Bariatric surgery should be an option for treating type 2 diabetes, societies say

Bariatric surgery should be included in guidelines as a treatment option for people with type 2 diabetes and obesity, leading diabetes societies have recommended in a joint statement that formally recognised surgery for the first time as a standard therapeutic intervention for the condition.1

A multidisciplinary group of 48 clinicians and academics, including representatives of diabetes societies, met to review the scientific and clinical evidence for bariatric surgery—which they termed “metabolic surgery” in recognition of the effects on glycaemic control in addition to weight loss. The group discussed research published between 2005 and 2015 before agreeing on recommendations that were then circulated for consultation by other professionals and the public.

In its final statement, the group suggested that metabolic surgery should be recommended to treat type 2 diabetes in patients with a body mass index (BMI) of 40.0 kg/m² and higher regardless of the level of glycaemic control, as well as in patients with a BMI of 35.0-39.9 kg/m² where hyperglycaemia is inadequately controlled by lifestyle and optimal medical therapy.

The group also suggested that metabolic surgery should be considered for patients with type 2 diabetes and a BMI of 30.0-34.9 kg/m² where hyperglycaemia is not controlled despite optimal treatment with either oral or injectable medications. They said that the BMI thresholds should be reduced by 2.5 kg/m² for Asian patients.

They said that this development could be one of the most significant changes in diabetes care since the introduction of insulin in the 1920s.

“Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage type 2 diabetes,” the statement authors—led by Francesco Rubino, from King’s College London, UK, and David Cummings, from the University of Washington, Seattle, US—said.

“Despite growing evidence that metabolic surgery powerfully improves type 2 diabetes, existing diabetes treatment algorithms do not include surgical options,” they said.

The panel concluded that, “Although additional studies were needed to further demonstrate long term benefits, there was sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with type 2 diabetes and obesity.”

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