The recommendations of the Diabetes Surgery Summit-II panel for the role of surgery in treatment of diabetes was published last week in a paper titled; “Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.”

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The recommendations of Diabetes Surgery Summit – II (DSS-II) have reignited the debate regarding the role of surgery in treatment of diabetes. Reports over the past 25 years have shown a rapid and weight- independent improvement in type -2 diabetes (T2D) after gastric bypass surgery. These observations have now been validated in multiple randomized clinical studies that have shown a variety of bariatric operations (gastric bypass surgery, adjustable gastric banding, sleeve gastrectomy and biliopancreatic diversion) lead to rapid and durable remission of T2D when compared to maximal medical therapy. The increasing clinical evidence and the scientific insight to the underlying mechanisms, led to the second Diabetes Surgery Summit held in September, 2015 in London. The increasing clinical evidence and the scientific insight to the underlying mechanisms, led to the second Diabetes Surgery Summit which was held in September, 2015 in London, and led to a set of recommendations which were endorsed by over 45 medical societies that span the globe and represented all relevant medical disciplines including endocrinology, diabetes, obesity, surgery and gastroenterology.

This diverse medical community came to several consensus agreements, importantly that surgery should be recommended to treat T2D patients with BMI>40, those with BMI between 35.0–39.9 when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy, and considered in those with BMI between 30-34.9, if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. They also agreed that the GI tract constitutes a clinically and biologically meaningful target for the management of T2D.

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So what do these recommendations mean to the 400 million diabetic patients in the world and their doctors? The recommendations should not be taken that diabetes is now a surgical disease, but that surgery has a role to play in management of this chronic and disabling disease that is the leading cause of blindness, renal failure and amputation. What we need to do is to reeducate our primary care clinicians and diabetologists of the role of surgery, and remind our surgeons that following the procedure these patients continue to require endocrinological follow up as surgery is not perfect and diabetes recurrence a real fact.

 


“Surgery has a role to play in management of this chronic and disabling disease”


 

I think another important acknowledgement was that the gastrointestinal (GI) tract is a meaningful target for treatment of diabetes which should promote research in to less invasive GI-based procedures and new devices to replicate the metabolic benefits of surgery.

 


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Written by Ali Tavakkoli, MD

Dr. Tavakkoli is the co-director of the Center for Weight Management and Metabolic Surgery and director of Minimally Invasive Surgery fellowship at Brigham and Women’s Hospital and Associate Professor of Surgery at Harvard Medical School. His research focuses on mechanisms of diabetes resolution after bariatric surgery and he was the representative of the American College of Surgeons to the Diabetes Surgery Summit-II, where the new surgical recommendations were reviewed.