Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations
Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading dia...
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| Published in | Diabetes care Vol. 39; no. 6; pp. 861 - 877 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article Conference Proceeding |
| Language | English |
| Published |
United States
American Diabetes Association
01.06.2016
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options.
The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D.
A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee.
Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients.
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 T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies. |
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| AbstractList | Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m^sup 2^) and in those with class II obesity (BMI 35.0-39.9 kg/m^sup 2^) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m^sup 2^ if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m^sup 2^ for Asian patients. 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 T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies. BACKGROUNDDespite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options.AIMThe 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D.METHODSA multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee.RESULTSGiven its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients.CONCLUSIONSAlthough 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 T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies. Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. 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 T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies. |
| Author | Herman, William H. Klupa, Tomasz Vidal, Josep Sadikot, Shaukat M. Dixon, John B. Wolfe, Bruce M. Cefalu, William T. Van Gaal, Luc Mingrone, Geltrude Morton, John M. Bhatt, Deepak L. Cohen, Ricardo V. Frühbeck, Gema Mechanick, Jeffrey I. Ratner, Robert E. Amiel, Stephanie A. Lee, Wei-Jei Sugerman, Harvey J. Johnston, Desmond G. Alberti, K. George M.M. Kelly, Tracy Grant, Richard W. Kaplan, Lee M. Lebovitz, Harold E. Fioretto, Paola Taroncher-Oldenburg, Gaspar Dinneen, Sean F. Ferrannini, Ele Del Prato, Stefano Courcoulas, Anita P. Laferrère, Blandine Cummings, David E. Albache, Nizar le Roux, Carel W. Eckel, Robert H. Ji, Linong Boza, Camilo Nathan, David M. Kashyap, Sangeeta R. Pories, Walter J. Rayman, Gerry Rubino, Francesco Schauer, Philip R. Zimmet, Paul Z. Batterham, Rachel L. Gagner, Michel Ikramuddin, Sayeed Korner, Judith Weng, Jianping |
| Author_xml | – sequence: 1 givenname: Francesco surname: Rubino fullname: Rubino, Francesco organization: King’s College London, London, U.K – sequence: 2 givenname: David M. surname: Nathan fullname: Nathan, David M. organization: Harvard Medical School, Boston, MA – sequence: 3 givenname: Robert H. surname: Eckel fullname: Eckel, Robert H. organization: University of Colorado Anschutz Medical Campus, Aurora, CO – sequence: 4 givenname: Philip R. surname: Schauer fullname: Schauer, Philip R. organization: Cleveland Clinic, Cleveland, OH – sequence: 5 givenname: K. George M.M. surname: Alberti fullname: Alberti, K. George M.M. organization: Imperial College London, London, U.K – sequence: 6 givenname: Paul Z. surname: Zimmet fullname: Zimmet, Paul Z. organization: Monash University, Melbourne, Victoria, Australia – sequence: 7 givenname: Stefano surname: Del Prato fullname: Del Prato, Stefano organization: University of Pisa, Pisa, Italy – sequence: 8 givenname: Linong surname: Ji fullname: Ji, Linong organization: Peking University, Beijing, China – sequence: 9 givenname: Shaukat M. surname: Sadikot fullname: Sadikot, Shaukat M. organization: Diabetes India, Mumbai, India – sequence: 10 givenname: William H. surname: Herman fullname: Herman, William H. organization: University of Michigan, Ann Arbor, MI – sequence: 11 givenname: Stephanie A. surname: Amiel fullname: Amiel, Stephanie A. organization: King’s College London, London, U.K – sequence: 12 givenname: Lee M. surname: Kaplan fullname: Kaplan, Lee M. organization: Harvard Medical School, Boston, MA – sequence: 13 givenname: Gaspar surname: Taroncher-Oldenburg fullname: Taroncher-Oldenburg, Gaspar organization: Philadelphia, PA – sequence: 14 givenname: David E. surname: Cummings fullname: Cummings, David E. organization: University of Washington, Seattle, WA – sequence: 15 givenname: Nizar surname: Albache fullname: Albache, Nizar – sequence: 16 givenname: Rachel L. surname: Batterham fullname: Batterham, Rachel L. – sequence: 17 givenname: Deepak L. surname: Bhatt fullname: Bhatt, Deepak L. – sequence: 18 givenname: Camilo surname: Boza fullname: Boza, Camilo – sequence: 19 givenname: William T. surname: Cefalu fullname: Cefalu, William T. – sequence: 20 givenname: Ricardo V. surname: Cohen fullname: Cohen, Ricardo V. – sequence: 21 givenname: Anita P. surname: Courcoulas fullname: Courcoulas, Anita P. – sequence: 22 givenname: Sean F. surname: Dinneen fullname: Dinneen, Sean F. – sequence: 23 givenname: John B. surname: Dixon fullname: Dixon, John B. – sequence: 24 givenname: Ele surname: Ferrannini fullname: Ferrannini, Ele – sequence: 25 givenname: Paola surname: Fioretto fullname: Fioretto, Paola – sequence: 26 givenname: Gema surname: Frühbeck fullname: Frühbeck, Gema – sequence: 27 givenname: Michel surname: Gagner fullname: Gagner, Michel – sequence: 28 givenname: Richard W. surname: Grant fullname: Grant, Richard W. – sequence: 29 givenname: Sayeed surname: Ikramuddin fullname: Ikramuddin, Sayeed – sequence: 30 givenname: Desmond G. surname: Johnston fullname: Johnston, Desmond G. – sequence: 31 givenname: Sangeeta R. surname: Kashyap fullname: Kashyap, Sangeeta R. – sequence: 32 givenname: Tracy surname: Kelly fullname: Kelly, Tracy – sequence: 33 givenname: Tomasz surname: Klupa fullname: Klupa, Tomasz – sequence: 34 givenname: Judith surname: Korner fullname: Korner, Judith – sequence: 35 givenname: Blandine surname: Laferrère fullname: Laferrère, Blandine – sequence: 36 givenname: Harold E. surname: Lebovitz fullname: Lebovitz, Harold E. – sequence: 37 givenname: Wei-Jei surname: Lee fullname: Lee, Wei-Jei – sequence: 38 givenname: Carel W. surname: le Roux fullname: le Roux, Carel W. – sequence: 39 givenname: Jeffrey I. surname: Mechanick fullname: Mechanick, Jeffrey I. – sequence: 40 givenname: Geltrude surname: Mingrone fullname: Mingrone, Geltrude – sequence: 41 givenname: John M. surname: Morton fullname: Morton, John M. – sequence: 42 givenname: Walter J. surname: Pories fullname: Pories, Walter J. – sequence: 43 givenname: Robert E. surname: Ratner fullname: Ratner, Robert E. – sequence: 44 givenname: Gerry surname: Rayman fullname: Rayman, Gerry – sequence: 45 givenname: Harvey J. surname: Sugerman fullname: Sugerman, Harvey J. – sequence: 46 givenname: Luc surname: Van Gaal fullname: Van Gaal, Luc – sequence: 47 givenname: Josep surname: Vidal fullname: Vidal, Josep – sequence: 48 givenname: Jianping surname: Weng fullname: Weng, Jianping – sequence: 49 givenname: Bruce M. surname: Wolfe fullname: Wolfe, Bruce M. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27222544$$D View this record in MEDLINE/PubMed |
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| CODEN | DICAD2 |
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| Snippet | Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include... BACKGROUNDDespite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not... |
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| SubjectTerms | Algorithms Bariatric Surgery - standards Cardiovascular Diseases - prevention & control Consensus Cooperative Behavior Diabetes Diabetes Mellitus, Type 2 - surgery Disease control Endocrinology - organization & administration Endocrinology - standards Gastrointestinal surgery Health care policy Humans Hyperglycemia Internationality Obesity Obesity - surgery Practice Guidelines as Topic Risk Factors Societies, Medical - organization & administration Societies, Medical - standards Surgical outcomes |
| Title | Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations |
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