Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Consider impact on weight when choosing glucose-lowering meds for overweight or obese patients. E

• Consider impact on weight when choosing glucose-lowering meds for overweight or obese patients. E

• Minimize the medications for comorbid conditions that are associated with weight gain. E

• Weight loss meds may be effective adjuncts to diet, physical activity & behavioral counseling for select patients. A

If patient response to weight loss medications <5% after 3 months or there are safety or tolerability issues at any time, discontinue medication and consider alternative medications or treatment approaches. A

• If patient response to weight loss medications <5% after 3 months or there are safety or tolerability issues at any time, discontinue medication and consider alternative medications or treatment approaches. A

Evidence supports gastrointestinal operations as effective treatments for overweight T2DM patients.

• Evidence supports gastrointestinal operations as effective treatments for overweight T2DM patients.

• Randomized controlled trials with postoperative follow-up ranging from 1 to 5 years have documented sustained diabetes remission in 30–63% of patients, though erosion of remission occurs in 35-50% or more.

• With or without diabetes relapse, the majority of patients who undergo surgery maintain substantial improvement of glycemic control for at least 5 to 15 years

Metabolic surgery should be recommended to treat T2DM for all appropriate surgical candidates with BMIs > 40 (37.5*) and those with BMIs 35.0-39.9 (32.5-37.4*) when hyperglycemia is inadequately controlled despite lifestyle & optimal medical therapy. A

• Metabolic surgery should be recommended to treat T2DM for all appropriate surgical candidates with BMIs > 40 (37.5*) and those with BMIs 35.0-39.9 (32.5-37.4*) when hyperglycemia is inadequately controlled despite lifestyle & optimal medical therapy. A

• Metabolic surgery should be considered for the treatment of T2DM in adults with BMIs 30-34.9 (27.5-32.4*) when hyperglycemia is inadequately controlled despite optimal medical control by either oral or injectable medications (including insulin). B

• Metabolic surgery should be performed in high-volume centers with multidisciplinary teams that understand and are experienced in the management of diabetes and gastrointestinal surgery. C

Long-term lifestyle support and routine monitoring of micronutrient/nutritional status must be provided after surgery. C

• Long-term lifestyle support and routine monitoring of micronutrient/nutritional status must be provided after surgery. C

• People presenting for metabolic surgery should receive a comprehensive mental health assessment. B Surgery should be postponed in patients with histories of alcohol or substance abuse, significant depression, suicidal ideation, or other mental health conditions until these conditions have been fully addressed. E

• People who undergo metabolic surgery should be evaluated to assess the need for ongoing mental health services to help them adjust to medical and psychosocial changes after surgery. C

Costly

• Costly

• Some associated risks

• Outcomes vary

• Patients undergoing metabolic surgery may be at higher risk for depression, substance abuse, and other psychosocial issues

Most people with T1DM should be treated with multiple daily injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion (CSII). A

• Most people with T1DM should be treated with multiple daily injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion (CSII). A

• Individuals who have been successfully using CSII should have continued access after they turn 65 years old. E

Consider educating individuals with T1DM on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. E

• Consider educating individuals with T1DM on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. E

• Most individuals with T1DM should use insulin analogs to reduce hypoglycemia risk. A

FDA approved for T1DM

• FDA approved for T1DM

• Amylin analog

• Delays gastric emptying, blunts pancreatic glucose secretion, enhances satiety

• Induces weight loss, lowers insulin dose

• Requires reduction in prandial insulin to reduce risk of severe hypos

Can normalize glucose but require lifelong immunosuppression.

• Can normalize glucose but require lifelong immunosuppression.

• Reserve pancreas transplantation for T1D patients:

• Undergoing renal transplant
• Following renal transplant
• With recurrent ketoacidosis or severe hypos

• Islet cell transplant investigational

• Consider for patients requiring pancreatectomy who meet eligibility criteria.