Type 2 diabetes and metabolic surgery guidelines and recommendations should urgently be unified
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Type 2 diabetes and metabolic surgery guidelines and recommendations should urgently be unified Bruno Halpern1,2 · Marcio C. Mancini1,3 Received: 29 June 2020 / Accepted: 3 September 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Abstract Metabolic surgery has been studied in the last decades as an effective and safe treatment for type 2 diabetes (T2D), and randomized controlled trials generally found surgery superior when compared with medical treatment. In 2016, the DSS-II Joint Statement recognized the importance of metabolic surgery in the treatment of T2D and urged clinicians to discuss, recommend, or at least consider this procedure for their patients. Diabetes societies also cogitate metabolic surgery as an option for T2D patients in their guidelines. However, there are some differences in recommendations that could lead a careful reader to some confusion. This was potentialized in a recent document published by the same DSS-II group concerning prioritization for surgery after the COVID-19 pandemic, in which the criteria suggested for an expedited recommendation that is not exactly evidence-based, and collided substantially with several clinical guidelines worldwide, especially with regard to secondary prevention of cardiovascular disease. A more harmonious discussion and unified guidelines between clinicians and surgeons are needed in order to provide the same message for those who read different articles. Keywords Bariatric surgery · Metabolic surgery · Type 2 diabetes · Obesity · Cardiovascular disease · Guidelines · Diabetes treatment
Introduction Bariatric surgery is a widely studied treatment for obesity, with clear benefits in terms of weight loss, improvement in comorbidities, and several observational evidences of reduced hard outcomes and mortality [1–4]. Any guideline for the treatment of obesity must include it, as it is the most effective therapy for this disease [3, 4]. The benefits of bariatric surgery for patients who also have type 2 diabetes led to the establishment of the expression “metabolic surgery,” to shift the focus of weight loss to improvement in glycemia and other metabolic components [5, 6]. Here, we will use the terms metabolic and bariatric * Bruno Halpern [email protected] 1
Obesity Group, Department of Endocrinology, Hospital das Clinicas Universidade de São Paulo, São Paulo, Brazil
2
Department of Epidemiology and Prevention, Brazilian Association for the Study of Obesity (ABESO), São Paulo, Brazil
3
Brazilian Society of Endocrinology and Metabolism (SBEM), Rio de Janeiro, Brazil
surgery interchangeably. Several observational studies and randomized controlled trials have evaluated metabolic surgery versus conventional treatment in different scenarios in patients with T2D, generally demonstrating superior glycemic control and higher remission rates in those patients submitted to surgery, as well as benefits in renal markers and reduced micro- and macrovascular events in observational data [7–12]. In this context, th
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