Rising Calls for Metabolic Surgery in Type 2 Diabetes
A new international consensus publication this week on metabolic surgery calls for its consideration, even in people with mild obesity who have type 2 diabetes. The guidelines, published this week in Diabetes Care are regarded by many as historic. They have already been endorsed by the Obesity Society, the American Diabetes Association, and 43 other organizations around the world, most of which are medical, not surgical, societies. Philip Schauer, a co-author, said:
I’ve seen lots of guidelines on medical care in my career, for everything from colonoscopy to guidelines on aspirin and all kinds of things, but I’ve never seen guidelines that have been endorsed by 45 medical organizations.
The publication points out that the clear value of metabolic surgery for reversing type 2 diabetes will render much of the guidance for weight loss surgery obsolete:
Unnecessarily delaying access to surgery might reduce health benefits and cost-effectiveness of surgery in patients with diabetes. Moreover, existing criteria used for coverage of bariatric surgery are of low relevance for metabolic surgery. For example, because BMI is not a standard diagnostic parameter or a measure of severity of T2D, using BMI thresholds as stand-alone criteria for metabolic surgery does not allow health care providers to appropriately select candidates for such operations or to define criteria for prioritization of this type of approach.
Adjusting to this new understanding of the value of metabolic surgery will take some time. Even under the older, more conservative guidance, more than two thirds of people who might benefit from surgery do not consider it appropriate for themselves. The most common estimate is that fewer than one percent of candidates for surgery actually receive it. Translating medical research into routine clinical practice is thought to take 17 years.
It may well take that long to fully realize the benefits of metabolic surgery for people with obesity and type 2 diabetes. But we hope not.
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May 28, 2016