Bariatric-metabolic (BM) surgery as a treatment for type 2 diabetes (T2DM) has progressed rapidly. There is now high quality evidence of efficacy, safety, reduced morbidity and mortality, and very favourable health economic profile. Yet surgery is rarely performed as a treatment for Type 2 diabetes and has been slow to enter the treatment algorithms of managing diabetes. The International Diabetes Federation has provided a position statement, and the NHMRC and NICE have included BM surgery in their algorithms for managing weight in patients with obesity and T2DM.
An international consensus conference was convened in collaboration with leading diabetes organizations to develop guidelines to inform clinicians and policy makers about benefits and limitations of metabolic surgery for T2DM. The evidence collected, the process used to reach consensus, and the level of international acceptance will be presented.
Key points of consensus:
Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2DM.
There is now sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among anti-diabetes interventions for people with T2DM and obesity.
Metabolic surgery should be recommended to treat T2DM 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 be considered for patients with T2DM and BMI 30.0-34.9 kg/m2 if hyperglycemia is inadequately controlled despite treatment with either oral or injectable medications.
Our challenge now is to understand where this fits into real world management of T2DM in Australia.