Objectives: To develop guidelines for the use of gastrointestinal surgery to treat type 2 diabetes and to craft an agenda for further research.
Background: Increasing evidence demonstrates that bariatric surgery can dramatically ameliorate type 2 diabetes. Not surprisingly, gastrointestinal operations are now being used throughout the world to treat diabetes in association with obesity, and increasingly, for diabetes alone. However, the role for surgery in diabetes treatment is not clearly defined and there are neither clear guidelines for these practices nor sufficient plans for clinical trials to evaluate the risks and benefits of such “diabetes surgery.”
Methods: A multidisciplinary group of 50 voting delegates from around the world gathered in Rome, Italy for the first International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes–(the “Diabetes Surgery Summit”). During the meeting, available scientific evidence was examined and critiqued by the entire group to assess the strength of evidence and to draft consensus statements. Through an iterative process, draft statements were then serially discussed, debated, edited, reassessed, and finally presented for formal voting. After the Rome meeting, statements that achieved consensus were summarized and distributed to all voting delegates for further input and final approval. These statements were then formally critiqued by representatives of several sientific societies at the 1st World Congress on Interventional Therapies for T2DM (New York, Sept 2008). Input from this discussion was used to generate the current position statement.
Results: A Diabetes Surgery Summit (DSS) Position Statement consists of recommendations for clinical and research issues, as well as general concepts and definitions in diabetes surgery. The DSS recognizes the legitimacy of surgical approaches to treat diabetes in carefully selected patients. For example, gastric bypass was deemed a reasonable treatment option for patients with poorly controlled diabetes and a body mass index ≥30 kg/m2. Clinical trials to investigate the exact role of surgery in patients with less severe obesity and diabetes are considered a priority. Furthermore, investigations on the mechanisms of surgical control of diabetes are strongly encouraged, as they may help advance the understanding of diabetes pathophysiology.
Conclusions: The DSS consensus document embodies the foundations of “diabetes surgery,” and represents a timely attempt by leading scholars to improve access to surgical options supported by sound evidence, while also preventing harm from inappropriate use of unproven procedures.
We report the position statement from the first International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes–(Diabetes Surgery Summit-DSS). This document embodies the foundations of diabetes surgery and recognizes the potential of surgery to advance the understanding and treatment of diabetes.
From the *Department of Surgery, Section of Metabolic Surgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY; †Catholic University of Rome, Rome, Italy; ‡Boston Obesity and Nutrician Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA; §Bariatric and Metabolic Institute, Lerner College of Medicine; Cleveland Clinic, Cleveland, OH; and ¶Department of Medicine and Diabetes Obesity Center of Excellence, Division of Metabolism, University of Washington, VA Puget Sound Health Care System and Diabetes & Obesity Center of Excellence, Seattle, WA.
Dr. Rubino conceived the idea of the DSS. Drs. Rubino, Kaplan, Schauer, and Cummings served as co-directors of the DSS and equally participated in the planning and execution of the conference. They all have contributed to the preparation of the manuscript and have reviewed and accepted its current version.
DSS was supported by a generous grants from the following sponsors: Covidien, Ethicon, Allergan, Storz, GI Dynamics, Roche, Amylin, Power Medical Interventions.
The Sponsors had no role in any aspect of the conference organization or in the selection of the voting delegates. They have not influenced the analysis of the findings, the preparation of the manuscript or its content.
Reprints: Francesco Rubino, MD, Gastrointestinal Metabolic Surgery, Weill Cornell Medical College of Cornell University, 525 East 68th St P-714, New York, NY 10065. E-mail: firstname.lastname@example.org.