american diabetic association: 2009

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American Diabetic Association: 2009

Standards of Medical Care in Diabetes
Diabetic Care 2009

Introduction:

The American Diabetes Association (ADA) is a United States-based association working to fight the consequences of diabetes and to help those affected by diabetes. The Association funds research to manage, cure and prevent diabetes (including type 1 diabetes, type 2 diabetes, gestational diabetes, and pre-diabetes); delivers services to hundreds of communities; provides information for both patients and health care professionals; and advocates on behalf of people denied their rights because of diabetes.

Summary of Recommendation:

Gastro-Intestinal (Bariatric) surgery should be considered for adults with BMI 35 kg/m2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy. (B)

Patients with type 2 diabetes who have undergone Gastro-Intestinal (Bariatric) surgery need life-long lifestyle support and medical monitoring. (E)

Although small trials have shown glycemic benefit of Gastro-Intestinal (Bariatric) surgery in patients with type 2 diabetes and BMI of 30–35 kg/m 2, there is currently insufficient evidence to generally recommend surgery in patients with BMI 35kg/m2 outside of a research protocol. (E)

The long-term benefits, cost-effectiveness, and risks of Gastro-Intestinal (Bariatric) surgery in individuals with type 2 diabetes should be studied in well-designed ran-domized controlled trials with optimal medical and lifestyle therapy as the comparator. (E)

Level of Evidence Description

A: Clear evidence from well-conducted, generalizable, randomized controlled trials
B: Supportive evidence from well-conducted cohort studies
C: Supportive evidence from poorly controlled or uncontrolled studies
E: Expert consensus or Clinical experience