International expert consensus on surgery for type 2 diabetes mellitus

Area of Science:

• Endocrinology
• Metabolic Surgery
• Diabetes Management

Background:

• Metabolic and bariatric surgery (MBS) is a key treatment for Type 2 diabetes mellitus (T2DM).
• Limited evidence-based guidelines exist for preoperative, operative, and postoperative care in T2DM patients undergoing MBS.
• A Delphi consensus process was initiated to address this guideline gap.

Purpose of the Study:

• To establish an evidence-based expert consensus on metabolic surgery for T2DM.
• To cover preoperative, operative, and postoperative considerations for MBS in T2DM patients.
• To provide guidance for clinicians and grade the quality of evidence.

Main Methods:

• A Delphi consensus-building exercise involving 52 international multidisciplinary experts.
• Literature review and evaluation of 44 proposed statements.
• Assessment of evidence quality using GRADE criteria.

Main Results:

• Consensus (>80% agreement) reached on 43 out of 44 statements.
• Agreement on the nature, terminology, and mechanisms of MBS for T2DM.
• Current T2DM remission prediction scores are insufficient; further research is needed for personalized treatment. MBS for T2DM is cost-effective, with varying safety and efficacy across procedures.

Conclusions:

• This consensus provides essential guidance for clinicians on metabolic surgery for T2DM.
• It addresses various aspects of MBS, including preoperative, operative, and postoperative care.
• The statement grades the quality of evidence for proposed recommendations.