International call for bariatric surgery to be used as treatment for type 2 diabetes

by Barbara Hewitt on May 25, 2016

Obesity surgery, also known as bariatric surgery, should be recognised as a standard treatment option for type 2 diabetes, according to a leading group of international diabetes organisations.

In a joint statement, the group states that surgery ought to be recommended to treat people with type 2 diabetes who have certain levels of Body Mass Index such as 40 and over or 37.5 and over for Asian people, regardless of their blood glucose control.

It also included a BMI of 35 and over, or 32.5 and over for Asian people, for those whose blood glucose levels are inadequately controlled by lifestyle changes and blood glucose lowering medication.


And for those with a BMI of 30 and over, or 27.5 and over for Asian people, whose blood glucose levels are inadequately controlled by lifestyle changes and blood glucose lowering medication.

The guidelines are based on a wide body of evidence, including 11 randomised trials, showing that in most cases surgery can lead to reductions in blood glucose levels below the type 2 diabetes diagnosis threshold or a substantial improvement in blood glucose levels leading to a reduction in medication. Economic studies also show that the treatment can be cost effective.

The new guidelines emerged from the Second Diabetes Surgery Summit (DSS-II), an international consensus conference held last year in London, and jointly organised with Diabetes UK, the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, and Diabetes India. The goal of the Summit was to develop global guidelines to inform clinicians and policy makers about benefits and limitations of type 2 diabetes surgery.

Charity Diabetes UK is among the organisations making the recommendations. “We strongly support the call for obesity surgery to be fully recognised as an active treatment option for type 2 diabetes alongside established forms of type 2 diabetes treatments, such as lifestyle changes, and blood glucose lowering medications because there is a wide body of evidence that shows surgery is an effective treatment option for type 2 diabetes and can be cost effective for the NHS,” said Simon O’Neill, Director of Health Intelligence and Professional Liaison at Diabetes UK.

“However, many people who stand to benefit from this potentially lifesaving treatment are missing out due to needless barriers to obesity surgery services. Even people who meet the criteria for the surgery are being made to wait too long, even though we know that people with type 2 diabetes benefit most from the surgery if it is carried out closer to the time they were diagnosed,” he explained.

He pointed out that it is also essential that healthcare professionals are aware of the potential benefits of surgery for their patients with type 2 diabetes and commissioners ensure they have measures in place to support greater access to obesity surgery services.

“Type 2 diabetes is a serious health condition that can lead to debilitating and life threatening complications so it is essential that all effective treatment options for people with Type 2 diabetes are made available,” O’Neill added.

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, said that the UK is in the midst of an epidemic of diabetes, like many other countries around the world, and prevention of type 2 diabetes remains crucial.

“Prevention, however, is obviously no longer an option for the many patients diagnosed with type 2 diabetes. These patients should have access to all effective treatment options; for some, surgery may be the best choice,” he added.

Obesity surgery involves the removal of part of the stomach or reroutes the small intestine. Examples of these procedures include a gastric bypass where the stomach is made smaller and food is allowed to bypass part of the small intestines, gastric banding where an adjustable band is placed around the upper part of the stomach to create a pouch which can only hold small amount of food so you feel full quickly and a gastric sleeve where a stapling device is used to remove a large portion of the stomach.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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