IDF statement supports bariatric surgery for eligible diabetes patients
MedWire News: The International Diabetes Federation (IDF) has released a position statement supporting the use of bariatric surgery to treat diabetes in suitable patients.
"Bariatric surgery for severely obese people with Type 2 diabetes should be considered much earlier in management rather than held back as a last resort. It should be incorporated into Type 2 diabetes treatment protocols," said co-chairperson of the writing committee George Alberti, from Imperial College London, in the UK.
"Bariatric intervention is a health- and cost-effective therapy for Type 2 diabetes and obesity with an acceptable safety profile," he added. The statement, written by a specialist committee, recommends that surgery should be considered as an appropriate treatment in patients with Type 2 diabetes and obesity who have not been able to achieve recommended targets with medical therapy. This is particularly relevant if other major comorbidities are present.
Bariatric surgery is suggested by the authors to be an acceptable option for patients with a body mass index (BMI) of 35 kg/m2 or more, and as an alternative treatment option in those with a BMI of 30-35 kg/m2 whose diabetes is inadequately controlled by drug therapy. This is especially true for the latter group if they have additional major cardiovascular risk factors.
The authors note that the "at risk" or appropriate BMI range indicating surgery for people of Asian or other high-risk ethnicities can be reduced by 2.5 kg/m2.
Co-chairperson Paul Zimmet (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) said: "Bariatric surgery is a treatment that can be recommended for people with Type 2 diabetes and obesity not achieving… treatment targets with existing medical therapies, especially when there are other major co-morbidities such as hypertension, high cholesterol, or sleep apnea."
Zimmet explained: "The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment prior to surgery and ongoing care as well."
The statement authors suggest that national registries of people who have undergone bariatric surgery should be set up to ensure quality patient care and to monitor short- and long-term outcomes.
The team also proposes that further research is required to optimize use of bariatric surgery for treatment of Type 2 diabetes.
Francesco Rubino, another member of the writing committee from the New York-Presbyterian Hospital and Weill Cornell Medical Center in the USA, said: "This is the first time the International Diabetes Federation or any major international organization has made recommendations on this rapidly developing area of therapy.
"It did so because of the urgent need for worldwide expert guidance on the use of bariatric surgery because of the increasing usage. We note the need to establish appropriate measures in education and selection of patients and safe and standardized surgical procedures. Long-term follow-up after surgery is essential."
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By Helen Albert