Metabolic Surgery for Type 2 Diabetes Treatment Guidelines PPT | NDEI

  • The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, convened with international diabetes organizations to develop global guidelines for the use of metabolic (bariatric) surgery for the treatment of type 2 diabetes.
  • This slide reviews the main recommendations of the DSS-II consensus conference.
  • 11 RCTs (postoperative follow-up 1-5 yrs) have documented sustained diabetes remission in 30-63% of patients. The majority of patients who undergo surgery maintain substantial improvement of glycemic control from baseline for at least 5-15 years. GI surgery has also shown greater reductions in CVD risk factors and enhancements in quality of life compared withmedical/lifestyle interventions.
  • Beyond inducing weight loss-related metabolic improvements, some bariatric/metabolic surgeries engage mechanisms such as changes in gut hormones, bile acid metabolism, microbiota, intestinal glucose metabolism, and nutrient sensing.
  • The majority of these RCTs have only examined 1- to 2-year results, and only a handful of them have examined results for 3-5 years. Further evaluation of long-term outcomes of bariatric/metabolic surgery compared with medical/lifestyle interventions are needed.
  • Metabolic surgery is recommended to treat type 2 diabetes in patients with class III (BMI ≥40 kg/m2) and class II (BMI 35.0–39.9 kg/m2) obesity when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Historically, a BMI ≥35 kg/m2 is the most commonly used threshold for traditional bariatric surgery.

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;39:861-877.

June 2016