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New guidelines propose that surgery be considered a standard treatment option for type 2 diabetes

New clinical guidelines published 24 May 2016 and endorsed by leading international diabetes organisations, including the International Diabetes Federation (IDF), call for bariatric surgery, involving the manipulation of the stomach or intestine, to be considered a standard treatment option for type 2 diabetes.

The guidelines, published in Diabetes Care, recommend surgery to induce weight-loss for certain categories of people living with type 2 diabetes, which accounts for the majority of the estimated 415 million cases of diabetes worldwide(1). The recommendation is based on evidence from multiple clinical trials that bariatric surgery can improve blood glucose levels more effectively than lifestyle or pharmaceutical interventions in obese people with type 2 diabetes.

Overweight and obesity are major risk factors for type 2 diabetes. Bariatric surgery involves the removal of part of the stomach or a reroute of the small intestine. Although it is as safe as other common operations such as gallbladder surgery, there are risks of complications and long-term nutritional deficiencies that require rigorous long-term follow-up by expert teams.

“The management of type 2 diabetes is placing an increasing burden on individuals and families, national health systems and countries,” said Dr David Cavan, Director of Policy and Programmes at IDF. “It is therefore important that effective treatment options are made available to all people living with type 2 diabetes.”

Type 2 diabetes is a major cause of blindness, kidney failure, lower limb amputations, heart attacks and stroke. IDF estimated that in 2015 over USD670 billion was spent globally to treat diabetes and prevent complications (1). Despite this, less than 50% of people with type 2 diabetes currently achieve the appropriate blood glucose levels to avoid or reduce the risk of long-term complications.

The new guidelines, which emerged from the Second Diabetes Surgery Summit (DSS-II) held in London in September 2015 as a collaboration between IDF, Diabetes UK, American Diabetes Association, Chinese Diabetes Society and Diabetes India, recommend bariatric surgery for people with type 2 diabetes who have a BMI of 40 and those with a BMI of 30 who are not able to adequately control their blood glucose levels through other means. This threshold is lower for people of Asian descent.

This is the first time that guidelines recommend surgery as a specific treatment option for type 2 diabetes. “My hope is that the new guidelines will help stimulate a healthier public debate about surgical intervention in diabetes, based on scientific evidence,” said Professor Francesco Rubino, Chair of Metabolic and Bariatric Surgery at King’s College London, Consultant surgeon at King’s College Hospital and first author on the guidelines report.

The guidelines, which include a series of articles, a joint statement and commentary, can be viewed here.