Diabetes patients should be offered option of metabolic surgery

In a joint statement endorsed by 45 international organizations published in the journal Diabetes Care, diabetes clinicians and researchers are calling for metabolic surgery to be recommended or considered as a treatment option for some people with Type 2 diabetes.

A special issue of Diabetes Care sets out the first clinical guidelines for when to recommend or consider metabolic surgery as treatment for people with Type 2 diabetes.

''Surgery represents a radical departure from conventional approaches to diabetes. The new guidelines effectively introduce one of the biggest changes for diabetes care in modern times,'' says Francesco Rubino, a Professor of Metabolic and Bariatric Surgery at King's College London, Consultant Surgeon at King's College Hospital and first author of the paper.

The new guidelines emerged from the Second Diabetes Surgery Summit (DSS-II), an international consensus conference held in September 2015 at King's College London, and jointly organised with Diabetes UK, the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, and Diabetes India.

A second paper published in Diabetes Care explores the costs and benefits of meeting potential demand for metabolic surgery in the UK and US. The paper examines conceptual and practical barriers to the surgery identified through a Policy Lab hosted at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes in September 2015 at King's.

Professor Jennifer Rubin from the Policy Institute at King's which hosted the Policy Lab says, ''The case for increasing the uptake of bariatric / metabolic surgery appears strong enough to engage policymakers and practitioners in a concerted discussion of how best to use surgical resources in conjunction with other interventions in good diabetes practice.''

Professor Rubino's research provided the first experimental evidence that bariatric surgery can improve diabetes independently of weight loss.

In a Comment published in Nature, Professor Rubino warns that capitalising on these latest insights about how to treat Type 2 diabetes will require a shift in mindsets across healthcare and research.

Long-standing preconceptions will need to be put aside to effectively tackle the rising rates of diabetes across the globe, particularly in low- and middle-income countries where surgery is not likely to be available for most patients.

The broad endorsement of surgery as a treatment option should inspire fresh approaches in research, writes Professor Rubino. Researchers and clinicians are already trying to mimic the effects of gastrointestinal surgery using less invasive interventions. Pharmacological interventions that target mechanisms of metabolic regulation within the gut are also being investigated.