Patient Selection Metabolic Surgery for Type 2 Diabetes Treatment Guidelines | 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 recommendations for selecting type 2 diabetes patients for metabolic surgery.
  • Eligibility should be assessed by a multidisciplinary team of specialists.
  •  Contraindications include diagnosis of type 1 diabetes (unless surgery is otherwise indicated, such as for severe obesity), drug or alcohol use, uncontrolled psychiatric illness, lack of comprehension of the risks/benefits, outcomes or alternatives, lack of commitment to nutritional supplementation and follow-up, and adolescent age.
  • Metabolic surgery is recommended as an option to treat type 2 diabetes in patients with:
    • Class III obesity (BMI ≥40 kg/m2)* regardless of the level of glycemic control or complexity of glucose-lowering regimens
    • Class II obesity (BMI 35.0-39.9 kg/m2)* with inadequately controlled hyperglycemia despite lifestyle and optimal medical therapy
  • Metabolic surgery may also be considered in patients with type 2 diabetes and Class I obesity (BMI 30.0-34.9 kg/m2)* whose glycemia is poorly controlled despite optimal medical treatment by oral or injectable medications.

*All BMI thresholds should be reconsidered depending on ancestry, and should be reduced by 2.5 kg/m2 for Asian patients.

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