Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
Article

Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world’s leading diabetes organizations

Philip R. Schauer, MD, Zubaidah Nor Hanipah, MD and Francesco Rubino, MD
Cleveland Clinic Journal of Medicine July 2017, 84 (7 suppl 1) S47-S56; DOI: https://doi.org/10.3949/ccjm.84.s1.06
Philip R. Schauer
Director, Bariatric and Metabolic Institute, Cleveland Clinic
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
Zubaidah Nor Hanipah
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Francesco Rubino
Department of Metabolic and Bariatric Surgery, Diabetes and Nutrition Science Division, King’s College London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Relative distribution of body mass index of patients with diabetes.

    SHIELD = Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (2004); 4,266 of 127,420 survey respondents with diabetes (type 1 = 368; type 2 = 3,898).

    NHANES = National Health and Nutrition Examination Survey (1999–2002); 998 of 11,441 survey repondents with diabetes (type 1 and 2).

    Data from Bays et al.1

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Most common metabolic surgical procedures.

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Postoperative complication rates of surgical procedures in patients with type 2 diabetes mellitus: US data.

    CABG = coronary artery bypass graft; RYGB = Roux-en-Y gastric bypass

    Reprinted with permission from John Wiley & Sons (Aminian A, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab 2015; 17:198–201.) ©2014 John Wiley & Sons Ltd.

  • FIGURE 4
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 4

    Mortality rates of 8 procedures in patients with diabetes (2008–2012).

    CABG = coronary artery bypass grafting; RYGB = Roux-en-Y gastric bypass

    Reprinted with permission from John Wiley & Sons (Aminian A, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab 2015; 17:198–201.) ©2014 John Wiley & Sons Ltd.

  • FIGURE 5
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 5

    Algorithm for the treatment of type 2 diabetes, as recommended by the 2nd Diabetes Surgery Summit’s voting delegates.

Tables

  • Figures
    • View popup
    TABLE 1

    Metabolic surgery for type 2 diabetes mellitus: Randomized controlled clinical trials

    StudyPts with BMI < 35 kg/m2Study designNo. ptsFollow-up (mo)Remission criteriaRemissiona or change in HbA1c (%)P value
    Dixon2822%LAGB vs control6024HbA1c < 6.2%73 vs 13< .001
    Schauer29,30,4336%RYGB vs SG vs control15060HbA1c ≤ 6.0%22 vs 15 vs 0< .05
    Mingrone31,320%RYGB vs BPD vs control6060HbA1c ≤ 6.5%42 vs 68 vs 0.003
    Ikramuddin33,3459%RYGB vs control12024HbA1c < 6.0%44 vs 9< .001
    Liang35100%RYGB vs control10112HbA1c < 6.5%90 vs 0 vs 0b< .0001
    Halperin3634%RYGB vs control3812HbA1c < 6.5%58 vs 16.03
    Courcoulas37,3843%RYGB vs LAGB vs control6936HbA1c < 6.5%40 vs 29 vs 0.004
    Wentworth39100%LAGB vs control5124FBG < 7.0 mmol/L52 vs 8.001
    Parikh40100%RYGB/LAGB/SG vs control576HbA1c < 6.5%65 vs 0.0001
    Ding4134%LAGB vs control4512HbA1c < 6.5%33 vs 23c.46
    Cummings4225%RYGB vs control4312HbA1c < 6.0%60 vs 5.9.002
    Shah4485RYGB vs control8024HbA1c < 6.5%60 vs 2.5< .001
    • Remission criteria:

    • ↵a Remission was primary or secondary end point; HbA1c value without diabetes medications, unless otherwise specific.

    • ↵b Remission was not precisely defined; HbA1c < 6.5% by extrapolation.

    • ↵c Intermittent diabetes medications.

    • BMI = body mass index; BPD = biliopancreatic diversion; FBG = fasting blood glucose; HbA1c = glycated hemoglobin; LAGB = laparoscopic adjustable gastric band; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy

    • Modified from Schauer PR, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care 2016; 39:908–911. ©2016 American Diabetes Association. All rights reserved. Material from this publication is used with the permission of American Diabetes Association.

    • View popup
    TABLE 2

    Complications after metabolic surgery

    ComplicationsFrequency (%)
    Sepsis from anastomotic leak0.1–5.6
    Hemorrhage1–4
    Cardiopulmonary events< 1
    Thromboembolic disease0.34
    Death0.1–0.3
    Late complications for LAGB
     Band slippage15
     Leakage2–5
     Erosion1–2
    Late complications of bypass procedures
     Anastomotic stricture1–5
     Marginal ulcer1–5
     Bowel obstruction0.5–2
    Micronutrient and macronutrient deficiencies from RYGB 2–3 years postoperatively
     Iron deficiency45–52
     Vitamin B12 deficiency8–37
     Calcium deficiency10
     Vitamin D deficiency51
    Fat-soluable vitamin deficiencies (A, D, E, and K) and protein calorie malnutrition from BPD-DS procedures1–5
    • BPD-DS = biliopancreatic diversion with duodenal switch; LAGB = laparoscopic adjustable gastric banding

    • From Schauer PR, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care 2016; 39:908–911. ©2016 American Diabetes Association. All rights reserved. Material from this publication is used with the permission of American Diabetes Association.

    • View popup
    TABLE 3

    American Diabetes Association’s recommendations for the treatment of type 2 diabetes mellitus

    TreatmentBody mass index category (kg/m2)
    23.0a or
    25.0–26.9
    27.0–29.927.5a
    or 30.0–34.9
    35.0–39.9≥ 40
    Diet, physical activity, and behavioral therapy†††††
    Pharmacotherapy††††
    Metabolic surgery†††
    • ↵a Cutoff points for Asian American individuals.

    • ↵† Treatment may be indicated for selected motivated patients.

    • From American Diabetes Association. Obesity management for the treatment of type 2 diabetes. Sec. 7. In: Standards of Medical Care in Diabetes—2017. Diabetes Care 2017; 40(suppl 1):S57–S63. ©2017 American Diabetes Association. All rights reserved. Material from this publication is used with the permission of American Diabetes Association.

PreviousNext
Back to top

In this issue

Cleveland Clinic Journal of Medicine: 84 (7 suppl 1)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 7 suppl 1
1 Jul 2017
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world’s leading diabetes organizations
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world’s leading diabetes organizations
Philip R. Schauer, Zubaidah Nor Hanipah, Francesco Rubino
Cleveland Clinic Journal of Medicine Jul 2017, 84 (7 suppl 1) S47-S56; DOI: 10.3949/ccjm.84.s1.06

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world’s leading diabetes organizations
Philip R. Schauer, Zubaidah Nor Hanipah, Francesco Rubino
Cleveland Clinic Journal of Medicine Jul 2017, 84 (7 suppl 1) S47-S56; DOI: 10.3949/ccjm.84.s1.06
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • ABSTRACT
    • LIMITATIONS OF LIFESTYLE MANAGEMENT AND MEDICATIONS
    • METABOLIC SURGERY FOR TYPE 2 DM
    • METABOLIC SURGERY OUTCOMES
    • METABOLIC SURGERY: CLINICAL TRIALS
    • METABOLIC SURGERY: ADVERSE EVENTS
    • METABOLIC SURGERY: COST EFFECTIVENESS
    • WHO SHOULD HAVE METABOLIC SURGERY?
    • SUMMARY
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • New treatments for peripheral artery disease
  • Functional tricuspid regurgitation: Feasibility of transcatheter interventions
  • A practical approach to the cholesterol guidelines and ASCVD prevention
Show more Article

Similar Articles

Subjects

  • Diabetes
  • Endocrinology
  • Gastroenterology
  • Obesity

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2025 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire