Bariatric surgery should be considered as a treatment for diabetes, according to new recommendations issued by the International Diabetes Federation.
The guidance echoes the clinical guidelines of the American Diabetes Association, which also state that weight loss surgery for very overweight diabetics should be considered as an option if other treatments fail.
The IDF’s stance represents a “radical departure” for the group compared to its previous guidelines and goes beyond the ADA’s recommendations to suggest that surgery could be considered as an option even for moderately overweight diabetics who are just 25 to 40 pounds overweight, according to Philip Schauer, a bariatric surgeon at the Cleveland Clinic and a panel member.
The recommendations also reflect the broader, gradual shift among many in the field that current medical treatments for diabetes — such as pills and insulin shots — don’t work for everyone, and for many patients, the benefits of bariatric surgery appear to outweigh the risk, says Schauer.
Not everyone agrees, however, that the research evidence is compelling. The amount of data on moderately overweight patients is limited, though a number of clinical trials are currently being conducted, says Schauer.
Especially with young people or less obese individuals, the long-term consequences of bariatric surgery need to be studied, says Sue Kirkman, an endocrinologist who works for the American Diabetes Association. There are some concerns in the long run about calcium and other vitamin deficiencies, and some evidence of bone disease, according to Kirkman, who wasn’t involved with the IDF’s recommendations.
But there is more and more accumulated evidence about the efficacy of bariatric surgery in treating diabetes, including in teenagers.
“I think in general the field is evolving more and more toward seeing it [surgery] as a viable or reasonable treatment,” said Kirkman. “In the past it was kind of seen as the last-ditch treatment.”