The Diabetes Surgery Summit (DSS) Consensus Conference reviewed research and clinical recommendations regarding gastric surgery as a treatment of type 2 diabetes mellitus (T2DM). Type 2 diabetes mellitus is a condition in which the body is resistant to the effects of insulin, which is a hormone produced by the pancreas, or does not produce enough insulin to maintain a normal glucose level. (1) "Not surprisingly, gastrointestinal operations are now being used throughout the world to treat diabetes in association with obesity, and increasingly, for diabetes alone", comments Francesco Rubino, M.D., from Weill Cornell Medical College/New York Presbyterian Hospital and DSS delegate. (2)
The goal of the DSS was to issue guidelines for the use of gastrointestinal surgery for the treatment of patients with T2DM and to develop a plan for further research. The delegates agreed that surgical intervention to treat T2DM in carefully selected patients was appropriate. Gastric bypass was recognized as a reasonable option for patients with poorly controlled T2DM and a body mass index (BMI) of 30 kg/m2 or more. Body mass index is a measurement of body fat based on height and weight and applies to men and women between the ages of 18 and 65 years. The BMI classifications are 18.5 to 24.99 is normal weight, 25 to 29.99 is overweight, 30 to 34.99 is obesity class 1, 35 to 39.99 is obesity class 2, and 40 or greater is morbid obesity. (3) Further clinical trials to determine the role of gastric surgery in patients who have less severe obesity and diabetes was recommended. Gastrointestinal surgery may include Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding or biliopancreatic diversion.
An important research priority is to identify the appropriate use of gastrointestinal surgery to treat T2DM patients who are less overweight. Controlled clinical trials are recommended to determine the safety and efficancy of gastrointestinal metabolic surgery and to identify criteria other than BMI to help select appropriate patients. The collaboration of endocrinologists, surgeons, and basic scientists can improve the understanding of gastrointestinal mechanisms of metabolic regulations and improve T2DM treatment. (2)