala Asia Pacific, Metabolic & Asociation Latinoamericana Association for the Bariatric Surgery Society De Circurjanos Endoscpistas Study of Obesity
Emirates Obesity Surgery Interest Group Belgian Endocrine Society Canadian Diabetes Diabetes UK Association
European Association for Gastroenterology IFSO Sweden and Endoscopy European Association for Indian Association of Gastrointestinal the Study of Diabetes Endo-Surgeons
International Atherosclerosis Endocrine Society European Association for International Federation for the Surgery Society Endoscopic Surgery of Obesity and Metabolic Disorders
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Italian Society of Japan Society for the Study National Obesity Forum The New York Endocrinology of Obesity Academy of Sciencs
Obesity & Metabolic Surgery The Obesity Society Obesity Surgery Society of The Philippine Society for Society of India Australia & New Zealand Metabolic and Bariatric Surgery
Research Society for the Study of Diabetes in India Qatar Diabetes Sociedad Argentina Sociedade Brasileira de Cirurgia Association – Qatar Foundation de Diabetes Bariatrica e Metabolica
Sociedade Brasileira Sociedade Brasileira de Sociedad de Cirujanos Sociedad Espanola de Diabetes (SBD) Endocronologia e Metabologia de Chile de Diabetes
Società Italiana di Diabetologia Società Italiana dell'Obesità Società Italiana di Chirurgia dell’Obesità Società Italiana per la e delle malattie metaboliche Prevezione Cardiovascolare
Society for Society of American Gastrointestinal The Society for Surgery Swiss Society for the Study of Morbid Endocrinology and Endoscopic Surgeons of the Alimentary Tract Obesity and Metabolic Disorders
This program is supported in name only by the American Heart Association’s Councils on Basic Cardiovascular Sciences, Clinical Cardiology, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, Kidney in CV Disease, and High Blood Pressure Research. http://www.heart.org/HEARTORG/
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 3 2nd World Congress on Interventional Therapies for Type 2 Diabetes
The International Diabetes Federation (IDF) Position Statement on Interventional Treatments of Type 2 Diabetes
During the World Congress, the IDF will officially announce its Position Statement on Metabolic/Bariatric Surgery and GI Interventions for the Treatment of Diabetes
Monday, March 28, 2011 11:10 am - 12:30 pm • Grand Ballroom, Hilton New York
The IDF consensus developing meeting was held at the IDF head office in Brussels, Belgium (5-6 December, 2010). This meeting was convened by:
Professor George Alberti Professor Paul Zimmet Imperial College, London and Newcastle University, UK Baker IDI Heart & Diabetes Institute, Melbourne, Australia Professor John B. Dixon Professor Francesco Rubino Baker IDI Heart & Diabetes Institute, Melbourne, Australia Weill Cornell Medical College, New York, NY, USA
Other attendees at the meeting were:
Professor Stephanie Amiel Professor Pierre Lefebvre King's College London, UK IDF and University of Liege, Belgium Professor Louise A. Baur Dr. Carel Le Roux University of Sydney, Australia Imperial College London, UK Professor Nam H. Cho Professor Jean-Claude Mbanya Ajou University School of Medicine, Korea International Diabetes Federation, Cameroon Dr. Bruno Geloneze Professor Gertrude Mingrone University of Campinas (UNICAMP), Brazil Catholic University of Rome, Italy Professor Jan Willem Greve Professor Philip R. Schauer Atrium Medical Center, Netherlands Cleveland Clinic Lerner College of Medicine, USA Professor Linong Ji Professor Luc Van Gaal Peking University People's Hospital, China Antwerp University Hospital, Belgium Dr. Muffazal Lakdawala Dr. David Whiting Saifee Hospital, India International Diabetes Federation, Belgium Professor Wei-Jei Lee Professor Bruce M. Wolfe Ming-Sheng General Hospital, National Taiwan Oregon Health and Science University (OHSU), USA University, Taiwan All panel members made a substantial contribution to the meeting and subsequent formulation of the position statement.
The consensus meeting was supported with an unrestricted educational grant by: Allergan Inc, Irvine, CA, USA Ethicon, Ethicon Endo-Surgery, Inc, Cincinnati, Ohio, USA MetaCure Inc, Mount Laurel, NJ, USA These companies played no role in the discussion or preparation of the IDF position statement.
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Contents
Welcom e...... 1 Endorsing Societie s...... 2-3 International Diabetes Federation Statement ...... 4 General Informatio n...... 6-7 Congress Advisory Committe e...... 9 Congress Program Committe e...... 11-13 Distinguished Facult y ...... 14-21 Guest Expert s...... 22 Program-At-A-Glanc e ...... 23-24 PROGRAM Monday, March 28 ...... 26-27 Tuesday, March 29 ...... 28-32 Breakout Sessions/Workshops ...... 30-32 Wednesday, March 30 ...... 33-34 Faculty Index ...... 35 Exhibitor Director y ...... 37-38 Exhibit Floor Pla n...... 38 Poster Sessions ...... 39 Diabetes: A Global Epidemi c ...... 41 Gastrointestinal Procedure s...... 43-47 Disclosure s ...... 48-49 Congress Sponsors ...... 50 2nd World Congress on Interventional Therapies for Type 2 Diabetes
GENERAL INFORMATION
The World Congress will take place March 28-30, 2011 at the Hilton New York, 1335 Avenue of the Americas, New York, NY 10013 Telephone: (+1) 212-586-7000 • Guest Fax: (+1) 212-315-1374
EDUCATIONAL DISCLAIMER SPEAKER READY ROOM The primary purpose of this congress is education. Information All Congress speakers are required to check in at the Speaker presented, as well as publications, technologies, and/or services Ready Room no later than two hours in advance of your discussed, are intended to inform you about the knowledge, presentation. The Speaker Ready Room is located in the techniques, and experiences of the faculty who are willing to Gibson Suite on the hotel’s second floor. share such information with colleagues. A diversity of professional opinions exists on the topics of the Congress, and Speaker Ready Room Hours: the views of the conference’s faculty are solely for educational Sunday, March 27, 2011 2:00 pm - 6:00 pm purposes. Faculty’s views neither represent those of the 2nd Monday, March 28, 2011 7:00 am - 6:00 pm World Congress on Interventional Therapies for Type 2 Diabetes Tuesday, March 29, 2011 6:30 am - 6:00 pm nor constitute endorsement by the endorsing societies listed in Wednesday, March 30, 2011 7:00 am - 12:00 pm this syllabus. The Congress declaims any and all liability or damages to any individual attending this conference and for REGISTRATION all claims, which may result from the use of information, publications, technologies, products and/or services of the Registration Hours: meeting. Faculty disclosure statements have been provided Sunday, March 27, 2011 10:30 am - 7:00 pm by speakers and are included at the end of this syllabus. Monday, March 28, 2011 7:00 am - 9:00 pm Tuesday, March 29, 2011 6:30 am - 7:00 pm ACCREDITATION Wednesday, March 30, 2011 7:00 am - 2:00 pm Due to the structure and multidisciplinary nature of the Congress, continuing medical education and nursing credits are not Only registered participants may attend the Scientific Sessions available through the Congress this year. and the Social Events offered by the World Congress. All registered participants are entitled to: GUIDE TO MEETING ROOMS • Attend all Scientific Sessions Second Floor • Attend the Exhibits, and the Poster Sessions • Promenade - World Congress Registration • Receive Final Program and Abstracts • Clinton Suite - Press Office • Breakfast and Coffee Breaks March 28-30 and Boxed • Gibson Suite - Speaker Ready Room Lunches on March 28-29 • Rhinelander Gallery - Exhibits, Poster Sessions, Continental Breakfasts and Lunches BADGES • Sutton Center - Breakout Sessions The official badge must be worn for admission to all activities of • Sutton North/Beekman - Breakout Sessions the Congress. • Sutton South/Regent - Breakout Sessions PRESS Third Floor • Grand Ballroom - Opening Ceremony, Plenary Sessions Working press from print and electronic media may receive • Trianon Ballroom - Welcome Reception complimentary registration on submission of a copy of press credentials and a completed registration form. A Press Office All meeting room floors being used for the World Congress will be available in the Clinton Suite on the 2nd floor. are accessible by elevators. Escalators also provide access between First, Second, and Third Floors. Press Office Hours: Monday, March 28, 2011 7:00 am - 6:00 pm Tuesday, March 29, 2011 7:00 am - 6:00 pm Wednesday, March 30, 2011 7:00 am - 12:00 pm
6 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org SCIENTIFIC EXHIBITS LOST & FOUND Scientific Exhibits and Posters will be located inside the Please return all lost or found items to the Registration Desk. Rhinelander Gallery on the hotel’s second floor. Exhibit and All items left at the World Congress Lost and Found will be poster hours are: turned over to New York Hilton upon conclusion of the event. Monday, March 28 7:00 am - 6:45 pm IN CASE OF EMERGENCY (Poster Session from 5:45 – 6:45 pm) In the event of any emergency situation, dial extension 5747 or Tuesday, March 29 6:30 am – 3:00 pm 66 from any house phone or your hotel room. New York Hilton has security personnel trained in first aid and CPR and a direct LANGUAGE link to NYC emergency services such as ambulance and The official language of the Congress is English. No simultaneous paramedics to render aid quickly. translation is provided. SMOKING WIFI HOTSPOT The New York Hilton sleeping rooms, public and meeting space A wifi hotspot is offered to participants to remotely access is 100% smoke-free. There is a “Smoking Oasis” out front of Internet. The wifi hotspot is located inside the Rhinelander the Hotel on the main ramp. Ballroom. Funding for the 2nd World Congress wifi hotspot is graciously provided by Allergan . PERSONAL INSURANCE COVERAGE Registration for the World Congress implies that the participant MEALS & COFFEE BREAKS agrees that neither the Organizing Committee (consisting of the Advisory and Program Committees), the Weill Cornell Medical Continental breakfast and box lunch will be available inside the College, the NewYork-Presbyterian Hospital nor the Giovanni Rhinelander Gallery on Monday and Tuesday. Coffee breaks, as Lorenzini Medical Foundation assume any liability or responsibility well as Wednesday’s continental breakfast, will be located in whatsoever. Congress delegates are requested to make their the Grand Ballroom Foyer. own arrangements for medical, travel, and personal insurance. WELCOME RECEPTION CELLULAR PHONES, BEEPERS & ELECTRONIC DEVICES Please join us for this unique opportunity to network with faculty , In consideration of fellow participants, it is requested that all cell guest experts and colleagues. Areas of conversation will be phones, beepers, pagers, and other electronic devices be nestled among tastes and flavors reminiscent of New York turned off or set to the silent/vibrate mode during all Scientific Neighborhoods. Relax and enjoy the music of the best cover Sessions to avoid disruption. band in New York City ~ Café Wha? ~ with your colleagues and friends to your favorite funk, classic rock, rhythm and and AMERICANS WITH DISABILITIES STATEMENT meringue dance music. The World Congress wishes to take those steps to ensure that Trianon Ballroom, Hilton New York no individual with a disability is excluded, denied services, Monday, March 28, 2011 segregated, or otherwise related to differently because of the 8:00 pm - 10:00 pm absence of auxiliary aids and services identified in the Americans with Disabilities Act. If any such services are necessary in order Tickets to the Welcome Reception are available for purchase at to participate in the Congress, please communicate your needs the Registration Desk until 12:00 pm on Monday, March 28. A in advance. ticket and official Congress badge are required for admittance. The Congress can assist with special needs (e.g. physical, CERTIFICATE OF ATTENDANCE dietary). For assistance, please stop by the Registration Desk. A Certificate of Attendance is available upon request, from the Registration Desk at the end of the Congress. The request form PROGRAM CHANGES AND MESSAGE BOARD may be found in your registration bag. A Program Change and Message Board is located in the Registration Area on the 2nd Floor Promenade, where any last BUSINESS CENTER minute changes to the Program will be posted. A fully staffed Business Center is located on the 2nd floor of the New York Hilton, adjacent to Guest Elevators (next to the CANCELLATION OF THE CONGRESS Madison Suite). Services include computer stations, Fax In the unlikely event that the 2nd World Congress on Services, Copy Machine, and Package Delivery. Interventional Therapies for Type 2 Diabetes is abbreviated or cancelled for any reason whatsoever, the Weill Cornell Medical Business Center Hours: College, the NewYork-Presbyterian Hospital and the Giovanni Monday - Friday 7:00 am - 7:00 pm Lorenzini Medical Foundation and Fondazione Giovanni Saturday & Sunday 9:00 am - 5:00 pm Lorenzini reserve the right, in their sole discretion, to unilaterally terminate the Congress. In such case, the registrant and/or any The Business Center may also be accessed 24 hours a day funding/supporting organization hereby agrees to waive any using your New York Hilton guest room key. The Business claim against the Weill Cornell Medical College, the NewYork- Center can be contacted though a house phone at Ext. 5212 Presbyterian Hospital and the Giovanni Lorenzini Medical or by calling (+1) 212-399-1977. Foundation and Fondazione Giovanni Lorenzini, for damages or compensation including but not limited to, fees for registration, housing, airfare, and incidental charges.
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2nd World Congress on Interventional Therapies for Type 2 Diabetes
Congress Advisory Committee
CONGRESS DIRECTOR Francesco Rubino, MD Chief, GI Metabolic Surgery M. Sue Kirkman, MD Director, Diabetes Surgery Center Senior Vice President, Medical Affairs Weill Cornell Medical College and Community Information NewYork-Presbyterian Hospital American Diabetes Association New York, NY USA Alexandria, VA USA
Linda Cann, MSEd Managing Director, Professional Education, Harold E. Lebovitz, MD Conventions and International Affairs Professor, Medicine American Diabetes Association SUNY Health Science Center at Brooklyn Alexandria, VA USA Brooklyn, NY USA
Fabrizio Michelassi, MD Lewis Atterbury Stinson Professor and Chairman Ricardo V. Cohen, MD Department of Surgery Co-Director Weill Cornell Medical College The Center for the Surgical Treatment of Surgeon-in-Chief Morbid Obesity & Metabolic Disorder NewYork-Presbyterian Hospital/Weill Alemão Oswaldo Cruz Hospital Cornell Medical Center São Paulo, Brazil New York, NY USA
David E. Cummings, MD Professor, Medicine Alfons Pomp, MD, FRCSC, FACS Metabolism, Endocrinology & Nutrition Leon C. Hirsch Professor of Surgery Deputy Director, Diabetes Endocrinology Chief, Section Laparoscopic & Bariatric Research Center Surgery University of Washington School of Medicine Weill Cornell Medical College Seattle, WA USA New York, NY USA
Philip Schauer, MD Antonio M. Gotto, Jr., MD, DPhil Professor, Surgery The Stephen and Suzanne Weiss Dean Lerner College of Medicine Professor, Medicine Director, Advanced Laparoscopic & Provost, Medical Affairs Bariatric Surgery Weill Cornell Medical College Cleveland Clinic New York, NY USA Cleveland, OH USA
Lee M. Kaplan, MD, PhD Professor, Medicine Paul Zimmet, MD, PhD Harvard Medical School Director Emeritus Director, MGH Weight Center Director International Research Massachusetts General Hospital Baker IDI Heart and Diabetes Institute Boston, MA USA Melbourne, Australia
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2nd World Congress on Interventional Therapies for Type 2 Diabetes
Program Committee
CONGRESS DIRECTOR
Francesco Rubino, MD Chief, GI Metabolic Surgery Director, Diabetes Surgery Center Weill Cornell Medical College NewYork-Presbyterian Hospital New York, NY USA
CLINICAL TRACK
CO-CHAIR Phillip Schauer, MD Professor, Surgery CHAIR Lerner College of Medicine Harold E. Lebovitz, MD Director, Advanced Laparoscopic & Professor, Medicine Bariatric Surgery SUNY Health Science Center at Brooklyn Cleveland Clinic Brooklyn, NY USA Cleveland, OH USA
RESEARCH TRACK
CHAIR David E. Cummings, MD CO-CHAIR Professor, Medicine Lee Kaplan, MD, PhD Metabolism, Endocrinology & Nutrition Professor, Medicine Deputy Director, Diabetes Endocrinology Harvard Medical School Research Center Director, MGH Weight Center University of Washington School of Medicine Massachusetts General Hospital Seattle, WA USA Boston, MA USA
POLICY TRACK
CHAIR CO-CHAIR Paul Zimmet, MD, PhD David R. Flum, MD, MPH Director Emeritus Professor, Surgery Director International Research Associate Chair, Research Baker IDI Heart and Diabetes Institute University of Washington Melbourne, Australia Seattle, WA USA
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Program Committee
Domenico Accili, MD Allison B. Goldfine, MD Professor, Medicine Associate Professor, Medicine Director, Diabetes and Endocrinology Harvard Medical School Research Center Section Head, Clinical Research Columbia University Joslin Diabetes Center New York, NY USA Boston, MA USA
Louis J. Aronne, MD, FACP Clinical Professor, Medicine M. Sue Kirkman, MD Director, Comprehensive Weight Control Senior Vice President, Medical Affairs Program and Community Information Weill Cornell Medical College American Diabetes Association New York, NY USA Alexandria, VA USA
Ricardo V. Cohen, MD Co-Director Samuel Klein, MD The Center for the Surgical Treatment of William H. Danforth Professor of Medicine Morbid Obesity & Metabolic Disorder and Nutritional Science Alemão Oswaldo Cruz Hospital Washington University School of Medicine São Paulo, Brazil St. Louis, MO USA
Rudolph L. Leibel, MD Christopher J. Murphy Memorial Professor John B. Dixon, MBBS, PhD, of Diabetes Research FRACGP, FRCPEdin Co-Director, Naomi Berrie Diabetes NHMRC Senior Research Fellow, Vascular Center; and Hypertension-Obesity Research Head, Division of Molecular Genetics Baker IDI Heart and Diabetes Institute Columbia University Medical Center Melbourne, Australia New York, NY USA
Robin S. Goland, MD Professor of Clinical Medicine and Carel W. Le Roux, MB, ChB Pediatrics Reader, Investigative Science Columbia University College of Department of Medicine Physicians & Surgeons Imperial College New York, NY USA London, UK
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Program Committee
Jesse Roth, MD, FACP Professor, Medicine Timothy E. McGraw, PhD Albert Einstein College of Medicine Professor, Biochemistry Investigator, Weill Cornell Medical College Feinstein Institute for Medical Research New York, NY USA Manhasset, NY USA
Jeffrey I. Mechanick, MD Clinical Professor, Medicine Endocrinology, Diabetes and Bone Disease Bruce Wolfe, MD Director, Metabolic Support Professor, Surgery Mount Sinai School of Medicine Oregon Health & Science University New York, NY USA Portland, OR USA
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Distinguished Faculty
Domenico Accili, MD Louis J. Aronne, MD, FACP Professor, Medicine Clinical Professor, Medicine Director, Diabetes & Endocrinology Director, Comprehensive Weight Control Research Center Program Columbia University Weill Cornell Medical College New York, NY USA New York, NY USA
Ted D. Adams, PhD, MPH Program Director, Nicola Basso, MD, FACS Cardiovascular Genetics, Professor, Surgery University of Utah and Health Fitness Paride Stefanini Department of Surgery Institute Sapienza University of Rome LDS Hospital, Intermountain Healthcare Azienda Policlinico Umberto I Salt Lake City, UT USA Rome, Italy
Richard N. Bergman, PhD Keck Professor of Medicine Sir K. George Alberti, MA, DPhil, Chair, Department of Physiology and BM BCh Biophysics Senior Research Investigator, Medicine Keck School of Medicine Imperial College University of Southern California London, UK Los Angeles, CA USA
Zachary T. Bloomgarden, MD Stephanie A. Amiel, MD Clinical Professor, Medicine, RD Lawrence Professor, Diabetic Medicine Endocrinology, Diabetes, & Bone Disease King’s College Mount Sinai School of Medicine London, UK New York, NY USA
Caroline M. Apovian, MD Professor, Medicine Boston University School of Medicine Stacy A. Brethauer, MD Director, Nutrition and Weight Associate Staff Surgeon Management Laparoscopic & Bariatric Surgery Boston Medical Center Cleveland Clinic Boston, MA USA Cleveland, OH USA
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Distinguished Faculty
Michael S. Brown, MD W.A. (Monty) Moncrief Distinguished Chair, Cholesterol & Arteriosclerosis Research Regental Professor, Molecular Genetics The University of Texas Southwestern Medical Center Tamara Darsow, PhD Dallas, TX USA Vice President Research Programs 1985 Nobel Laureate for Medicine or American Diabetes Association Physiology Alexandria, VA USA
Professor the Lord Ara Darzi of Henry Buchwald, MD, PhD Denham, PC KBE HonFREng Professor, Surgery and Biomedical FmedSci Engineering Professor, Surgery University of Minnesota Imperial College London Minneapolis, MN USA London, UK
Pradeep Chowbey, MD, FACS Chair, Minimal Access Surgery Joint Managing Director, Max Institute Aureo Ludovico De Paula, MD of Minimal Access, Metabolic & Bariatric Director, Surgery Surgery Specialty Hospital New Delhi, India Goias, Brazil
Ricardo V. Cohen, MD Ralph DeFronzo, MD Co-Director Professor, Medicine The Center for the Surgical Treatment of Chief, Diabetes Division Morbid Obesity and Metabolic Disorder University of Texas Health Science Alemão Oswaldo Cruz Hospital Center São Paulo, Brazil San Antonio, TX USA
David E. Cummings, MD Stefano Del Prato, MD Professor, Medicine Professor, Endocrinology and Metabolism, Endocrinology & Nutrition Metabolism Deputy Director, Diabetes Endocrinology Chief, Section of Diabetes Research Center University of Pisa University of Washington School of Medicine Cisanello Hospital Seattle, WA USA Pisa, Italy
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Distinguished Faculty
John B. Dixon, MBBS, PhD, FRACGP, FRCPEdin NHMRC Senior Research Fellow, Vascular and Hypertension-Obesity Michel Gagner, MD Research Clinical Professor, Surgery Baker IDI Heart and Diabetes Institute Clinique Michel Gagner MD, Inc. Melbourne, Australia Montreal, QC Canada
Robert H. Eckel, MD Professor, Medicine Manoel Galvao Neto, MD Professor, Physiology and Biophysics Surgeon & Gastroenterologist University of Colorado - Anshutz Scientific Coordinator Medical Campus Gastro Obeso Center Aurora, CO USA São Paulo, Brazil
Allison B. Goldfine, MD Associate Professor, Medicine Ele Ferrannini, MD Harvard Medical School Professor, Internal Medicine Section Head, Clinical Research University of Pisa Joslin Diabetes Center Pisa, Italy Boston, MA USA
Joseph L. Goldstein, MD Julie and Louis A. Beecherl Distin - guished Chair in Biomedical Science Regental Professor, Molecular Genetics David R. Flum, MD, MPH The University of Texas Southwestern Professor, Surgery Medical Center Associate Chair, Research Dallas, TX USA University of Washington 1985 Nobel Laureate for Medicine or Seattle, WA USA Physiology
Antonio M. Gotto, Jr. , MD, DPhil John Funder, MD, PhD, FRACP, The Stephen and Suzanne Weiss Dean FRCP Professor, Medicine Professor, Medicine Provost, Medical Affairs Prince Henry's Institute Weill Cornell Medical College Clayton, Australia New York, NY USA
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Distinguished Faculty
Shashank R. Joshi, MBBS, MD, Jan Willem M. Greve, MD, PhD DM Professor, Surgery Professor, Consultant Chair, Department of Surgery Grant Medical College and Sir JJ Group Atrium Medical Center Parkstad of Hospitals Heerleen, Limburg The Netherlands Mumbai, India
Peter Hill, MD, PhD Steven H. Kahn, MB, ChB Corporate Medical Director Professor, Medicine Medical Administration Department VA Puget Sound Health Care System Hamad Medical Corporation University of Washington Doha, Qatar Seattle, WA USA
Lee Kaplan, MD, PhD Bjorn Hofmann, MSc, PhD Professor, Medicine Professor, Medical Ethics Harvard Medical School Institute for Health and Society Director, MGH Weight Center University of Oslo Massachusetts General Hospital Oslo, Norway Boston, MA USA
Catherine Keating, MPH Senior Research Fellow Jens Juul Holst, MD Deakin Health Economics, Faculty of Professor, Medical Physiology Health Institute of Biomedical Sciences Deakin University Copenhagen, Denmark Melbourne, Australia
Linong Ji, MD Co-Director, Peking University Diabetes Center Director, Department Of Endocrinology And Metabolism, Peking University People’s Hospital M. Sue Kirkman, MD President, Chinese Diabetes Society Senior Vice President, Medical Affairs Vice President, and Community Information Chinese Endocrinologist Association American Diabetes Association Beijing, China Alexandria, VA USA
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Distinguished Faculty
Samuel Klein, MD William H. Danforth Professor of Carel W. Le Roux, MD, PhD Medicine and Nutritional Science Reader, Investigative Science Washington University School of Department of Medicine Medicine Imperial College St Louis, MO USA London, UK
Judith Korner, MD, PhD Associate Professor, Medicine Director, Weight Control Center Harold E. Lebovitz, MD Columbia University Medical Center Professor, Medicine New York, NY USA SUNY Health Science Center at Brooklyn Brooklyn, NY USA
Frank Lefevre, MD Associate Professor, Medicine Blandine B. Laferrere, MD Senior Scientist, BCBSA Technology Associate Professor, Medicine Evaluation Center Columbia University College of Physicians Northwestern Feinberg School of and Surgeons Medicine New York, NY USA Chicago, IL USA
Rudolph L. Leibel, MD Muffazal Abdulkader Lakdawala, MD Christopher J. Murphy Memorial Professor Chief, Minimal Access & Bariatric Surgery of Diabetes Research Department Co-Director, Naomi Berrie Diabetes Center Centre for Obesity and Diabetes Support Head, Division of Molecular Genetics Saifee Hospital Columbia University Medical Center Mumbai, India New York, NY USA
David Lautz, MD Director of Bariatric Surgery Ruth E. Ley, PhD Harvard Medical School, Brigham and Assistant Professor, Microbiology Women's Hospital Cornell University Boston, MA USA Ithaca, NY USA
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Distinguished Faculty
Xavier Pi-Sunyer, MD Rui Li, PhD Chief of Endocrinology and Health Economist Professor of Medicine Centers for Disease Control and St. Luke’s Roosevelt Hospital Prevention Columbia University Atlanta, GA USA New York, NY USA
Alfons Pomp, MD, FRCSC, FACS Leon C. Hirsch Professor of Surgery Chief, Section Laparoscopic & Timothy E. McGraw, PhD Bariatric Surgery Professor, Biochemistry Weill Cornell Medical College Weill Cornell Medical College New York, NY USA New York, NY USA
Jeffrey I. Mechanick, MD Clinical Professor, Medicine, Endocrinology, Diabetes and Bone Walter J. Pories, MD, FACS Disease Professor, Surgery, Biochemistry Director, Metabolic Support and Exercise and Sports Science Mount Sinai School of Medicine East Carolina University New York, NY USA Greenville, NC USA
Jesse Roth, MD, FACP Geltrude Mingrone, MD, PhD Professor, Medicine Professor, Internal Medicine, Albert Einstein College of Medicine Endocrinology Investigator, Feinstein Institute for Catholic University of the Sacred Heart Medical Research Rome, Italy Manhasset, NY USA
Francesco Rubino, MD John J. Moore, DO, FAAFP Chief, GI Metabolic Surgery Patient Management Medical Director Director, Diabetes Surgery Center for the Northeast Region Weill Cornell Medical College AETNA NewYork-Presbyterian Hospital Blue Bell, PA USA New York, NY USA
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Distinguished Faculty
Lars V. Sjöström, MD, PhD Mohammed Fathy Saoud, PhD Professor Emeritus, SOS Secretariate President Internal Medicine Qatar Foundation Sahlgrenska University Hospital Doha, Qatar Göteborg, Sweden
Phillip Schauer, MD Professor, Surgery Lerner College of Medicine Myrlene Staten, MD Director, Advanced Laparoscopic & Senior Advisor, Diabetes Translational Bariatric Surgery Research Cleveland Clinic NIDDK, National Institutes of Health Cleveland, OH USA Bethesda, MD USA
Harvey J. Sugerman, MD Gary Schwartz, PhD Emeritus Professor, Surgery Professor of Medicine & Neuroscience Editor-in-Chief, Surgery for Obesity and Albert Einstein College of Medicine of Related Diseases Yeshiva University Virginia Commonwealth University Bronx, NY USA Richmond, VA USA
Randy J. Seeley, PhD Sean D. Sullivan, PhD Director, Cincinnati Diabetes Obesity Center Professor, Health Sciences and University of Cincinnati Department of Pharmacy Donald C. Harrison Endowed Professor Associate Dean for Research in Medicine University of Washington School Metabolic Diseases Institute of Pharmacy Cincinnati, OH USA Seattle, WA USA
Gerald I. Shulman, MD, PhD Investigator, Howard Hughes Medical Institute Professor, Physiological Chemistry, Medicine (Endocrinology) and Cellular & Molecular Physiology Associate Director, Diabetes-Endocrinology Research Center Tess Van Der Merwe, MBChB, PhD Associate Director, Medical Scientist Training Director Program Centres of Excellence for Metabolic Yale University School of Medicine Medicine and Surgery New Haven, CT USA Gauteng, South Africa
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Distinguished Faculty
Paul Zimmet, MD, PhD Bruce Wolfe, MD, FACS Director Emeritus Professor, Surgery Director International Research Oregon Health & Science University Baker IDI Heart and Diabetes Institute Portland, OR USA Melbourne, Australia
Carol H. Wysham, MD Clinical Associate Professor, Medicine University of Washington School of Medicine Mahmoud Ali Zirie, MD Section Head, Rockwood Center for Professor, Medicine Diabetes & Endocrinology Head, Endocrinology Diabetes Division Rockwood Clinic Hamad Medical Corporation Spokane, WA USA Doha, Qatar
James Young, MD Professor, Medicine Executive Dean Lerner College of Medicine Institute Chair Endocrinology & Metabolism Institute Cleveland Clinic Cleveland, OH USA
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Guest Experts
In addition to contributing to the scholarship of the audience, the presence of Guest Experts is meant to facilitate a lively discussion and debate throughout the course of the World Congress. Guest Experts will also steer group discussion during breakout sessions on Tuesday, March 29th. We would like to thank the following individuals for providing a unique perspective to the emerging field of interventional diabetology:
Vince Aguirre, MD ...... USA Luiz Vicente Berti, MD ...... Brazil Morris J. Birnbaum, MD, PhD ...... USA Robin Blackstone, MD, FACS ...... USA Camilo Boza, MD, FACS ...... Chile David J. Brillon, MD ...... USA Marco Castagneto, MD ...... Italy Lee-Ming Chuang, MD, PhD ...... Taiwan Gregory F. Dakin, MD ...... USA Alex Escalona, MD ...... Chile Mathias A. Fobi, MD, FACS, FASMBS, FICS, FACN ...... USA Paolo Gentileschi, MD ...... Italy Giovanni Ghirlanda, MD ...... Italy Ramen Goel, MD ...... India Neil E. Hutcher, MD, FACS ...... USA William B. Inabnet, III, MD, FACS ...... USA Kazunori Kasama, MD, FACS ...... Japan Subhash Kini, MD, FRCS, FACS ...... USA John G. Kral, MD, PhD, FACS ...... USA Wei-Jei Lee, MD, PhD ...... Taiwan Bassem M. Masri, MD ...... USA Francois Pattou, MD ...... France Antonio E. Pontiroli, MD ...... Italy Almino Ramos, MD ...... Brazil Mitch Roslin, MD, FACS ...... USA Naina Sinha, MD ...... USA April D. Strader, PhD ...... USA Richard Stubbs, MD, FRCS, FRACS ...... New Zealand Michel Suter, MD ...... Switzerland Julio Teixeira, MD, FACS ...... USA Antonio José Torres, MD, PhD ...... Spain Jonathan A. Waitman, MD ...... USA
22 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Program At-A-Glance
MONDAY, MARCH 28, 2011 7:00 am - 8:00 am Continental Breakfast (Rhinelander Gallery)
7:00 am - 9:00 pm Registration Open (2nd Floor Promenade)
7:00 am - 6:45 pm Exhibits and Posters (Rhinelander Gallery)
8:00 am - 8:20 am Opening Ceremony (Grand Ballroom)
8:20 am - 8:35 am Introduction of the World Congress: Scope and Methods F. Rubino (New York, NY USA)
CLINICAL TRACK SESSION I (Grand Ballroom) 8:35 am - 10:50 am Clinical Outcomes of Conventional and Surgical Treatments for T2DM
10:50 am - 11:10 am Refreshment Break (Grand Ballroom Foyer)
POLICY TRACK SESSION I (Grand Ballroom) 11:10 am - 12:30 pm The International Diabetes Federation (IDF) Position Statement on Interventional Treatments of Type 2 Diabetes
12:30 pm - 1:30 pm Lunch (Rhinelander Gallery)
CLINICAL TRACK SESSION II (Grand Ballroom) 1:30 pm - 3:00 pm CV Risk Reduction and Survival in Patients with Diabetes: Medical versus Surgical Therapy
3:00 pm - 3:20 pm Refreshment Break (Grand Ballroom Foyer)
CLINICAL TRACK SESSION III (Grand Ballroom) 3:20 pm - 5:45 pm Diabetes Surgery: Indications, Choice of Procedure & Peri-Operative Management
5:45 pm - 6:45 pm Poster Session (Rhinelander Gallery)
8:00 pm - 11:00 pm Welcome Reception (Trianon Ballroom)
TUESDAY, MARCH 29, 2011 6:30 am - 7:30 am Continental Breakfast (Rhinelander Gallery)
6:30 am - 7:00 pm Registration Open (2nd Floor Promenade)
6:30 am - 3:00 pm Exhibits and Posters (Rhinelander Gallery)
RESEARCH TRACK SESSION I (Grand Ballroom) 7:30 am - 9:40 am Mechanisms of Action of Surgery
RESEARCH TRACK SESSION II (Grand Ballroom) 9:40 am - 11:10 am Novel Experimental Approaches for Diabetes/Obesity
11:10 am - 11:30 am Refreshment Break (Grand Ballroom Foyer)
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 23 2nd World Congress on Interventional Therapies for Type 2 Diabetes
TUESDAY, MARCH 29, 2011 (cont’d)
RESEARCH TRACK SESSION III (Grand Ballroom) 11:30 am - 1:00 pm Defining Priorities for Clinical Research in Metabolic/Diabetes Surgery
1:00 pm - 2:00 pm Lunch (Rhinelander Gallery)
POLICY TRACK SESSION II (Grand Ballroom) 2:00 pm - 3:00 pm Global Burden of Diabetes and Resource Availability for Interventional Approaches
POLICY TRACK SESSION III (Grand Ballroom) 3:00 pm - 4:30 pm Cost Effectiveness of Diabetes Surgery: Implications for Public and Private Health Insurance
4:30 pm - 4:50 pm Refreshment Break (Grand Ballroom Foyer)
BREAKOUT SESSIONS AND WORKSHOPS (Sutton Complex Rooms) 4:50 pm - 6:50 pm Breakout Sessions Clinical (Sutton North/Beekman) Research (Sutton Center) Policy (Sutton South/Regent)
WEDNESDAY, MARCH 30, 2011
7:00 am - 2:00 pm Registration Open (2nd Floor Promenade)
7:00 am - 8:00 am Continental Breakfast (Grand Ballroom Lobby)
KEYNOTE LECTURE (Grand Ballroom) 8:00 am - 9:00 am Surviving Starvation: Essential Role of the Ghrelin-Growth Hormone Axis M.S. Brown (Dallas, TX USA) J.L. Goldstein (Dallas, TX USA)
RESEARCH TRACK SESSION IV (Grand Ballroom) 9:00 am - 10:40 am The Role of the Gut in the Physiology and Pathophysiology of Obesity and Diabetes
10:40 am - 11:00 am Refreshment Break (Grand Ballroom Foyer)
PANEL DISCUSSION (Grand Ballroom) 11:00 am - 12:00 pm The GI tract: Could it be the missing link between obesity and diabetes?
EXECUTIVE SUMMARIES/TAKE HOME MESSAGE (Grand Ballroom) 12:00 pm - 1:15 pm Presentation of Executive Summaries and Conclusions
1:20 pm World Congress Adjourns
24 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org
2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
MONDAY, MARCH 28, 2011
7:00 am - 8:00 am CONTINENTAL BREAKFAST (Rhinelander Gallery)
8:00 am - 8:20 am Opening Ceremony Grand Ballroom 8:20 am - 8:35 am Introduction of the World Congress: Scope and Methods Grand Ballroom F. Rubino (New York, NY USA)
CLINICAL TRACK SESSION I 8:35 am - 10:50 am Grand Ballroom
Clinical Outcomes of Conventional and Surgical Treatments for T2DM Chairs: W. Pories (Greenville, NC USA) • H.E. Lebovitz (Brooklyn, NY USA)
8:35 am - 8:55 am Glycemic and metabolic control with current pharmacologic treatments S. Del Prato (Pisa, Italy) 8:55 am - 9:15 am Glycemic and metabolic outcomes with bariatric/metabolic surgery: overview P. Schauer (Cleveland, OH USA) 9:15 am - 9:30 am Long-term prevention and remission of diabetes after bariatric surgery in the SOS study L. Sjöström (Göteborg, Sweden) 9:30 am - 9:45 am Safety profiles of pharmaceutical approaches H.E. Lebovitz (Brooklyn, NY USA) 9:45 am - 10:00 am Safety profiles of surgical approaches: short and long term B.M. Wolfe (Portland, OR USA) 10:00 am - 10:50 am Panel Discussion Panelists: S.A. Amiel (London, UK) , Z.T. Bloomgarden (New York, NY USA) , J. Dixon (Melbourne, Australia) , A. Pomp (New York, NY USA) , H. Buchwald (Minneapolis, MN USA) , A.B. Goldfine (Boston, MA USA) , K.G. Alberti (London, UK) , J.I. Mechanick (New York, NY USA) , X. Pi-Sunyer (New York, NY USA)
10:50 am - 11:10 am COFFEE BREAK (Grand Ballroom Foyer)
POLICY TRACK SESSION I 11:10 am - 12:30 pm Grand Ballroom
The International Diabetes Federation (IDF) Position Statement on Interventional Treatments of Type 2 Diabetes Chairs: J. Dixon (Melbourne, Australia) • K.G. Alberti (London, UK)
11:10 am - 11:20 am Existing guidelines for surgical treatment of obesity and diabetes (NIH, DSS, ADA) L.M. Kaplan (Boston, MA USA) 11:20 am - 11:40 am The IDF position statement on interventional therapies for type 2 diabetes P. Zimmet (Melbourne, Australia) 11:40 am - 12.30 pm Panel Discussion Panelists: C. Wysham (ADA) (Seattle, WA USA) , J.I. Mechanick (AACE) (New York, NY USA) , S.A. Amiel (Diabetes UK) (London, UK) , X. Pi-Sunyer (NHLBI) (New York, NY USA) , A.M. Gotto (New York, NY USA) , F. Rubino (New York, NY USA) , R.H. Eckel (Aurora, CO USA)
12:30 pm - 1:30 pm LUNCH BREAK (Rhinelander Gallery)
26 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
CLINICAL TRACK SESSION II 1:30 pm - 3:00 pm Grand Ballroom
CV Risk Reduction and Survival in Patients with Diabetes: Medical versus Surgical Therapy Chairs: A.M. Gotto (New York, NY USA) • K.G. Alberti (London, UK)
1:30 pm - 1:50 pm CV risk, CVD and diabetes-related mortality: impact of pharmacologic approaches R.H. Eckel (Aurora, CO USA) 1:50 pm - 2:05 pm Long-term (20 years) impact of bariatric surgery on CV risk and CVD: an update from the SOS study L. Sjöström (Göteborg, Sweden) 2:05 pm - 2:15 pm The impact of bariatric/metabolic surgery on CV risk and long-term survival T.D. Adams (Salt Lake City, UT USA) 2:15 pm - 3:00 pm Panel Discussion Panelists: R. DeFronzo (San Antonio, TX USA) , E. Ferrannini (Pisa, Italy) , S.R. Joshi (Mumbai, India) , S.E. Kahn (Seattle, WA USA) , J. Young (Cleveland, OH USA) , H.J. Sugerman (Richmond, VA USA) , W. Pories (Greenville, NC USA)
3:00 pm - 3:20 pm COFFEE BREAK (Grand Ballroom Foyer)
CLINICAL TRACK SESSION III 3:20 pm - 5:45 pm Grand Ballroom
Diabetes Surgery: Indications, Choice of Procedure & Peri-Operative Management Chairs: L. Aronne (New York, NY USA) • J. Young (Cleveland, OH USA)
3:20 pm - 3:35 pm Predicting factors of diabetes control/reasonable criteria for surgical indication J. Korner (New York, NY USA) 3:35 pm - 3:50 pm Preoperative management of diabetic patients C.M. Apovian (Boston, MA USA) 3:50 pm - 4:05 pm Which surgical procedure is best? Summary of available evidence from comparative clinical studies in high and low BMI patients H.J. Sugerman (Richmond, VA USA) 4:05 pm - 4:40 pm Panel Discussion Panelists: H.E. Lebovitz (Brooklyn, NY USA) , S.R. Joshi (Mumbai, India) , J.I. Mechanick (New York, NY USA) , J. Dixon (Melbourne, Australia) , M. Gagner (Montreal, QC, Canada) , R.V. Cohen (São Paulo, Brazil)
4:40 pm - 4:55 pm Postoperative management of obese and diabetic patients; the role of integrated/multimodality therapies L. Aronne (New York, NY USA)
4:55 pm - 5:15 pm A rational and physiologic approach to the management of diabetes after surgery R. DeFronzo (San Antonio, TX USA)
5:15 pm - 5:45 pm Panel Discussion Panelists: C. Wysham (Seattle, WA USA) , S.E. Kahn (Seattle, WA USA) , R.N. Bergman (Los Angeles, CA USA) , L. Ji (Beijing, China) , S. Del Prato (Pisa, Italy)
5:45 pm - 6:45 pm POSTER SESSION (Rhinelander Gallery)
8:00 pm WELCOME RECEPTION (Trianon Ballroom)
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 27 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
TUESDAY, MARCH 29, 2011
6:30 am - 7:30 am CONTINENTAL BREAKFAST (Rhinelander Gallery)
RESEARCH TRACK SESSION I 7:30 am - 9:40 am Grand Ballroom
Mechanisms of Action of Surgery Chairs: L.M. Kaplan (Boston, MA USA) • S.E. Kahn (Seattle, WA USA)
7:30 am - 7:45 am Mechanisms of Weight Loss: beyond restriction and malabsorption R.J. Seeley (Cincinnati, OH USA)
7:45 am - 8:00 am Effect of GI surgery on insulin secretion/sensitivity S. Klein (St. Louis, MO USA)
8:00 am - 8:15 am Effects of GI surgery on food choices and energy expenditure C.W. Le Roux (London, UK)
8:15 am - 8:30 am Effects of GI surgery on glucose homeostasis J.J. Holst (Copenhagen, Denmark)
8:30 am - 9:00 am Debate: Diabetes control by GI surgery is explained by weight-independent mechanisms 8:30 am - 8:45 am Yes: D.E. Cummings (Seattle, WA USA) 8:45 am - 9:00 am No: E. Ferrannini (Pisa, Italy) 9:00 am - 9:40 am Panel Discussion: Weight independent mechanisms of diabetes control: weighing the evidence Panelists: J. Korner (New York, NY USA) , G. Mingrone (Rome, Italy) , R.N. Bergman (Los Angeles, CA USA) , R. DeFronzo (San Antonio, TX USA) , B.B. Laferrere (New York, NY USA) , G.J. Schwartz (New York, NY USA)
RESEARCH TRACK SESSION II 9:40 am - 11:10 am Grand Ballroom
Novel Experimental Approaches for Diabetes/Obesity Chairs: H. Buchwald (Minneapolis, MN USA) • S. Klein (St. Louis, MO USA)
9:40 am - 9:55 am Novel GI surgical procedures (DJB and Ileal Interposition: alone and with associated sleeve gastrectomy) R.V. Cohen (São Paulo, Brazil) 9:55 am - 10:10 am Endoluminal procedures for obesity/diabetes S.A. Brethauer (Cleveland, OH USA)
10:10 am - 10:25 am Endoluminal devices for obesity/diabetes L.M. Kaplan (Boston, MA USA) 10:25 am - 10:40 am Pacing/GI electric stimulation for diabetes H.E. Lebovitz (Brooklyn, NY USA) 10:40 am - 11:10 am Panel Discussion Panelists: J.W.M. Greve (Heerleen, Netherlands) , M. Galvao Neto (São Paulo, Brazil) , A. De Paula (Goiania, Brazil), W. Pories (Greenville, NC USA), J. Funder (Clayton, Australia), S.R. Joshi (Mumbai, India)
11:10 am - 11:30 am COFFEE BREAK (Grand Ballroom Lobby)
28 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
RESEARCH TRACK SESSION III 11:30 am - 1:00 pm Grand Ballroom
Defining Priorities for Clinical Research in Metabolic/Diabetes Surgery Chairs: A.B. Goldfine (Boston, MA USA) • J. Roth (Manhasset, NY USA)
11:30 am - 11:45 am Clinical trials in diabetes surgery: overview of ongoing trials; challenges for study design, practical issues in surgical trials A.B. Goldfine (Boston, MA USA) 11:45 am - 12:00 pm Clinical trials in diabetes surgery: ethical aspects B.M. Hofmann (Oslo, Norway) 12:00 pm - 12:15 pm Advantages and disadvantages of each design, multisite vs consortium model for large clinical trials F. Rubino (New York, NY USA) 12:15 pm - 1:00 pm Panel Discussion: Priorities for clinical research in diabetes surgery; costs/funding, ethical aspects Panelists: P. Schauer (Cleveland, OH USA) , R. DeFronzo (San Antonio, TX USA) , J. Korner (New York, NY USA) , D. Lautz (Boston, MA USA) , M. Staten (Bethesda, MD USA), F. Saoud (Doha, Qatar), T. Darsow (Alexandria, VA USA)
1:00 pm - 2:00 pm LUNCH BREAK (Rhinelander Gallery)
POLICY TRACK SESSION II 2:00 pm - 3:00 pm Grand Ballroom
Global Burden of Diabetes and Resource Availability for Interventional Approaches Chairs: P. Zimmet (Melbourne, Australia) • P. Chowbey (New Delhi, India)
2:00 pm - 2:15 pm The global epidemiology of diabetes P. Zimmet (Melbourne, Australia) 2:15 pm - 2:30 pm The global costs of diabetes R. Li (Atlanta, GA USA) 2:30 pm - 3:00 pm Panel Discussion: Specific regional challenges for diabetes prevention and treatment Panelists: L. Ji (Beijing, China) , J. Funder (Clayton, Australia) , T. Van Der Merwe (Pretoria, South Africa) , A. Darzi (London, UK), M. Ali Zirie (Doha, Qatar), R. Li (Atlanta, GA USA)
POLICY TRACK SESSION III 3:00 pm - 4:30 pm Grand Ballroom
Cost Effectiveness of Diabetes Surgery: Implications for Public and Private Health Insurance Chairs: A. Darzi (London, UK) • D. Flum (Seattle, WA USA)
3:00 pm - 3:15 pm Review of what we know about cost-effectiveness of bariatric surgery with special regard to patients with diabetes C. Keating (Burwood, Australia) 3:15 pm - 3:30 pm How governments consider evidence on cost-effectiveness S.D. Sullivan (Seattle, WA USA) 3:30 pm - 3:45 pm How payers consider the evidence of cost and effectiveness F. Lefevre (Chicago, IL USA) 3:45 pm - 4:30 pm Panel Discussion: Simply cost-effective? Reconciling cost-evaluations related to diabetes interventions Panelists: R. Li (Atlanta, GA USA) , C. Keating (Burwood, Australia) , S.D. Sullivan (Seattle, WA USA) , F. Lefevre (Chicago, IL USA) , J.J. Moore (Blue Bell, PA USA)
4:30 pm - 4:50 pm COFFEE BREAK (Grand Ballroom Foyer)
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 29 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
TUESDAY, MARCH 29, 2011 (continued)
BREAKOUT SESSIONS AND WORKSHOPS 4:50 pm - 6:50 pm Breakout Sessions for Interactive Discussion and Preparation of Executive Summary
CLINICAL TRACK 4:50 pm - 6:50 pm Sutton North/Beekman
Defining appropriate surgical candidates and good clinical practice for perioperative management and post-operative follow-up Chairs: H.E. Lebovitz (Brooklyn, NY USA) • P. Schauer (Cleveland, OH USA)
4:50 pm - 5:25 pm Workshop A: Defining appropriate surgical candidates for diabetes surgery
4:50 pm - 4:55 pm Who should be referred for surgical treatment of diabetes? H.E. Lebovitz (Brooklyn, NY USA) 4:55 pm - 5:10 pm Expert Panel Comments W.J. Pories (Greenville, NC USA) , L.J. Aronne (New York, NY USA) , R. DeFronzo (San Antonio, TX USA) , J. Young (Cleveland, OH USA) 5:10 pm - 5:25 pm Q&A: Guest Experts and Audience Interactive Opinion Polls
5:25 pm - 6:20 pm Workshop B: Defining ideal indications for each surgical procedure
5:25 pm - 5:50 pm Which patients should undergo... Biliopancreatic Diversion/DS - A. Pomp (New York, NY USA) Sleeve Gastectomy - M. Gagner (Montreal, QC, Canada) Gastric Bypass - P. Schauer (Cleveland, OH USA) Gastric Banding - J.B. Dixon (Melbourne, Australia) Novel GI Procedures: To re-route or not to re-route the bowel? - R.V. Cohen (São Paulo, Brazil) 5:50 pm - 6:05 pm Expert Panel Comments H. Buchwald (Minneapolis, MN USA) , P. Chowbey (New Delhi, India) , A.L. De Paula (Goiânia, Brazil) , J.W.M. Greve (Heerleen, Netherlands) 6:05 pm - 6:20 pm Q&A: Guest Experts and Audience Interactive Opinion Polls
6:20 pm - 6:50 pm Workshop C: Defining and measuring success of surgical treatment of diabetes
6:20 pm - 6:25 pm Definition of success and appropriate clinical measures to assess outcomes of surgical treatment J.I. Mechanick (New York, NY USA) 6:25 pm - 6:40 pm Expert Panel Comments H.J. Sugerman (Richmond, VA USA) , J. Korner (New York, NY USA) , R. DeFronzo ( San Antonio, TX USA) , S.R. Joshi (Mumbai, India) 6:40 pm - 6:50 pm Q&A: Guest Experts and Audience Interactive Opinion Polls
30 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
BREAKOUT SESSIONS AND WORKSHOPS 4:50 pm - 6:50 pm Breakout Sessions for Interactive Discussion and Preparation of Executive Summary
RESEARCH TRACK 4:50 pm - 6:50 pm Sutton Center
Defining priorities for clinical trials and investigations on mechanisms of action of surgery Chairs: L. Kaplan (Boston, MA USA) • D.E. Cummings (Seattle, WA USA)
4:50 pm - 5:35 pm Workshop A: Defining mechanisms of action of surgery and their implications for future diabetes therapies and understanding of disease mechanisms
4:50 pm - 5:00 pm Mechanisms of action of metabolic surgery: what is clear and what is not Lessons for future pharmacologic therapies Lessons about diabetes/obesity pathophysiology L. Kaplan (Boston, MA USA) 5:00 pm - 5:20 pm Expert Panel Comments G. Mingrone (Rome, Italy) , G. Schwartz (Bronx, NY USA) , B.B. Laferrere (New York, NY USA) , R.N. Bergman (Los Angeles, CA USA) 5:20 pm - 5:35 pm Q&A: Guest Experts and Audience Interactive Opinion Polls
5:35 pm - 6:10 pm Workshop B: Defining appropriate methods of innovation in bariatric and metabolic surgery and novel interventional treatments for diabetes
5:35 pm - 5:40 pm Defining proper clinical and pre-clinical assessment of new surgical procedures and devices C.W. Le Roux (London, UK) 5:40 pm - 5:55 pm Expert Panel Comments B.M. Hofmann (Oslo, Norway) , M.Galvao Neto (S ão Paulo, Brazil) , S. Klein (St. Louis, MO USA) , S. Del Prato (Pisa, Italy) 5:55 pm - 6:10 pm Q&A: Guest Experts and Audience Interactive Opinion Polls
6:10 pm - 6:50 pm Workshop C: Defining priorities for clinical research
6:10 pm - 6:15 pm Diabetes surgery: the most compelling clinical issues that require priority testing by randomized clinical trials D.E. Cummings (Seattle, WA USA) 6:15 pm - 6:35 pm Expert Panel Comments A.B. Goldfine (Boston, MA USA) , M. Staten (Bethesda, MD USA) , S.H. Kahn (Seattle, WA USA) , X. Pi-Sunyer (New York, NY USA), D. Lautz (Boston, MA USA) 6:35 pm - 6:50 pm Q&A: Guest Experts and Audience Interactive Opinion Polls
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 31 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
TUESDAY, MARCH 29, 2011 (continued)
BREAKOUT SESSIONS AND WORKSHOPS 4:50 pm - 6:50 pm Breakout Sessions for Interactive Discussion and Preparation of Executive Summary
POLICY TRACK 4:50 pm - 6:50 pm Sutton South/Regent
Proposing practical solutions to improve access to surgery when indicated Chairs: P. Zimmet (Melbourne, Australia) • D. Flum (Seattle, WA USA)
4:50 pm - 5:50 pm Workshop A: Creating a pathway to reconcile professional guidelines P. Zimmet (Melbourne, Australia)
5:00 pm - 5:40 pm Panel Discussion/Round Table with official representatives of the following organizations: NHLBI Obesity Guidelines (X. Pi-Sunyer, New York, NY USA ), ADA (M.S. Kirkman, Alexandria, VA USA ), AACE (J.I. Mechanick, New York, NY USA ), ASMBS (B. Wolfe, Portland, OR USA ), TOS (C.M. Apovian, Boston, MA USA ), SBCBM (R.V. Cohen, São Paulo, Brazil ), SICOB (N. Basso, Rome, Italy ), IFSO (M. Lakdawala, Mumbai, India ) 5:40 pm - 5:50 pm Interactive Opinion Polls
5:50 pm - 6:50 pm Workshop B: Payer perspectives: creating a pathway for policymakers and payers to reconcile approaches D. Flum (Seattle, WA USA)
6:00 pm - 6:40 pm Panel Discussion/Round Table F. Lefevre (Chicago, IL USA) , S.D. Sullivan (Seattle, WA USA) , J. Funder (Clayton, Australia) , L. Ji (Beijing, China) , C. Keating (Buswood, Australia) , T. Van Der Merwe (Pretoria, South Africa) , P. Hill (Doha, Qatar) , J.J. Moore (Blue Bell, PA USA) 6:40 pm - 6:50 pm Interactive Opinion Polls
32 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
WEDNESDAY, MARCH 30, 2011
7:00 am - 8:00 am CONTINENTAL BREAKFAST (Grand Ballroom Foyer)
KEYNOTE LECTURE 8:00 am - 9:00 am Grand Ballroom
8:00 am - 9:00 am Surviving Starvation: Essential Role of the Ghrelin-Growth Hormone Axis M.S. Brown (Dallas, TX USA) J.L. Goldstein (Dallas, TX USA)
The Nobel Prize in Physiology or Medicine 1985 was awarded jointly to Michael S. Brown and Joseph L. Goldstein “for their discoveries concerning the regulation of cholesterol metabolism” .
RESEARCH TRACK SESSION IV 9:00 am - 10:40 am Grand Ballroom
The role of the gut in the physiology and pathophysiology of obesity and diabetes Chairs: T.E. McGraw (New York, NY USA) • D. Accili (New York, NY USA)
9:00 am - 9:20 am Conventional paradigm of the pathophysiology of obesity R.L. Leibel (New York, NY USA) 9:20 am - 9:40 am Conventional paradigm of the pathophysiology of diabetes R.N. Bergman (Los Angeles, CA USA) 9:40 am - 10:00 am The physiologic role of the gut in energy and glucose homeostasis J.J. Holst (Copenhagen, Denmark) 10:00 am - 10:20 am The role of intestinal microbiota in insulin resistance, obesity/diabetes R.E. Ley (Ithaca, NY USA) 10:20 am - 10:40 am Impaired GI physiology in individuals with diabetes/obesity D.E. Cummings (Seattle, WA USA)
10:40 am - 11:00 am COFFEE BREAK (Grand Ballroom Foyer)
PANEL DISCUSSION 11:00 am - 12:00 pm Grand Ballroom
The GI tract: could it be the missing link between obesity and diabetes?
11:00 am - 11:05 am Introduction F. Rubino (New York, NY USA)
11:05 pm - 12:00 pm Panel Discussion M.S. Brown (Dallas, TX USA) , J.L. Goldstein (Dallas, TX USA) , G. Shulman (New Haven, CT USA) , S. Klein (St. Louis, MO USA) , R. DeFronzo (San Antonio, TX USA) , S.E. Kahn (Seattle, WA USA) , J. Roth (Manhasset, NY USA) , L.M. Kaplan (Boston, MA USA)
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 33 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Scientific Program
WEDNESDAY, MARCH 30, 2011 (continued)
EXECUTIVE SUMMARIES/TAKE HOME MESSAGE 12:00 pm - 1:15 pm Grand Ballroom
Presentation of Executive Summaries and Conclusions Chairs: M. Sue Kirkman (Alexandria, VA USA) • W. Pories (Greenville, NC USA)
12:00 pm - 12:12 pm Clinical Practice H.E. Lebovitz (Brooklyn, NY USA) 12:12 pm - 12:24 pm Priorities for Clinical Research D.E. Cummings (Seattle, WA USA) 12:24 pm - 12:36 pm Reconciling Guidelines P. Zimmet (Melbourne, Australia) 12:36 pm - 12:48 pm Public Health Policies D. Flum (Seattle, WA USA) 12:48 pm - 1:00 pm The evolving paradigm of diabetes pathogenesis J. Roth (Manhasset, NY USA)
1:00 pm - 1:15 pm INTERACTIVE OPINION POLLS
1:15 pm - 1:20 pm CLOSING REMARKS
34 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Faculty Index A L Accili, Domenico ...... 33 Laferrere, Blandine B...... 28, 31 Adams, Ted D...... 27 Lakdawala, M...... 32 Alberti, K. George ...... 26, 27 Lautz, David B...... 29, 31 Amiel, Stephanie A...... 26 Lebovitz, Harold E...... 26, 27, 28, 30, 34 Apovian, Caroline M...... 27, 32 Lefevre, Frank ...... 29, 32 Aronne, Louis ...... 27, 30 Leibel, Rudolph L...... 33 LeRoux, Carel W...... 28, 31 B Ley Ruth, E...... 33 Basso, Nicola ...... 32 Li, Rui ...... 29 Bergman, Richard N...... 27, 28, 31, 33 Bloomgarden Zachary T...... 26 M Brethauer, Stacy A...... 28 McGraw, Timothy E...... 33 Brown, Michael S...... 33 Mechanick, Jeffrey I...... 26, 27, 30, 32 Buchwald, Henry ...... 26, 28, 30 Mingrone, Geltrude ...... 28, 31 Moore, J.J...... 29, 32 C Chowbey, Pradeep ...... 29, 30 P Cohen, Ricardo V...... 27, 28, 30, 32 Pi-Sunyer, Xavier ...... 26, 31, 32 Cummings, David E...... 28, 31, 33, 34 Pomp, Alfons ...... 26, 30 Pories, Walter J...... 26, 27, 28, 30, 34 D Darsow, Tamara ...... 29 R Darzi, Ara ...... 29 Roth, Jesse ...... 29, 33, 34 DeFronzo, Ralph ...... 27, 28, 29, 30, 33 Rubino, Francesco ...... 26, 29, 33 De Paula, Aureo ...... 28, 30 Del Prato, Stefano ...... 26, 27, 31 S Dixon, John ...... 26, 27, 30 Saoud, Moh'd. Fathy ...... 29 Schauer, Phillip ...... 26, 29, 30 E Schwartz, Gary J...... 28, 31 Eckel Robert H...... 26, 27 Seeley, Randy J...... 28 Shulman, Gerald ...... 33 F Sjöström, Lars V...... 26, 27 Ferrannini, Ele ...... 27, 28 Staten, Myrlene ...... 29, 31 Flum, David R...... 29, 32, 34 Sugerman, Harvery J...... 27, 30 Funder, John ...... 28, 29, 32 Sullivan, Sean D...... 29, 32
G V Gagner, Michel ...... 27, 30 Van Der Merwe, Tess ...... 29, 32 Galvao Neto, Manoel ...... 28, 31 Goldfine Allison B...... 26, 29, 31 W Goldstein, Joseph L...... 33 Wolfe, Bruce M...... 26, 32 Gotto, Antonio M...... 26, 27 Wysham, Carol H...... 26, 27 Greve, Jan Willem M...... 28, 30 Y H Young, James ...... 27, 30 Hill, Peter ...... 32 Hofmann, Bjørn M...... 29, 31 Z Holst, Jens Juul ...... 28, 33 Zimmet, Paul ...... 26, 29, 32, 34 Zirie, Mahmoud Ali ...... 29 J Ji, Linong ...... 27, 29, 32 Joshi, Shashank R...... 27, 28, 30
K Kahn, Steven H...... 27. , 28, 31, 33 Kaplan, Lee M...... 26, 28, 31, 33 Keating, Catherine ...... 29, 32 Kirkman, M. Sue ...... 32, 34 Klein Samuel ...... 28, 31, 33 Korner, Judith ...... 27, 28, 29, 30
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 35 Share the World Congress with your Staff and Colleagues!
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Purchase the DVD at the Congress Registration Desk or after the Congress at www.wcidt.org
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EXHIBITOR DIRECTORY
American Diabetes Foundation Ethicon Endo-Surgery Booth 207 Booth 102 Linda Cann Annie Havens +1.703.299.2068 +1.513.337.8645 [email protected] [email protected]
The American Diabetes Association is the leading non-profit Ethicon Endo-Surgery, a Johnson & Johnson company, organization focused on providing resources to health care develops and markets advanced medical devices for minimally professionals and people with diabetes to improve care and invasive and open surgical procedures, focusing on procedure- patient outcomes. The association has a worldwide professional enabling devices for the interventional diagnosis and treatment membership of over 15,000 and over 425,000 lay members. of conditions in general and bariatric surgery, as well as Join the new grassroots movement to “Stop Diabetes.” gastrointestinal health, gynecology and surgical oncology. More information can be found at www.ethiconendo.com. Allergan Booth 104 GI Dynamics Booth 106 Pat Allen +1.714.246.4667 Wade Fox [email protected] +1.781.357.3306 [email protected] Allergan has joined the effort to fight the growing obesity epidemic with the LAP-BAND ® Adjustable Gastric Banding GI Dynamics is focused on developing effective, non-surgical System, the first minimally invasive surgical approach approved approaches for treating type 2 diabetes and obesity. The in the United States by the FDA, to help patients achieve company's patented EndoBarrier ™ technology has the potential sustained weight loss, realize their goals for healthy living, and to deliver medical innovations for people combating diabetes reduce obesity-related risks. and weight problems or diabetes risk factors. Data from clinical trials demonstrate that the EndoBarrier may provide rapid improvement in glycemic control and significant weight loss by Covidien modifying metabolic pathways. Booth 100 Gaurav Lamba Gore Medical Products +1.203.821.4770 Booth 202 [email protected] Pamela Hickey Gina Baldo +1.410.506.8283 +1.203.821.4770 [email protected] [email protected] Gore Medical Products Division has provided creative Covidien is a leading global healthcare products company that therapeutic solutions to complex medical problems for three creates innovative medical solutions for better patient outcomes decades. During that time, more than 35 million Innovative and delivers value through clinical leadership and excellence. Gore Medical Devices have been implanted, saving and Covidien manufactures a diverse range of industry-leading improving the quality of lives worldwide. The extensive Gore products in five segments including Surgical and Energy-based Medical family of products includes vascular grafts, endovascular Devices. Please visit www.covidien.com to learn more. and interventional devices, surgical materials for hernia repair, soft tissue reconstruction, staple line reinforcement, and sutures for use in vascular, cardiac and general surgery.
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 37 Karl Storz Endoscopy-America Inc. Qatar Foundation and Booth 204 Hamad Medical Corporation Julia Benoit Booth 203 +1.800.421.0837 Ramez Jaber [email protected] +9.744.454.0855 [email protected] KARL STORZ Endoscopy-America, a leader for 65 years in endoscopy technologies, has earned a reputation for more Qatar Foundation for Education, Science and Community than its high-quality products. The company is also well Development (QF) is supporting Qatar on its journey from regarded for its commitment to advancing medical technology carbon economy to knowledge economy by unlocking human and research programs. Among these is dedication to the potential. This will not just benefit Qatar. It will benefit the world. research of Interventional Therapies for Type II Diabetes. QF is a private, non-profit organization founded in 1995 by His Highness Sheikh Hamad Bin Khalifa Al-Thani, Amir of Qatar. Its Chairperson and main driving force is Her Highness Sheikha Moza Bint Nasser.
QF carries out its mission through three strategic pillars: education, science and research, and community development. QF’s education pillar brings world-class universities to Qatar to help create an education sector in which young people can develop the attitudes and skills required for a knowledge economy. Meanwhile, its science and research pillar builds Qatar's innovation and technology capacity by developing and commercializing solutions through key sciences. Finally, its community development pillar helps foster a progressive society while also enhancing cultural life, protecting Qatar’s heritage and addressing immediate social needs in the community.
For a complete list of QF’s initiatives and projects, visit http://www.qf.org.qa
Rhinelander Gallery - Exhibits and Posters
WIFI HOTSPOT AREA
206 204 202 200
207 205 203 201
100 106 104 102
ENTRANCE
38 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Please refer to the Abstract Book for POSTER SESSIONS Rhinelander Gallery
Poster Display and Viewing: Monday, March 28: 7:00 am - 6:45 pm Tuesday, March 29: 6:30 am - 3:00 pm
Poster Sessions: One of the authors is required to attend his or her poster as follows. The formal poster session will be on Monday March 28 from 5:45 pm-6:45 pm. The Presenting Author is highlighted in bold
Please refer to the Abstract Book for the complete listing of Poster Sessions and Abstracts
An Author Index is included immediately following the Abstracts Listing.
*Special Note: Posters marked with YIA are competing for the Young Investigator Award .
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 39 40 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Diabetes: A Global Epidemic
I Diabetes currently affects 285 million people worldwide I Type 2 diabetes has become the most frequent and is expected to affect 438 million by 2030. condition in people with kidney failure in countries of the Western world. The reported incidence varies I In 2010, the five countries with the largest numbers of between 30% and 40% in countries such as Germany people with diabetes were India (50.8 million), China and the USA. (43.2 million), the United States (26.8 million), Russia (9.6 million), and Brazil (7.6 million). I 10% to 20% of people with diabetes die of renal failure.
I I In 2010, the five countries with the highest diabetes It is estimated that more than 2.5 million people prevalence in the adult population were Nauru (30.9%), worldwide are affected by diabetic retinopathy. United Arab Emirates (18.7%), Saudi Arabia (16.8%), I Diabetic retinopathy is the leading cause of vision Mauritius (16.2%), and Bahrain (15.4%). loss in adults of working age (20 to 65 years) in I By 2030, the largest increases in diabetes prevalence will industrialized countries. take place in developing countries. I On average, people with type 2 diabetes will die 5-10 I Each year a further 7.7 million people develop diabetes. years before people without diabetes, mostly due to cardiovascular disease. I Each year 4 million deaths are attributable to diabetes. An even greater number die from cardiovascular disease I Cardiovascular disease is the major cause of death in made worse by diabetes-related lipid disorders and diabetes, accounting for some 50% of all diabetes hypertension. fatalities, and much disability.
I Every 10 seconds a person dies from diabetes-related I People with type 2 diabetes are over twice as likely to causes. have a heart attack or stroke as people who do not have diabetes. Indeed, people with type 2 diabetes are as likely I Every 10 seconds two people develop diabetes. to suffer a heart attack as people without diabetes who have already had a heart attack. I Diabetes is the fourth leading cause of global death by disease.
I At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%.
I At least 60% of new cases of type 2 diabetes is Sources : preventable by adopting a healthy diet and increasing Diabetes Atlas, fourth edition, physical activity. International Diabetes Federation, 2009. Diabetes Fact Sheets: I Diabetes is the largest cause of kidney failure in developed Time to Act, International Diabetes Federation, 2004. countries and is responsible for huge dialysis costs. World Health Organisation Diabetes Unit - www.who.int/diabetes.
Diabetes currently affects 285 million people worldwide, according to the International Diabetes Federation (IDF).
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 41
Conventional Bariatric/Metabolic Procedures
Roux-en-Y Gastric Bypass (RYGB) After its first report by Edward Mason in 1967, the technique of gastric bypass has undergone several modifications. The current technique involves the use of a surgical stapler to create a small and vertically oriented gastric pouch usually less than 30 cc in size. The upper pouch, which is completely divided from the gastric remnant is anastomosed to the jejunum (between 30 and 75 cm from the ligament of Treitz). Bowel continuity is restored by an entero-entero anastomosis between the excluded biliary limb and the alimentary limb usually 75-to 100 cm distal to the gastro-jejunostomy. After RYGB, ingested food bypasses approximately 95% of the stomach, the entire duodenum and a portion of the jejunum, but bile and nutrients mix in the distal jejunum and can be absorbed through the remaining portion of the small bowel (jejunum-ileum).
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 43 Conventional Bariatric/Metabolic Procedures
Laparoscopic Adjustable Gastric Banding (LAGB) The LAGB is a restrictive procedure that involves encircling the upper part of the stomach with a band-like, saline-filled tube just distal to the gastroesophageal junction. The amount of restriction may be adjusted by injecting or withdrawing saline solution from the hollow core of the band through a subcutaneous port.
Sleeve Gastrectomy (SG) Sleeve gastrectomy is a component of BPD-DS; an opera - tion that can be performed in two stages (sleeve gastrec - tomy first, followed by the intestinal rearrangement months later) to reduce operative time and minimize surgical risk in super-obese patients (BMI>60). The dramatic weight loss consequent to the first stage of the BPD-DS has encouraged the use of SG as a stand-alone procedure. In addition to reducing the capacity of the stomach, SG eliminates the ghrelin-rich gastric fundus and can cause changes in intra-gastric pressure and gastric motility, all of which might play a role in the mechanism of action of the operation. Sleeve gastrectomy has been also shown to substantially improve diabetes in severely obese patients as well as in experimental rodent models of diabetes. The long-term (>5 years) clinical efficacy of the procedure is still under investigation.
44 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org Conventional Bariatric/Metabolic Procedures
Biliopancreatic Diversion (BPD) and BPD-DS The operation involves a gastric resection (usually leaving behind a 200-500 ml sized stomach) + a long intestinal bypass. The gastric resection can be horizontal as in the Scopinaro procedure (Fig 1A) or vertical - “sleeve gastrectomy” in its variant named “BPD-Duodenal Switch”- Fig 1B). The remnant stomach is anastomosed to the distal 250 cm of small intestine (called alimentary limb). The excluded small intestine (including the duodenum, the jejunum and part of the proximal ileum) carries the bile and pancreatic secretions (biliary limb) and Figure 1A is connected to the alimentary channel just 50-100 cm proximal to the ileocecal valve. The short segment of small bowel where bile and nutrients mix is called “common limb” and is the only site where fat and starches are absorbed, whereas the alimentary limb (usually 200-250 cm in length) allows only partial absorption of nutrients.
Figure 1B
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 45 Investigational Gastrointestinal Procedures
Duodenal-Jejunal Bypass (DJB) Originally described by Rubino as an experimental procedure to investigate mechanisms of action of gastric bypass surgery, the operation consists of a stomach- preserving bypass of a short segment of proximal small intestine, equivalent to the amount of intestine bypassed in a standard gastric bypass (RYGB). A variant of this procedure includes the association of proximal intestinal Figure 2A bypass with sleeve resection of the stomach (DJB-SG- Fig 2B) to reduce potential for marginal ulcerations and potentially increase clinical efficacy. These procedures have been used to treat diabetes in low BMI patients (R. Cohen and others). Long-term efficacy data are not yet available and these procedures should be considered investigational in humans.
Figure 2B
46 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org Investigational Gastrointestinal Procedures
Ileal Interposition (IT) The concept of ileal-interposition was first described by Koopmans and Sclafani in rodents experiments as a weight loss procedure. A small segment of ileum with its vascular and nervous supplies intact, is surgically interposed into the proximal small intestine, accelerating its exposure to ingested nutrients. IT can be performed alone or in association with sleeve gastrectomy and duodenal exclusion. The procedure requires a minimum of 3 anastomosis (vs the 2 of gastric bypass operations) and is technically complex, especially when associated with sleeve gastrectomy or duodenal exclusion. Early human studies suggest that these procedures can improve diabetes in non-obese subjects; however, long-term metabolic sequalae are unknown, and long-term safety is still to be evaluated. The procedure should be considered experimental in humans.
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 47 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Disclosures
Faculty Disclosures
Apovian, Caroline M. Dixon, John B. Consultant: Amylin, Orexigen, Allergan, Pfizer, Johnson & Consultant: Allergan Inc., Metagenics (Bariatric Advantage), Johnson, Abott, Merck, GI Dynamics Scientific Intake Grant/Research: Atkins Foundation, MetaProteomics, Amylin, Speaker’s Bureau: Metagencis (Bariatirc Advantage), Eli Lilly, Orexigen Nestle Australia, Optifast Medical Advisory Board Grant/Research (Principal): Allergan Inc., Nestle Australia, Opti - Aronne, Louis J. fast Medical Advisory Board, ResMed, Scientific Intake Contracted Research: Amylin Pharmaceuticals, Inc., Course Director: Florida Hospital F. Hoffmann-La Roche Ltd., Novo Nordisk, Orexigen Course Co-Director: MISS Therapeutics, Inc. Consultant/Advisory Boards: Abbott Laboratories, Amylin Funder, John Pharmaceuticals, Inc., GI Dynamics, Inc., Roche Laboratories, Consultant: Pfizer, Merck, CBio, Allergan, Novo NorDisk Inc., Johnson & Johnson, NeuroSearch, Inc., Novo Nordisk, Orexigen Therapeutics, Inc., VIVUS, Inc., GlaxoSmithKline Gagner, Michel Consumer Healthcare, LP Speaker’s Bureau: Ethicon, Olympus, CineMed, Coviden Ownership Interest: Cardiometabolic Support Network, LLC Grant/Research Support (Principal): GORE
Bergman, Richard N. Galvao Neto, Manoel Consultant: Tethys Consultant: Ethicon Endo Surgery, GI Dynamics Grant/Research Support (Principal): Amylin Greve, Jan Willem M. Bloomgarden, Zachary T. Consultant: GI Dynamics Consultant: BMS/AZ, Merck, Novo Nordisk Grant/Research Support (Principal): GI Dynamics Speaker’s Bureau: Merck, Novo Nordisk, GlaxoSmithKlien, Kahn, Steven H. BMS BI Consultant: Boenringer Ingelheim, Eli Lilly, GlaxoSmithKlien, Stock Shareholder (self managed): Bard, CVS, Roche, Novartis, Intarcia Therapeutics, Merck, Novo Nordisk St. Jude Grant/Research: Daiichi Sankyo Brethauer, Stacy A. Kaplan, Lee Consultant: Ethicon Endo Consultant: GI Dynamics Speaker’s Bureau: Ethicon Endo, Covidien Grant/Research (Principal): GI Dynamics Grant/Research Support (Principal): Bard/Davol, Ethicon Endo Keating, Catherine Buchwald, Henry Grant/Research Support (Principal): Allergan Health Consultant: Ethicon Endo-Surgery, Fulfillium, Metacure Grant/Reserach Support (Principal): Meacure, Ethicon Klein, Samuel Endo-Surgery, WE Gore Consultant: Amylin, Dannon/Yakult, Ethicon Endosurgery, Stock Shareholder (self managed): Metacure Merck, Orexigen, Takeda Pharmaceuticals, Vivus Pharmaceuticals Cummings, David E. Speaker’s Bureau: Merck Grant/Research (Principal): Johnson & Johnson, Ethicon Grant/Research Support (Principal): National Institute of Health Endosurgery (NIH), Barnes-Jewish Hospital Foundation, DSM Nutritional Darsow, Tamara Products, Endo-Ethicon Surgery, Pfizer Stock Shareholder (self managed): Amylin Stockholder: Aspirations Medical Technologies Endowments: Atkins Foundation Charitable Trust, Kilo Darzi, Ara Foundation Consultant: Covidien Korner, Judith DeFronzo, Ralph Grant/Research Support (Principal): Covidien Consultant: Takeda, Amylin, ISIS, Boehringer Ingelheim Scientific Advisory Board: Nutrisystem Speaker’s Bureau: Novo Nordisk Grant/Reserach Support (Principle): Takeda, Amylin Lautz, David Grant/Research (Principal): Covidien Del Prato, Stefano Speaker’s Bureau: GlaxoSmithKline, Sanofi-Aventis Lebovitz, Harold E. Grant/Research Support (Principle): Merck & Co., Sanofi-Aventis, Consultant: Amylin Corporation, Astra-Zeneca, Biocon Pharma, Novo Nordisk Enzymotec, Glaxo Smith Kline (International), MetaCure, Advisory Panels: Novartis Pharmaceuticals, Merck & Co., Sanofi-Aventis Roche Pharmaceuticals, Roche Diagnostics Corporation, Pfizer Speaker’s Bureau: Glaxo Smith Kline (International) Inc., Eli Lilly & Co., Amylin Pharmaceuticals, Inc., Mannkind Stockholder: Merck Corporation; Boehringer Ingelheim, Bristol-Meyers Squibb, Advisory Board: Amylin Corporation, ATTCC, Biocon Pharma, Novo Nordisk Indigene, Intra Pharmaceuticals, Merck, MetaCure, Poxel Pharma
48 2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 2nd World Congress on Interventional Therapies for Type 2 Diabetes
Disclosures
Faculty Disclosures Faculty With No Conflicts of Interest
Pi-Sunyer, Xavier Accili, Domenico Consultant: Amylin, McNeil Nutritionals, Novo Nordiak, Vivus Adams, Ted D. Inc., Weight Watchers, Orezigen Alberti, Sir K. George Amiel, Stephanie A. Pories, Walter J. Basso, Nicola Consultant: Johnson & Johnson Brown, Michael S. Grant/Research (Principal): Johnson & Johnson, GlaxoSmithKline Chowbey, Pradeep Cohen, Ricardo V. Rubino, Francesco De Paula, Aureo Ludovico Consultant: NGM Biotech Eckel, Robert H. Grant/Research Support (Principal): Covidien, Roche Ferrannini, Ele Schauer, Phillip Flum, David R. Consultant: Gore Goldfine, Allison B. Grant/Research (Principal): Baxter, Covidien, Allergan Goldstein, Joseph L. Board of Directors: Remedy MD, Surgical Excellence LLC Gotto, Jr., Antonio M. Scientific Advisory Board: Ethicon Endosurgery, Stryker Hill, Peter Endoscopy, Bard-Davol, Barosense, Surgiquest, Hofmann, Bjorn Cardinal/Snowden Pencer Holst, Jens Juul Holst Ji, Linong Seeley, Randy J. Joshi, Shashank R. Consultant: Ethicon Endo Kirkman, Sue Speaker’s Bureau: Novo Nordisk Laferrere, Blandine B. Grant/Research Support (Principal): Ethicon Endo, Novo Lakdawala, Muffazal Abdulkader Nordisk Le Roux, Carel W. Lefevre, Frank Sjöström, Lars V. Leibel, Rudolph L. Consultant: AZ, Johnson & Johnson, Several Ley, Ruth Grant/Research Support (Principle): Johnson & Johnson, Li, Rui Roche, Sanofi McGraw, Timothy E. Wysham, Carol H. Mechanick, Jeffrey I. Consultant: Amylin Pharmaceuticals Mingrone, Geltrude Speaker’s Bureau: Sanofi Aventis, Amylin Pharma Moore, John J. Pomp, Alfons Roth, Jesse Saoud, Mohammed Fathy Schwartz, Gary Shulman, Gerald Staten, Myrlene Sugerman, Harvey J. Sullivan, Sean D. Van Der Merwe, Tess Wolfe, Bruce Young, James Zimmet, Paul Zirie, Mahmoud Ali
2nd World Congress on Interventional Therapies for Type 2 Diabetes • March 28-30, 2011 • New York, NY, USA • www.wcidt.org 49 2nd World Congress on Interventional Therapies for Type 2 Diabetes
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