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Joint statement recommends bariatric surgery as treatment for type 2 diabetes
Bariatric surgery should be considered part of the standard of care in the treatment of type 2 diabetes for certain patients, according to a joint consensus statement endorsed by 45 international professional organizations.
The statement marks the first time that bariatric surgery is being recommended as a treatment option specifically for diabetes.
“Surgery represents a radical departure from conventional approaches to diabetes,” Francesco Rubino, MD, professor of metabolic and bariatric surgery at King’s College London, said in a press release. “The new guidelines effectively introduce, both conceptually and practically, one of the biggest changes for diabetes care in modern times. This change is supported by documented clinical efficacy and by the evidence of an important role of the gut in metabolic regulation, which makes it an appropriate target for antidiabetes interventions.”
Rubino, along with a multidisciplinary group of 48 researchers (75% nonsurgeons), participated in the second Diabetes Surgery Summit (DSS-II), an international consensus conference convened in September and organized by the American Diabetes Association, International Diabetes Federation, Diabetes UK, Chinese Diabetes Society and Diabetes India. The goal of the summit was to develop global guidelines to inform clinicians about the benefits and limitations of bariatric surgery for type 2 diabetes.
The researchers used three rounds of Delphi-like questionnaires to measure consensus for 32 data-based conclusions; drafts were then presented at the DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes, where they were open to public comment.
The researchers concluded that numerous randomized controlled trials demonstrated that patients who underwent bariatric surgery achieved glycemic control and reduced their cardiovascular risk. They recommended metabolic surgery to treat patients with type 2 diabetes and class III obesity (BMI 40 kg/m²), and type 2 diabetes and class II obesity (BMI 35-39.9 kg/m²) when lifestyle and medical therapy fail to control hyperglycemia. Researchers also recommended bariatric surgery be considered for patients with type 2 diabetes and a BMI between 30 kg/m² and 34.9 kg/m², if those patients cannot maintain glycemic control with oral or injectable medications.
The researchers noted that the BMI thresholds should be reduced by 2.5 kg/m² for Asian patients.
“When medications and lifestyle modifications do not work to control type 2 diabetes, metabolic surgery is an effective and safe treatment for patients and physicians to consider,” Philip Schauer, MD, a bariatric surgeon and director of Cleveland Clinic's Bariatric and Metabolic Center, told Endocrine Today. “Physicians can find practical pre- and postoperations management guidelines in the document.”
Schauer said clinical trials during the past 10 years, including the Cleveland Clinic-led STAMPEDE trial, demonstrated the long-term benefits of metabolic surgery and its “legitimate place” along with other diabetes treatments. In 5-year follow-up data for STAMPEDE, patients with mild to moderate obesity and type 2 diabetes who underwent bariatric surgery had better glycemic control vs. patients assigned an intensive medical therapy approach.
“More research is underway to continue to study the long-term effects of surgery,” Schauer said.
The joint statement was published online in Diabetes Care. – by Regina Schaffer
Disclosure: The DSS-II and WCITD 2015 were supported by the International Diabetes Surgery Task Force, DIAMOND MetaCure, Fractyl, Gore, King’s College London, King’s College Hospital, MedImmune, NGM Biopharmaceuticals and Novo Nordisk. The sponsors played no role in the selection of voting delegates, the Delphi process, the meeting programming or writing of the joint statement. Schauer reports serving as a paid consultant for Ethicon.