A group of experts in diabetes care have published first-ever clinical guidelines this week for when to recommend or consider bariatric/metabolic surgery expressly as a treatment option for type 2 diabetes, even for patients who are not severely obese.

Under the new guidelines, metabolic surgery (such as gastric bypass) can be considered to treat type 2 diabetes in patients with a body mass index (BMI) as low as 30 or down to 27.5 for Asians, compared with the traditional cutoff of greater than 35 with diabetes.

This is the first time guidelines recommend surgery as a treatment option specifically for diabetes.

Dr. David Cummings
Dr. David Cummings speaking at the 2nd Diabetes Surgery Summit in London

Dr. David Cummings, professor (Metabolism, Endocrinology and Nutrition), is the senior and corresponding author on the paper reporting these new guidelines, and of four related papers in a special issue of Diabetes Care this week.

“Although this might seem like a modest numerical change, it encompasses a very large proportion of people with diabetes in the USA,” said Cummings.  “Moreover, in Asia, more than 98 percent of people with diabetes have a BMI below 35 and thus would not qualify for metabolic surgery based on the old 1991 NIH recommendations.”

The new guidelines do not recommend surgery as a first choice, but as an option if patients have not responded to traditional therapies.

The guidelines have been formally ratified/endorsed by 46 international societies to date, including the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, Diabetes India, European Association for the Study of Obesity, Endocrine Society, The Obesity Society, American Association of Clinical Endocrinologists, American College of Surgeons, American Gastroenterological Association, and the national diabetes societies of most major European and South American nations. These organizations span every continent except Antarctica. 

“As far as we can tell, in terms of the number and scope of ratifying societies, these are the most widely endorsed clinical practice guidelines ever, in any field of medicine or surgery,” said Cummings.