Journal Article

International expert consensus on surgery for type 2 diabetes mellitus

Balibrea, Jose M., Kristinsson, Jon A., O’Kane, Mary, Goel, Ramen, Khunti, Kamlesh, Busetto, Luca, Ogden, Jane, Kasama, Kazunori, McGowan, Barbara, Miras, Alex D., Shahabi, Shahab, Le Roux, Carel, Carbajo, Miguel A., Alqahtani, Aayed, Morton, John, Pouwels, Sjaak, Salminen, Paulina, Serlie, Mireille J., Pournaras, Dimitri, Bhatt, Deepak L., Prager, Gerhard, Singhal, Rishi, Miller, Karl, Chesworth, Paul, Aminian, Ali, Clare, Ken, Weiner, Rudolf, Mahawar, Kamal, Taheri, Shahrad, Herrera, Miguel F., Shikora, Scott A., Blakemore, Alexandra I., Hanif, Wasim, Tahrani, Abd A., Peterli, Ralph, Behrens, Estuardo, Graham, Yitka, Ponce, Jaime, Parretti, Helen M., Neto, Manoel Galvao, Finer, Nicholas, Pinkney, Jonathan H., Sarwer, David, Stenberg, Erik, Abbott, Sally, Shabbir, Asim, Kermansaravi, Mohammad, Chowbey, Pradeep, McKechnie, Andrew, Kassir, Radwan, Logue, Jennifer, Amr, Bassem, Batterham, Rachel L., Kothari, Shanu N., Knop, Filip K., Omar, Islam

2025

Overview

Introduction Metabolic and bariatric surgery (MBS) has been an established treatment option for patients with Type 2 diabetes mellitus (T2DM), but there is a relative paucity of evidence-based guidelines on preoperative, operative, and postoperative considerations concerning metabolic surgery for T2DM patients. To address this gap, we initiated a Delphi consensus process with a diverse group of international multidisciplinary experts. Method We embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. We defined the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results Consensus, defined as > 80% agreement, was reached for 43 out of 44 statements. The experts reached an agreement on the nature, terminology, and mechanisms of action of MBS. The currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is cost-effective, and MBS procedures for treating T2DM vary in their safety and efficacy. Conclusion This Delphi expert consensus statement guides clinicians on various aspects of metabolic surgery for T2DM and also grades the quality of the available evidence for each of the proposed statements.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Bariatric Surgery / Bariatric Surgery - methods / Care and treatment / Committees / Communication / Consensus / Delphi method / Delphi Technique / Diabetes / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - surgery / Diabetes therapy / Endocrinology / Endocrinology of obesity / Gastrointestinal surgery / Humans / Medicine / Medicine & Public Health / Metabolic Diseases / Metabolic Surgery / Metabolism / Mortgage-backed securities / Obesity / Patient compliance / Patients / Perioperative care / Practice Guidelines as Topic - standards / Remission / Review / rology / Surgery / Type 2 diabetes / Type 2 diabetes mellitus / Weight control