International expert consensus on surgery for type 2 diabetes mellitus

Mohammad Kermansaravi; Islam Omar; Nicholas Finer; Carel Le Roux; Miguel A. Carbajo; David Sarwer; Luca Busetto; Jaime Ponce; Jennifer Logue; Helen M. Parretti; Mary O’Kane; Shahab Shahabi; Kamlesh Khunti; Alexandra I. Blakemore; Erik Stenberg; Sally Abbott; Aayed Alqahtani; Ali Aminian; Bassem Amr; Jose M. Balibrea; Rachel L. Batterham; Estuardo Behrens; Deepak L. Bhatt; Paul Chesworth; Pradeep Chowbey; Ken Clare; Manoel Galvao Neto; Yitka Graham; Ramen Goel; Wasim Hanif; Miguel F. Herrera; Kazunori Kasama; Radwan Kassir; Filip K. Knop; Shanu N. Kothari; Jon A. Kristinsson; Barbara McGowan; Andrew McKechnie; Karl Miller; Alex D. Miras; John Morton; Jane Ogden; Ralph Peterli; Jonathan H. Pinkney; Dimitri Pournaras; Sjaak Pouwels; Gerhard Prager; Paulina Salminen; Mireille J. Serlie; Asim Shabbir; Rishi Singhal; Shahrad Taheri; Abd A. Tahrani; Rudolf Weiner; Scott A. Shikora; Kamal Mahawar

doi:10.1186/s12902-025-01961-w

International expert consensus on surgery for type 2 diabetes mellitus

Mohammad Kermansaravi
, Islam Omar
, Nicholas Finer
, Carel Le Roux
, Miguel A. Carbajo
, David Sarwer
, Luca Busetto
, Jaime Ponce
, Jennifer Logue
, Helen M. Parretti
, Mary O’Kane
, Shahab Shahabi
, Kamlesh Khunti
, Alexandra I. Blakemore
, Erik Stenberg
, Sally Abbott
, Aayed Alqahtani
, Ali Aminian
, Bassem Amr
, Jose M. Balibrea

Rachel L. Batterham, Estuardo Behrens, Deepak L. Bhatt, Paul Chesworth, Pradeep Chowbey, Ken Clare, Manoel Galvao Neto, Yitka Graham, Ramen Goel, Wasim Hanif, Miguel F. Herrera, Kazunori Kasama, Radwan Kassir, Filip K. Knop, Shanu N. Kothari, Jon A. Kristinsson, Barbara McGowan, Andrew McKechnie, Karl Miller, Alex D. Miras, John Morton, Jane Ogden, Ralph Peterli, Jonathan H. Pinkney, Dimitri Pournaras, Sjaak Pouwels, Gerhard Prager, Paulina Salminen, Mireille J. Serlie, Asim Shabbir, Rishi Singhal, Shahrad Taheri, Abd A. Tahrani, Rudolf Weiner, Scott A. Shikora, Kamal Mahawar

Iran University of Medical Sciences
Chelsea and Westminister Hospital NHS Foundation Trust
University of Warwick
Public Health Action Support Team
University College Dublin
Center of Excellence for the Study and Treatment of Obesity and Diabetes
Temple University
Padua University Hospital
CHI Memorial Medical Group
Lancaster Medical School
University of East Anglia
Leeds Teaching Hospitals NHS Trust
University of Leicester
Brunel University
Örebro University
New You Medical Center
Cleveland Clinic Foundation
Taunton and Somerset NHS Foundation Trust
Hospital Clínic de Barcelona
University College London
New Life Center
Icahn School of Medicine at Mount Sinai
Patient Representative
Max Hospital
Leeds Beckett University
Faculdade de Medicina do ABC
University of Sunderland
Wockhardt Hospitals India
University Hospitals Birmingham NHS Foundation Trust
Universidad Nacional Autónoma de México
Yotsuya Medical Cube
The View Hospital
Copenhagen University Hospital
University of South Carolina School of Medicine Greenville
Oslo University Hospital
Guy’s and St Thomas’ NHS Foundation Trust
Lewisham and Greenwich NHS Trust
Diakonissen Wehrle Private Hospital
Imperial College London
Yale School of Medicine
University of Surrey
University Hospital Bern
University Centre for Gastrointestinal and Liver Diseases
Plymouth University
North Bristol NHS Trust
Elisabeth-Tweesteden Hospital
Medical University of Vienna
Turku University Hospital
University of Turku
Amsterdam UMC
National University Health System
Weill Cornell Medical College Qatar
Sana Hospital Offenbach
Harvard Medical School
Sunderland Royal Hospital

Research output: Contribution to journal › Review article › peer-review

3 Citations (Scopus)

17 Downloads (Pure)

Abstract

Introduction: Metabolic and bariatric surgery (MBS) has been an established treatment option for patients with Type 2 diabetes mellitus (T2DM), but there is a relative paucity of evidence-based guidelines on preoperative, operative, and postoperative considerations concerning metabolic surgery for T2DM patients. To address this gap, we initiated a Delphi consensus process with a diverse group of international multidisciplinary experts. Method: We embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. We defined the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Consensus, defined as > 80% agreement, was reached for 43 out of 44 statements. The experts reached an agreement on the nature, terminology, and mechanisms of action of MBS. The currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is cost-effective, and MBS procedures for treating T2DM vary in their safety and efficacy. Conclusion: This Delphi expert consensus statement guides clinicians on various aspects of metabolic surgery for T2DM and also grades the quality of the available evidence for each of the proposed statements.

Original language	English
Article number	151
Number of pages	23
Journal	BMC Endocrine Disorders
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s12902-025-01961-w
Publication status	Published - 1 Jul 2025

Bibliographical note

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
you modifed the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To
view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Bariatric Surgery
Metabolic Surgery
Type 2 diabetes mellitus

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism

Access to Document

10.1186/s12902-025-01961-wLicence: CC BY-NC-ND

Abbott2025VORFinal published version, 1 MBLicence: CC BY-NC-ND

Cite this

Kermansaravi, M., Omar, I., Finer, N., Le Roux, C., Carbajo, M. A., Sarwer, D., Busetto, L., Ponce, J., Logue, J., Parretti, H. M., O’Kane, M., Shahabi, S., Khunti, K., Blakemore, A. I., Stenberg, E., Abbott, S., Alqahtani, A., Aminian, A., Amr, B., ... Mahawar, K. (2025). International expert consensus on surgery for type 2 diabetes mellitus. BMC Endocrine Disorders, 25(1), Article 151. https://doi.org/10.1186/s12902-025-01961-w

Kermansaravi, M, Omar, I, Finer, N, Le Roux, C, Carbajo, MA, Sarwer, D, Busetto, L, Ponce, J, Logue, J, Parretti, HM, O’Kane, M, Shahabi, S, Khunti, K, Blakemore, AI, Stenberg, E, Abbott, S, Alqahtani, A, Aminian, A, Amr, B, Balibrea, JM, Batterham, RL, Behrens, E, Bhatt, DL, Chesworth, P, Chowbey, P, Clare, K, Neto, MG, Graham, Y, Goel, R, Hanif, W, Herrera, MF, Kasama, K, Kassir, R, Knop, FK, Kothari, SN, Kristinsson, JA, McGowan, B, McKechnie, A, Miller, K, Miras, AD, Morton, J, Ogden, J, Peterli, R, Pinkney, JH, Pournaras, D, Pouwels, S, Prager, G, Salminen, P, Serlie, MJ, Shabbir, A, Singhal, R, Taheri, S, Tahrani, AA, Weiner, R, Shikora, SA & Mahawar, K 2025, 'International expert consensus on surgery for type 2 diabetes mellitus', BMC Endocrine Disorders, vol. 25, no. 1, 151. https://doi.org/10.1186/s12902-025-01961-w

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abstract = "Introduction: Metabolic and bariatric surgery (MBS) has been an established treatment option for patients with Type 2 diabetes mellitus (T2DM), but there is a relative paucity of evidence-based guidelines on preoperative, operative, and postoperative considerations concerning metabolic surgery for T2DM patients. To address this gap, we initiated a Delphi consensus process with a diverse group of international multidisciplinary experts. Method: We embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. We defined the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Consensus, defined as > 80\% agreement, was reached for 43 out of 44 statements. The experts reached an agreement on the nature, terminology, and mechanisms of action of MBS. The currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is cost-effective, and MBS procedures for treating T2DM vary in their safety and efficacy. Conclusion: This Delphi expert consensus statement guides clinicians on various aspects of metabolic surgery for T2DM and also grades the quality of the available evidence for each of the proposed statements.",

keywords = "Bariatric Surgery, Metabolic Surgery, Type 2 diabetes mellitus",

author = "Mohammad Kermansaravi and Islam Omar and Nicholas Finer and \{Le Roux\}, Carel and Carbajo, \{Miguel A.\} and David Sarwer and Luca Busetto and Jaime Ponce and Jennifer Logue and Parretti, \{Helen M.\} and Mary O{\textquoteright}Kane and Shahab Shahabi and Kamlesh Khunti and Blakemore, \{Alexandra I.\} and Erik Stenberg and Sally Abbott and Aayed Alqahtani and Ali Aminian and Bassem Amr and Balibrea, \{Jose M.\} and Batterham, \{Rachel L.\} and Estuardo Behrens and Bhatt, \{Deepak L.\} and Paul Chesworth and Pradeep Chowbey and Ken Clare and Neto, \{Manoel Galvao\} and Yitka Graham and Ramen Goel and Wasim Hanif and Herrera, \{Miguel F.\} and Kazunori Kasama and Radwan Kassir and Knop, \{Filip K.\} and Kothari, \{Shanu N.\} and Kristinsson, \{Jon A.\} and Barbara McGowan and Andrew McKechnie and Karl Miller and Miras, \{Alex D.\} and John Morton and Jane Ogden and Ralph Peterli and Pinkney, \{Jonathan H.\} and Dimitri Pournaras and Sjaak Pouwels and Gerhard Prager and Paulina Salminen and Serlie, \{Mireille J.\} and Asim Shabbir and Rishi Singhal and Shahrad Taheri and Tahrani, \{Abd A.\} and Rudolf Weiner and Shikora, \{Scott A.\} and Kamal Mahawar",

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doi = "10.1186/s12902-025-01961-w",

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T1 - International expert consensus on surgery for type 2 diabetes mellitus

AU - Kermansaravi, Mohammad

AU - Omar, Islam

AU - Finer, Nicholas

AU - Le Roux, Carel

AU - Carbajo, Miguel A.

AU - Sarwer, David

AU - Busetto, Luca

AU - Ponce, Jaime

AU - Logue, Jennifer

AU - Parretti, Helen M.

AU - O’Kane, Mary

AU - Shahabi, Shahab

AU - Khunti, Kamlesh

AU - Blakemore, Alexandra I.

AU - Stenberg, Erik

AU - Abbott, Sally

AU - Alqahtani, Aayed

AU - Aminian, Ali

AU - Amr, Bassem

AU - Balibrea, Jose M.

AU - Batterham, Rachel L.

AU - Behrens, Estuardo

AU - Bhatt, Deepak L.

AU - Chesworth, Paul

AU - Chowbey, Pradeep

AU - Clare, Ken

AU - Neto, Manoel Galvao

AU - Graham, Yitka

AU - Goel, Ramen

AU - Hanif, Wasim

AU - Herrera, Miguel F.

AU - Kasama, Kazunori

AU - Kassir, Radwan

AU - Knop, Filip K.

AU - Kothari, Shanu N.

AU - Kristinsson, Jon A.

AU - McGowan, Barbara

AU - McKechnie, Andrew

AU - Miller, Karl

AU - Miras, Alex D.

AU - Morton, John

AU - Ogden, Jane

AU - Peterli, Ralph

AU - Pinkney, Jonathan H.

AU - Pournaras, Dimitri

AU - Pouwels, Sjaak

AU - Prager, Gerhard

AU - Salminen, Paulina

AU - Serlie, Mireille J.

AU - Shabbir, Asim

AU - Singhal, Rishi

AU - Taheri, Shahrad

AU - Tahrani, Abd A.

AU - Weiner, Rudolf

AU - Shikora, Scott A.

AU - Mahawar, Kamal

N1 - Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modifed the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

PY - 2025/7/1

Y1 - 2025/7/1

N2 - Introduction: Metabolic and bariatric surgery (MBS) has been an established treatment option for patients with Type 2 diabetes mellitus (T2DM), but there is a relative paucity of evidence-based guidelines on preoperative, operative, and postoperative considerations concerning metabolic surgery for T2DM patients. To address this gap, we initiated a Delphi consensus process with a diverse group of international multidisciplinary experts. Method: We embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. We defined the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Consensus, defined as > 80% agreement, was reached for 43 out of 44 statements. The experts reached an agreement on the nature, terminology, and mechanisms of action of MBS. The currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is cost-effective, and MBS procedures for treating T2DM vary in their safety and efficacy. Conclusion: This Delphi expert consensus statement guides clinicians on various aspects of metabolic surgery for T2DM and also grades the quality of the available evidence for each of the proposed statements.

AB - Introduction: Metabolic and bariatric surgery (MBS) has been an established treatment option for patients with Type 2 diabetes mellitus (T2DM), but there is a relative paucity of evidence-based guidelines on preoperative, operative, and postoperative considerations concerning metabolic surgery for T2DM patients. To address this gap, we initiated a Delphi consensus process with a diverse group of international multidisciplinary experts. Method: We embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. We defined the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Consensus, defined as > 80% agreement, was reached for 43 out of 44 statements. The experts reached an agreement on the nature, terminology, and mechanisms of action of MBS. The currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is cost-effective, and MBS procedures for treating T2DM vary in their safety and efficacy. Conclusion: This Delphi expert consensus statement guides clinicians on various aspects of metabolic surgery for T2DM and also grades the quality of the available evidence for each of the proposed statements.

KW - Bariatric Surgery

KW - Metabolic Surgery

KW - Type 2 diabetes mellitus

UR - https://www.scopus.com/pages/publications/105009730845

U2 - 10.1186/s12902-025-01961-w

DO - 10.1186/s12902-025-01961-w

M3 - Review article

AN - SCOPUS:105009730845

SN - 1472-6823

VL - 25

JO - BMC Endocrine Disorders

JF - BMC Endocrine Disorders

IS - 1

M1 - 151

ER -

International expert consensus on surgery for type 2 diabetes mellitus

Abstract

Bibliographical note

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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