Guidelines Recommend Metabolic Surgery for Obese Patients with Diabetes

Metabolic surgery is recommended for the treatment of obese adults with type 2 diabetes, according to new international guidelines coming out of the 2nd Diabetes Surgery Summit (DSS-II). The guidelines were endorsed by 45 professional medical and surgical societies.

While previous research has shown metabolic and bariatric surgery to be an effective method of improving type 2 diabetes, existing treatment algorithms have neglected to include them.
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For this reason, the DSS-II was convened in order to develop global guidelines and explore the benefits and limitations of surgery for type 2 diabetes.

A group of 48 clinicians and scholars evaluated available evidence, then used Delphi-like questionnaires to measure consensus on 32 conclusions. These conclusions were put to public comment at both the DSS-II and the 3rd World Congress on Interventional Therapies for Type 2 Diabetes.

Among the recommendations:

  • Metabolic surgery should be recommended for patients with a body mass index of 40 kg/m2 or above and type 2 diabetes, or in those with a BMI of 35-29.9 kg/m2 with poor glucose control despite treatment.
  • Surgery should be considered in patients with poor glucose control and BMI of 30-34.9 kg/m2, despite use of insulin or oral medications.

“Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with type 2 diabetes and obesity,” the researchers concluded.

—Michael Potts

Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6): 861-877.