Guidelines for the use of bariatric surgery in type 2 diabetes

This report examined current guidelines for bariatric surgery in patients with type 2 diabetes. The authors concluded that bariatric surgery may be included as a treatment option in all patients with type 2 diabetes who are obese.

Bariatric surgery (reduction in stomach size) can improve type 2 diabetes (T2D). Bariatric surgery can improve control of blood glucose (sugar levels). It can also reduce the risk of cardiovascular disease (the narrowing or blockage of blood vessels that can lead to heart failure or stroke).However, bariatric surgery is not included in current guidelines as a treatment for T2D. Bariatric surgery may only be effective in T2D patients who have a certain body mass index (BMI, a measure of body fat based on weight and height).

Various clinicians and representatives of diabetes organizations met at the 2nd Diabetes Surgery Summit to discuss the recommendations for bariatric surgery in T2D patients based on evidence from clinical studies.

This report aimed to summarize the guidelines for bariatric surgery in T2D patients recommended by this Summit.

Patients should be selected based on whether the long-term benefits of surgery outweigh the potential risks. Patients should be monitored at lease every 6 months for the first 2 years following surgery, and cardiovascular risk factors should be controlled.

Bariatric surgery is recommended for T2D patients who have a BMI greater than 40 kg/m². In T2D patients with a BMI between 35 and 39.9 kg/m², surgery is recommended if lifestyle changes and medical therapy fail to effectively control blood glucose levels. Bariatric surgery can lead to an average 2% reduction in HbA1c (average blood glucose over 3 months) in patients with a BMI over 35 kg/m².

Surgery may be considered in T2D patients with a BMI between 30.0-34.9 kg/m² only when lifestyle changes and medical therapy are inadequate.

The BMI threshold should be lowered by 2.5 kg/m² in Asian T2D patients.

This report concluded that there is sufficient evidence supporting the inclusion of bariatric surgery as a treatment option in T2D patients who are obese. 

The evidence supporting these guidelines is based on short-term and medium-term studies. Longer term studies investigating the effectiveness of bariatric surgery are required. 

Consult your physician regarding the risks and benefits of bariatric surgery.