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Cited by 1,008Bariatric Surgery and OutcomesDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

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Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

Rubino, Francesco, Nathan, David M., Eckel, Robert H., Schauer, Philip R., Alberti, K. George M.M., Zimmet, Paul Z., Del Prato, Stefano, Ji, Linong, Sadikot, Shaukat M., Herman, William H., Amiel, Stephanie A., Kaplan, Lee M., Taroncher-Oldenburg, Gaspar, Cummings, David E., Delegates of the 2nd Diabetes Surgery Summit, Albache, Nizar, Batterham, Rachel L., Bhatt, Deepak L., Boza, Camilo, Cefalu, William T., Cohen, Ricardo V., Courcoulas, Anita P., Dinneen, Sean F., Dixon, John B., Ferrannini, Ele, Fioretto, Paola, Frühbeck, Gema, Gagner, Michel, Grant, Richard W., Ikramuddin, Sayeed, Johnston, Desmond G., Kashyap, Sangeeta R., Kelly, Tracy, Klupa, Tomasz, Korner, Judith, Laferrère, Blandine, Lebovitz, Harold E., Lee, Wei-Jei, le Roux, Carel W., Mechanick, Jeffrey I., Mingrone, Geltrude, Morton, John M., Pories, Walter J., Ratner, Robert E., Rayman, Gerry, Sugerman, Harvey J., Van Gaal, Luc, Vidal, Josep, Weng, Jianping, Wolfe, Bruce M.·2016·Diabetes Care
DOI 10.2337/dc16-0236
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Abstract

BACKGROUND: Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM: The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS: A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005–30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28–30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS: Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2) and in those with class II obesity (BMI 35.0–39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0–34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS: Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.

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  • Despite evidence of efficacy and cost-effectiveness of surgical interventions for obesity, only 0.1-2% of surgical candidates who qualify worldwide currently undergo such surgery.

    “Despite evidence of efficacy and cost-effectiveness50,51 of surgical interventions for obesity, only 0.1–2% of surgical candidates who qualify worldwide currently undergo such surgery52.”

    From Joint international consensus statement for ending stigma of obesity (2020) · cites this paper as [50]

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Authors
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., Amiel, S. A., Kaplan, L. M., Taroncher-Oldenburg, G., Cummings, D. E., Summit, D. O. T. 2. D. S., Albache, N., Batterham, R. L., Bhatt, D. L., Boza, C., Cefalu, W. T., Cohen, R. V., Courcoulas, A. P., Dinneen, S. F., Dixon, J. B., Ferrannini, E., Fioretto, P., Frühbeck, G., Gagner, M., Grant, R. W., Ikramuddin, S., Johnston, D. G., Kashyap, S. R., Kelly, T., Klupa, T., Korner, J., Laferrère, B., Lebovitz, H. E., Lee, W.-J., le Roux, C. W., Mechanick, J. I., Mingrone, G., Morton, J. M., Pories, W. J., Ratner, R. E., Rayman, G., Sugerman, H. J., Van Gaal, L., Vidal, J., Weng, J., & Wolfe, B. M.
Affiliations
  • King's College London (GB)
  • Harvard University (US)
  • University of Colorado Anschutz (US)
  • Cleveland Clinic (US)
  • Imperial College London (GB)
  • Monash University (AU)
  • University of Pisa, Pisa, Italy
  • Peking University (CN)
  • Diabetes India, Mumbai, India
  • University of Michigan (US)
  • Philadelphia, PA
  • University of Washington (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-05-13
Volume
39
Issue
6
Pages
861-877
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc16-0236
OpenAlex
W2397499320
Cited by
1,008
References
24
Citations by year
2026: 60 · 2025: 61 · 2024: 61 · 2023: 81 · 2022: 87 · 2021: 129 · 2020: 127 · 2019: 106 · 2018: 109 · 2017: 132 · 2016: 50
FWCI
130.06
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
metabolic surgery, bariatric surgery, type 2 diabetes, obesity, treatment algorithm, glycemic control, cardiovascular risk, body mass index thresholds, Asian patients, reimbursement policy, consensus recommendations
MeSH terms
Algorithms, Cardiovascular Diseases, Cooperative Behavior, Diabetes Mellitus, Type 2, Endocrinology, Humans, Obesity, Risk Factors, Societies, Medical, Practice Guidelines as Topic, Consensus, Internationality, Bariatric Surgery

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