International Diabetes Federation Position Statement on Bariatric Surgery

Yesterday, at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes in New York, the International Diabetes Federation (IDF) released a Position Statement calling for bariatric surgery to be considered earlier in the treatment of eligible patients, to help stem the serious complications that can result from diabetes.

The document includes the following statements:

• In addition to behavioural and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalising blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.
• Bariatric surgery is an appropriate treatment for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.
• Surgery should be an accepted option in people who have type 2 diabetes and a BMI of 35 or more.
• Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.
• Strategies to prioritise access to surgery may be required to ensure that the procedures are available to those most likely to benefit.
• Available evidence indicates that bariatric surgery for obese patients with type 2 diabetes is cost-effective.
• Bariatric surgery for type 2 diabetes must be performed within accepted international and national guidelines. This requires appropriate assessment for the procedure and comprehensive and ongoing multidisciplinary care, patient education, follow-up and clinical audit, as well as safe and effective surgical procedures. National guidelines for bariatric surgery in people with type 2 diabetes and a BMI of 35 or more need to be developed and promulgated.
• The morbidity and mortality associated with bariatric surgery is generally low, and similar to that of well-accepted procedures such as elective gall bladder or gall stone surgery.
• Bariatric surgery in severely obese patients with type 2 diabetes has a range of health benefits, including a reduction in all-cause mortality.
• In order to optimise the future use of bariatric surgery as a therapeutic modality for type 2 diabetes further research is required.

The entire statement is available here.

This statement comes in the light of the increasing recognition that surgical treatment for obesity leads to an often remarkable remission in diabetes (and some of its complications) as well as other weight-related health problems – this is certainly more than can be expected of any current medical treatments for type 2 diabetes.

Indeed, the strength of this data is such that I recently heard a couple of my colleagues discussing whether or not they could be found liable for not ‘disclosing’ to their diabetes patients that surgery now represents an increasingly accepted ‘alternative’ treatment for type 2 diabetes.

I certainly wonder how many of my readers would consider having surgery themselves if they were diagnosed with type 2 diabetes.

AMS
Edmonton, Alberta