Metabolic Surgery Procedures for Treating Type 2 Diabetes 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 the four most common types of metabolic surgery.
  • Roux-en-Y gastric bypass (RYGB) appears to have a more favorable risk-benefit profile than other surgery options in most patients with type 2 diabetes.
  • Vertical sleeve Gastrectomy (VSG) is an effective procedure that results in effective weight loss and major improvements in type 2 diabetes, as least in the short to medium term (1-3 years) in RCTs. It is the most commonly performed procedure, but the long-term effects from RCTs are relatively unknown. It could be a valuable option to treat diabetes in patients concerned about the risk of operations that involve bowel diversion.
  • Laparoscopic adjustable gastric banding (LAGB) is effective in improving glycemia in patients with obesity and type 2 diabetes, to the degree that it causes weight loss. The procedure has a greater risk for reoperation/revision compared with RYGB due to failure or band-related complications.
  • Biliopancreatic diversion (BPD) classic or duodenal switch variant (BPD-DS) may be the most effective procedure for glycemic control and weight loss, but the complex procedure is associated with long-term nutritional and micronutrient deficiencies with related complications (eg, anemia, bone demineralization, hypoproteinemia). Its risk-benefit profile is less favorable than that of the other bariatric/metabolic procedures for most patients, with the exception of patients with extreme levels of obesity (BMI>60 kg/m2).

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