New Recommendations for Type 2 Diabetes Control Highlight Metabolic Surgery

by Nicholson Clinic | Oct 26, 2018
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) agree that surgery can improve outcomes for certain diabetes sufferers.

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) agree that surgery can improve outcomes for certain diabetes sufferers.

In October 2018, the ADA-EASD organizations jointly released a report making recommendations for controlling hyperglycemia in type 2 diabetes patients. The report analyzed 479 current studies on treatment options. The panel found that metabolic surgery can reduce complications from type 2 diabetes, improve blood-sugar regulation and improve long-term life.

"Over the past two decades, numerous advances and innovations have drastically improved outcomes and provided nearly comparable life expectancy for people with diabetes. However, given the complexity of diabetes, without the proper care and support systems, the complications of poor blood glucose control are progressive and can be devastating. We are proud to call for this paradigm shift as the most logical and appropriate next steps in care through this joint consensus report with EASD. The needs of our patients require that we consider the many individual life factors in order to improve quality and length of life for as many people as possible," said the ADA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD in a statement prepared by the ADA.

The ADA found that metabolic surgery, such as partial gastrectomies and other bariatric procedures, is now recommended for patients with type 2 diabetes who can’t control hyperglycemia adequately with other measures, essentially lowering BMI thresholds. According to the ADA, bariatric surgery is now:

  • Recommended for people with a body mass index (BMI, a ratio of weight to height used to estimate how close a person is to a healthy weight) of 40 or higher (37.5 for Asian Americans, who often develop diabetes at a lower BMI than other groups), regardless of their A1C.
  • Recommended for people whose BMI falls between 35 and 39 (32.5 to 37.4 for Asian Americans) if, despite lifestyle changes and medication, their A1C is still above goal.
  • Considered an option for people with a BMI between 30 and 34.9 (27.5 to 32.4 for Asian Americans) if, despite medications (including insulin), their A1C is above goal.

After reviewing numerous studies and data, the ADA stated as recently as January 2018 that "metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors." Even when compared to various changes in lifestyle and medical interventions, metabolic surgery showed improvements in complications, cardiovascular disease, and cancer.

“The connection between type 2 diabetes and obesity is clear,” says Nicholson. “Taking steps to lose weight safely and effectively can make a very big difference in reducing complications from type 2 diabetes,” says Dr. Nick Nicholson, founder and lead surgeon at the Nicholson Clinic for Weight Loss Surgery.

Metabolic surgery isn’t for everyone, and will involve surgeries that will require long-term changes to a person's lifestyle. The ADA findings are not exhaustive and new research every day is helping to guide medical practitioners to provide better treatment and outcomes for type 2 diabetes patients.

“We must also recommit to further research that will help us to continuously refine these recommendations,” Cefalu stated. “With the right care plan and support, our patients can experience full lives with diabetes as we continue to understand the many facets of this sophisticated disease.”

About Nicholson Clinic
Founded by Dr. Nick Nicholson, one of the country’s leading weight loss surgeons and co-author of “Weight Loss Surgery: The Real Skinny,” the Nicholson Clinic for Weight Loss Surgery offers a variety of options to help patients gain control of their weight and their lives.

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