What are the DSS-II guidelines for bariatric surgery for type 2 diabetes mellitus (DM)?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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In morbidly obese patients, bariatric surgery has been shown to improve diabetes control and, in some situations, normalize glucose tolerance. It is certainly a reasonable alternative in carefully selected patients if an experienced team (providing appropriate preoperative evaluation, as well as technical surgical expertise) is available.

In 2011, the International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes released a position statement on bariatric surgery. The task force recommended bariatric surgery as an appropriate treatment for people with type 2 diabetes mellitus and obesity who have been unable to achieve recommended treatment targets using medical therapies, particularly if other major comorbidities exist. [322, 323]

According to guidelines released in 2016 by the 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, bariatric surgery should be considered even for type 2 diabetes patients with mild, class 1 obesity (BMI 30.0-34.9 kg/m2) if their hyperglycemia is inadequately controlled with optimal treatment. In addition, the guidelines state that bariatric surgery should be a “recommended option” for type 2 diabetes patients with class 3 obesity (BMI 40 kg/m2 or above) no matter what level of glycemic control has been achieved. The guidelines also say that of the different forms of bariatric surgery, Roux-en-Y gastric bypass seems to have the best risk/benefit profile for the majority of patients with type 2 diabetes. [324, 325]

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