international diabetic federation: 2011

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International Diabetic Federation: 2011

IDF Taskforce on Epidemiology & Prevention of Diabetes
Appropriate role of Surgery and other Gastrointestinal Interventions in the Treatment and Prevention of Type 2 Diabetes

Introduction:

The International Diabetes Federation (IDF) is an umbrella organization of over 200 national diabetes associations in over 160 countries. The Federation has been leading the global diabetes community since 1950. IDF’s mission is to promote diabetes care, prevention and a cure worldwide. The Federation’s activities aim to influence policy, increase public awareness and encourage health improvement, promote the exchange of high-quality information about diabetes, and provide education for people with diabetes and their healthcare providers. IDF is associated with the Department of Public Information of the United Nations and is in official relations with the World Health Organization (WHO) and the Pan American Health Organization (PAHO).

The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes and published in Diabetic Medicine 2011.

Summary of Recommendation:

Gastro-Intestinal surgery is an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.

  1. Gastro-Intestinal Surgery should be an accepted option in people who have Type 2 diabetes and a BMI of 35 kg⁄ m2 or more.
  2. Gastro-Intestinal Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 kg⁄ m2 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.
  3. In Asian, and some other ethnicities of increased risk, BMI action points may be reduced by 2.5 kg⁄m2.

The morbidity and mortality associated with surgery is generally low and similar to that of well-accepted procedures such as elective gall bladder or gallstone surgery.

Gastro-Intestinal surgery in severely obese patients with Type 2 diabetes has a range of health benefits, including a reduction in all-cause mortality.

Available evidence indicates that bariatric surgery for obese patients with Type 2 diabetes is cost-effective.

Clinically severe obesity is a complex and chronic medical condition. Societal prejudices about severe obesity, which also exist within the healthcare system, should not act as a barrier to the provision of clinically effective and cost-effective treatment options.

Strategies to prioritize access to surgery may be required to ensure that the procedures are available to those most likely to benefit.

In order to optimize the future use of Gastro-Intestinal surgery as a therapeutic modality for Type 2 diabetes, further research is required.