Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot - ballot
Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot - ballot
Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions
| Active as of 2024-05-16 |
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<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Citation</b><a name="33089"> </a><a name="hc33089"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">ResourceCitation "33089" Version "3" Updated "2023-12-06 10:59:54+0000" </p></div><p><b>url</b>: <code>https://fevir.net/resources/Citation/33089</code></p><p><b>identifier</b>: FEvIR Object Identifier/33089, <code>https://pubmed.ncbi.nlm.nih.gov</code>/27222544</p><p><b>version</b>: 1.0.0-ballot</p><p><b>title</b>: 27222544 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.</p><p><b>status</b>: active</p><p><b>date</b>: 2024-05-16 12:17:54+0000</p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href="http://www.hl7.org/Special/committees/dss">http://www.hl7.org/Special/committees/dss</a></p><p><b>description</b>: This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide.</p><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>FEvIR Platform Use (Details: Citation Classification Type code fevir-platform-use = 'FEvIR Platform Use', stated as 'FEvIR Platform Use')</td><td>Medline Base <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-artifact-classifier.html">Citation Artifact Classifier</a>#medline-base)</span></td></tr></table><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (m49.htm#001)</span></p><p><b>copyright</b>: https://creativecommons.org/licenses/by-nc-sa/4.0/</p><p><b>approvalDate</b>: 2017-09-28</p><p><b>lastReviewDate</b>: 2022-04-08</p><p><b>author</b>: Computable Publishing®: MEDLINE-to-FEvIR Converter: </p><blockquote><p><b>classification</b></p><p><b>type</b>: Citation Source <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-classification-type.html">Citation Classification Type</a>#citation-source)</span></p><p><b>classifier</b>: MEDLINE <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: MEDLINE Citation Owner <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-classification-type.html">Citation Classification Type</a>#medline-owner)</span></p><p><b>classifier</b>: National Library of Medicine, Index Section <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (elements_descriptions.html#owner_value#NLM)</span></p></blockquote><p><b>currentState</b>: Medline Citation Status of Medline <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-status-type.html">Citation Status Type</a>#medline-medline)</span>, PubMed PublicationStatus of ppublish <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-status-type.html">Citation Status Type</a>#pubmed-publication-status-ppublish)</span></p><blockquote><p><b>statusDate</b></p><p><b>activity</b>: PubMed Pubstatus of Entrez <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-status-type.html">Citation Status Type</a>#pubmed-pubstatus-entrez)</span></p><p><b>period</b>: ?? --> 2016-05-26 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: PubMed Pubstatus of Pubmed <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-status-type.html">Citation Status Type</a>#pubmed-pubstatus-pubmed)</span></p><p><b>period</b>: ?? --> 2016-05-26 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: PubMed Pubstatus of Medline <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-status-type.html">Citation Status Type</a>#pubmed-pubstatus-medline)</span></p><p><b>period</b>: ?? --> 2017-09-29 06:00:00+0000</p></blockquote><blockquote><p><b>citedArtifact</b></p><p><b>identifier</b>: <code>https://pubmed.ncbi.nlm.nih.gov</code>/27222544, <code>https://doi.org</code>/10.2337/dc16-0236, pii/39/6/861</p><h3>Titles</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Language</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td>Primary title <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-title-type.html">Title Type</a>#primary)</span></td><td>English <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ietf3066.html">Tags for the Identification of Languages</a>#en)</span></td><td>Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.</td></tr></table><h3>Abstracts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Text</b></td><td><b>Copyright</b></td></tr><tr><td style="display: none">*</td><td>**BACKGROUND:** Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options.
**AIM:** The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D.
**METHODS:** A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee.
**RESULTS:** Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients.
**CONCLUSIONS:** Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.</td><td>© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.</td></tr></table><blockquote><p><b>relatesTo</b></p><p><b>type</b>: comment-in</p><p><b>classifier</b>: Comment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D016420)</span></p><p><b>citation</b>: Nat Rev Endocrinol. 2016 Sep;12 (9):500-2</p><h3>Documents</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Url</b></td></tr><tr><td style="display: none">*</td><td><a href="https://pubmed.ncbi.nlm.nih.gov/27388983/">https://pubmed.ncbi.nlm.nih.gov/27388983/</a></td></tr></table><p><b>resourceReference</b>: <span><code>https://pubmed.ncbi.nlm.nih.gov</code>/27388983</span></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: comment-in</p><p><b>classifier</b>: Comment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> 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(#Q000458)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: standards <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#Q000592)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Humans <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D006801)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Internationality <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D038622)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Obesity <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D009765)</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: surgery <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#Q000601)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Practice Guidelines as Topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D017410)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is Major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Risk Factors <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D012307)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Societies, Medical <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D012955)</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: organization & administration <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#Q000458)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: standards <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#Q000592)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote></blockquote></blockquote></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: Publication Type <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#publication-type)</span></p><p><b>classifier</b>: Consensus Development Conference <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D016446)</span>, Journal Article <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D016428)</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: Knowledge Artifact Type <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#knowledge-artifact-type)</span></p><p><b>classifier</b>: Journal Article <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-citation-artifact-classifier.html">Citation Artifact Classifier</a>#D016428)</span></p><p><b>artifactAssessment</b>: <span>: Classifier added by Computable Publishing LLC</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: Citation Subset <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#citation-subset)</span></p><p><b>classifier</b>: IM <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (elements_descriptions.html#citationsubset#IM)</span></p></blockquote><blockquote><p><b>contributorship</b></p><p><b>complete</b>: true</p><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor0"> </a></p><blockquote><p/><p><a name="author0"> </a></p><p><a name="hcauthor0"> </a></p><p><b>name</b>: Francesco Rubino </p></blockquote><p><b>forenameInitials</b>: F</p><p><b>affiliation</b>: <span>: King's College London, London, U.K. francesco.rubino@kcl.ac.uk davidec@u.washington.edu.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor1"> </a></p><blockquote><p/><p><a name="author1"> </a></p><p><a name="hcauthor1"> </a></p><p><b>name</b>: David M Nathan </p></blockquote><p><b>forenameInitials</b>: DM</p><p><b>affiliation</b>: <span>: Harvard Medical School, Boston, MA.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor2"> </a></p><blockquote><p/><p><a name="author2"> </a></p><p><a name="hcauthor2"> </a></p><p><b>name</b>: Robert H Eckel </p></blockquote><p><b>forenameInitials</b>: RH</p><p><b>affiliation</b>: <span>: University of Colorado Anschutz Medical Campus, Aurora, CO.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor3"> </a></p><blockquote><p/><p><a name="author3"> </a></p><p><a name="hcauthor3"> </a></p><p><b>name</b>: Philip R Schauer </p></blockquote><p><b>forenameInitials</b>: PR</p><p><b>affiliation</b>: <span>: Cleveland Clinic, Cleveland, OH.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor4"> </a></p><blockquote><p/><p><a name="author4"> </a></p><p><a name="hcauthor4"> </a></p><p><b>name</b>: K George M M Alberti </p></blockquote><p><b>forenameInitials</b>: KG</p><p><b>affiliation</b>: <span>: Imperial College London, London, U.K.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor5"> </a></p><blockquote><p/><p><a name="author5"> </a></p><p><a name="hcauthor5"> </a></p><p><b>name</b>: Paul Z Zimmet </p></blockquote><p><b>forenameInitials</b>: PZ</p><p><b>affiliation</b>: <span>: Monash University, Melbourne, Victoria, Australia.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor6"> </a></p><blockquote><p/><p><a name="author6"> </a></p><p><a name="hcauthor6"> </a></p><p><b>name</b>: Stefano Del Prato </p></blockquote><p><b>forenameInitials</b>: S</p><p><b>affiliation</b>: <span>: University of Pisa, Pisa, Italy.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor7"> </a></p><blockquote><p/><p><a name="author7"> </a></p><p><a name="hcauthor7"> </a></p><p><b>name</b>: Linong Ji </p></blockquote><p><b>forenameInitials</b>: L</p><p><b>affiliation</b>: <span>: Peking University, Beijing, China.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor8"> </a></p><blockquote><p/><p><a name="author8"> </a></p><p><a name="hcauthor8"> </a></p><p><b>name</b>: Shaukat M Sadikot </p></blockquote><p><b>forenameInitials</b>: SM</p><p><b>affiliation</b>: <span>: Diabetes India, Mumbai, India.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor9"> </a></p><blockquote><p/><p><a name="author9"> </a></p><p><a name="hcauthor9"> </a></p><p><b>name</b>: William H Herman </p></blockquote><p><b>forenameInitials</b>: WH</p><p><b>affiliation</b>: <span>: University of Michigan, Ann Arbor, MI.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor10"> </a></p><blockquote><p/><p><a name="author10"> </a></p><p><a name="hcauthor10"> </a></p><p><b>name</b>: Stephanie A Amiel </p></blockquote><p><b>forenameInitials</b>: SA</p><p><b>affiliation</b>: <span>: King's College London, London, U.K.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor11"> </a></p><blockquote><p/><p><a name="author11"> </a></p><p><a name="hcauthor11"> </a></p><p><b>name</b>: Lee M Kaplan </p></blockquote><p><b>forenameInitials</b>: LM</p><p><b>affiliation</b>: <span>: Harvard Medical School, Boston, MA.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor12"> </a></p><blockquote><p/><p><a name="author12"> </a></p><p><a name="hcauthor12"> </a></p><p><b>name</b>: Gaspar Taroncher-Oldenburg </p></blockquote><p><b>forenameInitials</b>: G</p><p><b>affiliation</b>: <span>: Philadelphia, PA.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor13"> </a></p><blockquote><p/><p><a name="author13"> </a></p><p><a name="hcauthor13"> </a></p><p><b>name</b>: David E Cummings </p></blockquote><p><b>forenameInitials</b>: DE</p><p><b>affiliation</b>: <span>: University of Washington, Seattle, WA francesco.rubino@kcl.ac.uk davidec@u.washington.edu.</span></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a name="hcauthor14"> </a></p><blockquote><p/><p><a name="author14"> </a></p><p><a name="hcauthor14"> </a></p><p><b>name</b>: Delegates of the 2nd Diabetes Surgery Summit</p></blockquote></blockquote></blockquote></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author0</b><a name="author0"> </a><a name="hcauthor0"> </a></p><p><b>name</b>: Francesco Rubino </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author1</b><a name="author1"> </a><a name="hcauthor1"> </a></p><p><b>name</b>: David M Nathan </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author2</b><a name="author2"> </a><a name="hcauthor2"> </a></p><p><b>name</b>: Robert H Eckel </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author3</b><a name="author3"> </a><a name="hcauthor3"> </a></p><p><b>name</b>: Philip R Schauer </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author4</b><a name="author4"> </a><a name="hcauthor4"> </a></p><p><b>name</b>: K George M M Alberti </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author5</b><a name="author5"> </a><a name="hcauthor5"> </a></p><p><b>name</b>: Paul Z Zimmet </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author6</b><a name="author6"> </a><a name="hcauthor6"> </a></p><p><b>name</b>: Stefano Del Prato </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author7</b><a name="author7"> </a><a name="hcauthor7"> </a></p><p><b>name</b>: Linong Ji </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author8</b><a name="author8"> </a><a name="hcauthor8"> </a></p><p><b>name</b>: Shaukat M Sadikot </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author9</b><a name="author9"> </a><a name="hcauthor9"> </a></p><p><b>name</b>: William H Herman </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author10</b><a name="author10"> </a><a name="hcauthor10"> </a></p><p><b>name</b>: Stephanie A Amiel </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author11</b><a name="author11"> </a><a name="hcauthor11"> </a></p><p><b>name</b>: Lee M Kaplan </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author12</b><a name="author12"> </a><a name="hcauthor12"> </a></p><p><b>name</b>: Gaspar Taroncher-Oldenburg </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #author13</b><a name="author13"> </a><a name="hcauthor13"> </a></p><p><b>name</b>: David E Cummings </p></blockquote><hr/><blockquote><p><b>Generated Narrative: Organization #author14</b><a name="author14"> </a><a name="hcauthor14"> </a></p><p><b>name</b>: Delegates of the 2nd Diabetes Surgery Summit</p></blockquote><hr/><blockquote><p><b>Generated Narrative: ArtifactAssessment #meshHeading0</b><a name="meshHeading0"> </a><a name="hcmeshHeading0"> </a></p><p><b>artifact</b>: <a href="#">#</a></p><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Algorithms <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D000465)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is Major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Bariatric Surgery <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D050110)</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: standards <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#Q000592)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Cardiovascular Diseases <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D002318)</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: prevention & control <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#Q000517)</span></p><blockquote><p><b>component</b></p></blockquote></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Consensus <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D032921)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Cooperative Behavior <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D003299)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td>qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td><td>is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: components (if present) include qualifier codings <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R5/codesystem-cited-artifact-classification-type.html">Cited Artifact Classification Type</a>#mesh-heading "MeSH heading")</span></p><p><b>classifier</b>: Diabetes Mellitus, Type 2 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (#D003924)</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: qualifier <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>classifier</b>: is not a major topic <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> 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value="**BACKGROUND:** Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options.
**AIM:** The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D.
**METHODS:** A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee.
**RESULTS:** Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients.
**CONCLUSIONS:** Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies."/>
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IG © 2022+ HL7 International / Clinical Decision Support. Package hl7.fhir.uv.ebm#1.0.0-ballot based on FHIR 5.0.0. Generated 2024-05-16
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