The Diabetes Surgery Summit Consensus Conference: Recommendations for the Evaluation and Use of Gastrointestinal Surgery to Treat Type 2 Diabetes Mellitus
Abstract
OBJECTIVES: To develop guidelines for the use of gastrointestinal surgery to treat type 2 diabetes and to craft an agenda for further research. BACKGROUND: Increasing evidence demonstrates that bariatric surgery can dramatically ameliorate type 2 diabetes. Not surprisingly, gastrointestinal operations are now being used throughout the world to treat diabetes in association with obesity, and increasingly, for diabetes alone. However, the role for surgery in diabetes treatment is not clearly defined and there are neither clear guidelines for these practices nor sufficient plans for clinical trials to evaluate the risks and benefits of such "diabetes surgery." METHODS: A multidisciplinary group of 50 voting delegates from around the world gathered in Rome, Italy for the first International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes--(the "Diabetes Surgery Summit"). During the meeting, available scientific evidence was examined and critiqued by the entire group to assess the strength of evidence and to draft consensus statements. Through an iterative process, draft statements were then serially discussed, debated, edited, reassessed, and finally presented for formal voting. After the Rome meeting, statements that achieved consensus were summarized and distributed to all voting delegates for further input and final approval. These statements were then formally critiqued by representatives of several sientific societies at the 1st World Congress on Interventional Therapies for T2DM (New York, Sept 2008). Input from this discussion was used to generate the current position statement. RESULTS: A Diabetes Surgery Summit (DSS) Position Statement consists of recommendations for clinical and research issues, as well as general concepts and definitions in diabetes surgery. The DSS recognizes the legitimacy of surgical approaches to treat diabetes in carefully selected patients. For example, gastric bypass was deemed a reasonable treatment option for patients with poorly controlled diabetes and a body mass index > or =30 kg/m. Clinical trials to investigate the exact role of surgery in patients with less severe obesity and diabetes are considered a priority. Furthermore, investigations on the mechanisms of surgical control of diabetes are strongly encouraged, as they may help advance the understanding of diabetes pathophysiology. CONCLUSIONS: The DSS consensus document embodies the foundations of "diabetes surgery," and represents a timely attempt by leading scholars to improve access to surgical options supported by sound evidence, while also preventing harm from inappropriate use of unproven procedures.
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Controversies include whether PCOS is considered an obesity-related condition and may reduce BMI cut-offs.
“controversies, including whether PCOS is considered an obesity-related condition and may reduce BMI cut-offs, 271 need to be addressed. 270”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [271]
Cites
Stratton, I. M. (2000) · BMJ · doi:10.1136/bmj.321.7258.405 · Cited by 9,059 · see citing works
Bariatric Surgery: A Systematic Review and Meta-analysis
Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004) · JAMA · doi:10.1001/jama.292.14.1724 · Cited by 6,800 · see citing works
Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H., Lystig, T., Sullivan, M., Bouchard, C., Carlsson, B., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066254 · Cited by 4,668 · see citing works
Long-term mortality after gastric bypass surgery
Adams, T. D., Gress, R. E., Smith, S. C., Halverson, R. C., Simper, S. C., Rosamond, W. D., LaMonte, M. J., Stroup, A. M., & Hunt, S. C. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066603 · Cited by 2,572 · see citing works
Pories, W. J., Swanson, M. S., MacDonald, K. G., Long, S. B., Morris, P. G., Brown, B. M., Barakat, H. A., deRamon, R. A., Israel, G., Dolezal, J. M., et al. (1995) · Annals of Surgery · doi:10.1097/00000658-199509000-00011 · Cited by 2,293 · see citing works
Plasma Ghrelin Levels after Diet-Induced Weight Loss or Gastric Bypass Surgery
Cummings, D. E., Weigle, D. S., Frayo, R. S., Breen, P. A., Marina, K., Dellinger, E. P., & Purnell, J. Q. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa012908 · Cited by 2,239 · see citing works
Self-citationStandards of Medical Care in Diabetes—2009
American Diabetes Association (2009) · Diabetes Care · doi:10.2337/dc09-s013 · Cited by 2,167 · see citing works
Gastrointestinal Surgery for Severe Obesity
Panel, C. D. C. (1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-115-12-956 · Cited by 2,163 · see citing works
Diabetes in Asia: Epidemiology, Risk Factors, and Pathophysiology
Chan, J. C. N., Malik, V., Jia, W., Kadowaki, T., Yajnik, C. S., Yoon, K.-H., & Hu, F. B. (2009) · JAMA · doi:10.1001/jama.2009.726 · Cited by 1,997 · see citing works
Dixon, J. B., O’Brien, P. E., Playfair, J., Chapman, L., Schachter, L. M., Skinner, S., Proietto, J., Bailey, M., & Anderson, M. (2008) · JAMA · doi:10.1001/jama.299.3.316 · Cited by 1,434 · see citing works
Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity
Schauer, P. R., Ikramuddin, S., GOURASH, W. F., Ramanathan, R. K., & Luketich, J. D. (2000) · Annals of Surgery · doi:10.1097/00000658-200010000-00007 · Cited by 1,328 · see citing works
Self-citationEffect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus
Schauer, P. R., Burguera, B., Ikramuddin, S., Cottam, D., Gourash, W., Hamad, G., Eid, G. M., Mattar, S., Ramanathan, R., Barinas-Mitchel, E., et al. (2003) · Annals of Surgery · doi:10.1097/01.sla.0000089851.41115.1b · Cited by 1,183 · see citing works
Self-citationRubino, F., Forgione, A., Cummings, D. E., Vix, M., Gnuli, D., Mingrone, G., Castagneto, M., & Marescaux, J. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000224726.61448.1b · Cited by 928 · see citing works
Self-citationWittgrove, A. C., & Clark, G. W. (2000) · Obesity Surgery · doi:10.1381/096089200321643511 · Cited by 867 · see citing works
(1992) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/55.2.615s · Cited by 748 · see citing works
Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass
le Roux, C. W., Welbourn, R., Werling, M., Osborne, A., Kokkinos, A., Laurenius, A., Lönroth, H., Fändriks, L., Ghatei, M. A., Bloom, S. R., et al. (2007) · Annals of Surgery · doi:10.1097/sla.0b013e3180caa3e3 · Cited by 741 · see citing works
Trends in mortality in bariatric surgery: a systematic review and meta-analysis
Buchwald, H., Estok, R., Fahrbach, K., Banel, D., & Sledge, I. (2007) · Surgery · doi:10.1016/j.surg.2007.07.018 · Cited by 685 · see citing works
Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial: Design and Methods
Buse, J. B. (2007) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2007.03.003 · Cited by 661 · see citing works
Rubino, F., Gagner, M., Gentileschi, P., Kini, S. U., Fukuyama, S., Feng, J. J., & Diamond, E. (2004) · Annals of Surgery · doi:10.1097/01.sla.0000133117.12646.48 · Cited by 638 · see citing works
Self-citationNutritional Deficiencies following Bariatric Surgery: What Have We Learned?
Bloomberg, R. D., Fleishman, A., Nalle, J. E., Herron, D. M., & Kini, S. U. (2005) · Obesity Surgery · doi:10.1381/0960892053268264 · Cited by 514 · see citing works
Hormonal and Metabolic Mechanisms of Diabetes Remission after Gastrointestinal Surgery
Thaler, J. P., & Cummings, D. E. (2009) · Endocrinology · doi:10.1210/en.2009-0367 · Cited by 443 · see citing works
Self-citationMalabsorptive Gastric Bypass in Patients With Superobesity
Brolin, R. E., LaMarca, L. B., Ranatunga, S. A. C. D., Kenler, H. A., Ranatunga, S. A. C. D., Cody, R. P., & Ed.D (2002) · Journal of Gastrointestinal Surgery · doi:10.1016/s1091-255x(01)00022-1 · Cited by 385 · see citing works
Intensive Glycemic Control in the ACCORD and ADVANCE Trials
Dluhy, R. G., & McMahon, G. T. (2008) · New England Journal of Medicine · doi:10.1056/nejme0804182 · Cited by 375 · see citing works
The burden of type 2 diabetes: are we doing enough?
Zimmet, P. (2003) · Diabetes & Metabolism · doi:10.1016/s1262-3636(03)72783-9 · Cited by 328 · see citing works
Vidal, J., Ibarzábal, A., Romero, F., Delgado, S., Momblan, D. N. D. M., Flores, L., & Lacy, A. M. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9547-2 · Cited by 272 · see citing works
Khuri, S. F., Najjar, S. F., Daley, J., et al. (2001) · Annals of Surgery · doi:10.1097/00000658-200109000-00011 · Cited by 223 · see citing works
COHEN, R. V., Schiavon, C. A., Pinheiro, J. S., Correa, J. L., & Rubino, F. (2007) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2007.01.009 · Cited by 218 · see citing works
Self-citationLee, W., Wang, W., Lee, Y.-C., Huang, M., Ser, K., & Chen, J. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0319-4 · Cited by 201 · see citing works
Micronutrient deficiencies after gastric bypass for morbid obesity.
Jd, H. (1986) · PubMed · Cited by 197 · see citing works
Reaven, P. D., MORITZ, T. E., Schwenke, D. C., Anderson, R. J., Criqui, M. H., Detrano, R., Emanuele, N., Kayshap, M., Marks, J. B., Mudaliar, S. R. D., et al. (2009) · Diabetes · doi:10.2337/db09-0618 · Cited by 182 · see citing works
Available, N. A. N. (2001) · Diabetologia · doi:10.1007/s001250100612 · Cited by 180 · see citing works
Dl, S., Scopinaro, N., & Bloom, S. R. (1981) · PubMed · Cited by 162 · see citing works
Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies.
Re, B., Rc, G., Milgrim, L. M., & Ha, K. (1991) · PubMed · Cited by 150 · see citing works
Use and Outcomes of Laparoscopic Versus Open Gastric Bypass at Academic Medical Centers
Nguyen, N. T., Hinojosa, M. W., Fayad, C., Varela, J. E., & Wilson, S. E. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.03.011 · Cited by 138 · see citing works
A centenary of gastrointestinal endocrinology
Rehfeld, J. F. (2004) · Hormone and Metabolic Research · doi:10.1055/s-2004-826154 · Cited by 136 · see citing works
RAMOS, A. C., Neto, M. G., Souza, Y. M., Galvão, M., Murakami, A. H. F., Silva, A. C., Canseco, E., Santamaría, R., & Zambrano, T. A. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9759-5 · Cited by 136 · see citing works
Laparoscopic Roux-en-Y gastric bypass for BMI <35 kg/m2: a tailored approach
COHEN, R. V., Pinheiro, J. S., Correa, J. L., & Schiavon, C. A. (2006) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2006.02.011 · Cited by 129 · see citing works
Hamoui, N. (2003) · Archives of Surgery · doi:10.1001/archsurg.138.8.891 · Cited by 126 · see citing works
de Paula, A. L., Macedo, A. L. V., Prudente, A., Queiroz, L., Schraibman, V., & Pinus, J. (2006) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2006.03.005 · Cited by 104 · see citing works
Overview of the Epidemiology of Obesity and the Early History of Procedures to Remedy Morbid Obesity
MacDonald, K. G. (2003) · Archives of Surgery · doi:10.1001/archsurg.138.4.357 · Cited by 62 · see citing works
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Sjöström, L. (2013) · Journal of Internal Medicine · doi:10.1111/joim.12012 · Cited by 1,835 · see citing works
Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes
Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Leccesi, L., Nanni, G., Pomp, A., Castagneto, M., Ghirlanda, G., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1200111 · Cited by 1,791 · see citing works
Self-citationBariatric Surgery and Long-term Cardiovascular Events
Sjöström, L., Peltonen, M., Jacobson, P., Sjöström, C. D., Karason, K., Wedel, H., Ahlin, S., Anveden, Å., Bengtsson, C., Bergmark, G., et al. (2012) · JAMA · doi:10.1001/jama.2011.1914 · Cited by 1,656 · see citing works
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., et al. (2013) · Obesity · doi:10.1002/oby.20461 · Cited by 1,650 · see citing works
Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects
Carlsson, L. M. S., Peltonen, M., Ahlin, S., Anveden, Å., Bouchard, C., Carlsson, B., Jacobson, P., Lönroth, H., Maglio, C., Näslund, I., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1112082 · Cited by 794 · see citing works
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., et al. (2013) · Endocrine Practice · doi:10.4158/ep12437.gl · Cited by 395 · see citing works
Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline
Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G. A., Wong, J. L. A., Norman, R. J., Costello, M. F., & Groups, O. B. O. T. G. D. (2011) · Medical Journal of Australia · doi:10.5694/mja11.10915 · Cited by 379 · see citing works
De Luca, M., Angrisani, L., Himpens, J., Busetto, L., Scopinaro, N., Weiner, R., Sartori, A., Stier, C., Lakdawala, M., Bhasker, A. G., et al. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2271-4 · Cited by 296 · see citing works
Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity
Cohen, R. V., Pinheiro, J. C., Schiavon, C. A., Salles, J. E., Wajchenberg, B. L., & Cummings, D. E. (2012) · Diabetes Care · doi:10.2337/dc11-2289 · Cited by 282 · see citing works
Self-citationAmerican Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s008 · Cited by 244 · see citing works
Schauer, P. R., Mingrone, G., Ikramuddin, S., & Wolfe, B. (2016) · Diabetes Care · doi:10.2337/dc16-0382 · Cited by 215 · see citing works
Self-citationLi, J., Lai, D., & Wu, D. (2016) · Obesity Surgery · doi:10.1007/s11695-015-1996-9 · Cited by 190 · see citing works
Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes
Romeo, S., Maglio, C., Burza, M. A., Pirazzi, C., Sjöholm, K., Jacobson, P., Svensson, P.-A., Peltonen, M., Sjöström, L., & Carlsson, L. M. S. (2012) · Diabetes Care · doi:10.2337/dc12-0193 · Cited by 172 · see citing works
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s008 · Cited by 158 · see citing works
Rubino, F., Nathan, D. M., Eckel, R. H., Schauer, P. R., Alberti, K. G. M. M., Zimmet, P. Z., Del Prato, S., Ji, L., Sadikot, S. M., Herman, W. H., et al. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.05.018 · Cited by 157 · see citing works
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Metabolic surgery for type 2 diabetes
Cummings, D. E. (2012) · Nature Medicine · doi:10.1038/nm.2773 · Cited by 31 · see citing works
Self-citation
- Authors
- Rubino, F., Kaplan, L. M., Schauer, P. R., & Cummings, D. E.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Harvard University (US)
- Cleveland Clinic Lerner College of Medicine (US)
- Cleveland Clinic (US)
- Corresponding author
- Rubino, Francesco
- Venue
- Annals of Surgery
- Published
- 2010-03
- Volume
- 251
- Issue
- 3
- Pages
- 399-405
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2091289879
- Cited by
- 325
- References
- 40
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 11 · 2022: 7 · 2021: 11 · 2020: 13 · 2019: 13 · 2018: 6 · 2017: 17 · 2016: 31 · 2015: 22 · 2014: 33 · 2013: 27 · 2012: 44
- FWCI
- 52.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes surgery, type 2 diabetes, bariatric surgery, gastric bypass, obesity, surgical indications
- MeSH terms
- Diabetes Mellitus, Type 2, Humans, Digestive System Surgical Procedures, Bariatric Surgery
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