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Diabetes surgery summit consensus lays foundation for new field of medicine
Date:11/23/2009

he BMI Debate

In its position statement, the Diabetes Surgery Summit states: "Surgery should be considered for the treatment of type 2 diabetes" in patients with a BMI of 35 or more "who are inadequately controlled by lifestyle and medical therapy." The statement goes on to state that diabetes surgery may also be appropriate for treatment of people with type 2 diabetes and merely mild-to-moderate obesity (BMI 30-35). This goes beyond parameters established by the NIH for bariatric surgery in 1991, which reserved bariatric surgery for people with a BMI of 35 or more with an obesity-related condition, or a BMI of 40 or more with or without any obesity-related condition. These parameters are still adhered to by most insurance companies in determining coverage of the surgery.

"The science of diabetes, obesity and surgery has significantly advanced since 1991, and the evidence suggests that a precise BMI cut-off of 35 is not a good predictor of whether or not surgery will induce diabetes remission or improvement," Dr. Schauer says.

Dr. Rubino explains that BMI is an inadequate measure as a stand-alone criterion for patient selection:

"Once a patient has full-blown diabetes, BMI can't accurately predict that patient's cardiovascular risk, much less who will and won't be likely to benefit from surgery. It simply doesn't make sense to offer the surgical option to a patient with a BMI of 35 and deny it to one with a BMI of 34, especially if the latter patient has more severe diabetes. The health risks associated with a BMI of 35 may vary, too, with gender, race and ethnicity, compounding its inadequacy as a parameter for patient selection. High up on our research agenda is the search for new eligibility criteria that should be based on diabetes-specific metrics, and include patient's history, metabolic profile and disease severity."

A Multidisciplinary Effort

The DSS consensus document emphasizes the importance of mult
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Contact: Linda Kamateh
lib9027@med.cornell.edu
212-821-0560
New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College
Source:Eurekalert

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