Treat Obese Diabetics With Surgery, IDF Says

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Obese patients with type 2 diabetes should have bariatric surgery to treat their disease, according to a new position statement from the International Diabetes Federation.

Patients with diabetes and a body mass index (BMI) of 35 or more should be treated with any of the various forms of bariatric surgery, including gastric bypass and gastric banding, the IDF said.

Surgery should also be used in patients with a BMI of 30 to 35 whose diabetes is not adequately controlled by medications — especially among those with other major risk factors for heart disease, including hyperlipidemia, hypertension, and a history of myocardial infarction, according to the statement.

That latter recommendation conflicts with that of the American Diabetes Association, which recommends that surgery be used only for diabetic patients with a BMI of 35 or above, especially if they have other heart disease risk factors.

There’s not enough evidence to recommend surgery for patients with a BMI under 35, according to the ADA.

The IDF said it took the position in light of increasing rates of both obesity and diabetes, sparked by an “obesogenic” environment in developed countries. Research has shown that the surgery normalizes blood glucose levels and reduces the need for medications, according to the organization.

The IDF guideline writers noted that physicians should use a lower BMI reference for Asian patients and some other ethnicities — as much as 2.5 BMI points lower.

The statement was released Monday at the organization’s 2nd World Congress on Interventional Therapies for Diabetes in New York City.

The paper calls for the establishment of a national registry of patients who’ve had bariatric surgery “in order to ensure quality patient care and to monitor both short- and long-term outcomes.”

It also highlights the need for studies to establish criteria that help determine which patients will benefit most from surgery, and which ones will benefit most from which surgical procedures.

The new recommendations coincide with an FDA ruling last month that expanded the indication for Allergan’s Lap-Band device to include patients with a lower BMI — of 30 and up.