May 24, 2016

expert reaction to statement on surgical intervention in the treatment of type 2 diabetes

New guidelines published in the journal Diabetes Care recommend that surgery be considered a standard option for appropriate candidates with type 2 diabetes, including in mildly obese people, and they call for health care regulators to introduce appropriate reimbursement policies. To date guidelines have been formally endorsed by 45 worldwide medical and scientific societies.

These comments accompanied a briefing.

Prof. Nick Finer, Honorary Professor at UCL, and Senior Principal Clinical Scientist with Novo Nordisk, said:

“This is an important consensus statement from the world’s major diabetes organisations endorsing the substantial benefits of bariatric or ‘metabolic’ surgery for people with type 2 diabetes.  Based on a comprehensive review of the evidence the recommendations are in line with those from NICE and suggest that this surgery should be part of treatment pathways for the management of all those with diabetes, not just those with severe obesity. There is now a wealth of evidence (including randomised trials) that metabolic surgery achieves excellent blood glucose control and reduces cardiovascular risk factors although more long-term studies are needed. The paper describes the services needed for safe and effective surgery and the necessary follow up of patients. They make the point that the initial costs of surgery are quickly recovered through the improved health of patients making the treatment very cost effective. Hopefully this will drive the NHS to support greater access to this treatment. Sadly in England less than 1% of people who might benefit are offered surgery and at a high level there is still a refusal to respond to the evidence so that the numbers of surgeries has been declining over recent years. ”

‘Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations’ by Rubino et al. published in Diabetes Care on Tuesday 24th May

Declared interests

Prof. Nick Finer: Prof Finer is employed by Novo Nordisk and served on the Clinical Reference Group that before it was disbanded advised NHS England on Bariatric surgery.