Generated Narrative: ArtifactAssessment 179700 version: 11; Last updated: 2025-05-12 08:30:06+0000; Language: en Profile: Comparison ArtifactAssessmentCompared: Recommendation: ADA Obesity Management Recommendation 8.16-adapted Artifact Description: This Comparison Profile shows a comparison of top-level elements between two Resources and classifies each element pairing as Same or Different based on whether the content is a match. ArtifactPublicationStatus: Active identifier: FEvIR Object Identifier/179700 title: Comparison: Original and Adapted Recommendation: ADA Obesity Management Recommendation 8.16 citeAs: Comparison: Original and Adapted Recommendation: ADA Obesity Management Recommendation 8.16 [Database Entry: FHIR ArtifactAssessment Resource]. Contributors: In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179700. Revised 2025-05-12. Available at: https://fevir.net/resources/ArtifactAssessment/179700. Computable resource at: TBD#json. artifact: Recommendation: ADA Obesity Management Recommendation 8.16 content type: Primitive Element classifier: string Datatype path: resourceType component summary: Composition type: Original Resource Content Components - Summary Type Classifier * Composition Compared Resource Content string Datatype component type: Comparison of Resources Content classifier: Same Components - Type * Rationale for Change to Resource Content component type: Suggested Change to Resource Content component type: Contained Element Adaptation path: resourceType content type: Primitive Element classifier: string Datatype path: id component summary: 179466 type: Original Resource Content Components - Summary Type Classifier * 179699 Compared Resource Content string Datatype component type: Comparison of Resources Content classifier: Different Components - Type * Rationale for Change to Resource Content component type: Suggested Change to Resource Content component type: Contained Element Adaptation path: id content type: Object Element classifier: Manage as Meta path: meta component type: Original Resource Content component summary: {"versionId":"15","lastUpdated":"2023-11-24T19:36:33.794Z","profile":["http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation"]} type: Original Resource Content JSON component type: Compared Resource Content classifier: Manage as Meta Components - Summary Type * {"versionId":"1","lastUpdated":"2023-11-28T15:35:24.114Z","profile":["http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation"]} Original Resource Content JSON component type: Comparison of Resources Content classifier: Different component type: Suggested Change to Resource Content component summary: {"versionId":"15","lastUpdated":"2023-11-24T19:36:33.794Z","profile":["http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation"]} type: Contained Element Adaptation path: meta content type: Primitive Element classifier: string Datatype path: url component summary: https://fevir.net/resources/Composition/179466 type: Original Resource Content Components - Summary Type Classifier * https://fevir.net/resources/Composition/179699 Compared Resource Content string Datatype component type: Comparison of Resources Content classifier: Different component type: Suggested Change to Resource Content content type: Array Element classifier: Manage as Identifier path: identifier component type: Original Resource Content component summary: [{"type":{"text":"FEvIR Object Identifier"},"system":"https://fevir.net","value":"179466","assigner":{"display":"Computable Publishing LLC"}}] type: Original Resource Content JSON component type: Compared Resource Content classifier: Manage as Array of Identifier Components - Summary Type * [{"type":{"text":"FEvIR Object Identifier"},"system":"https://fevir.net","value":"179699","assigner":{"display":"Computable Publishing LLC"}}] Original Resource Content JSON component type: Comparison of Resources Content classifier: Different component type: Suggested Change to Resource Content component summary: [{"type":{"text":"FEvIR Object Identifier"},"system":"https://fevir.net","value":"179466","assigner":{"display":"Computable Publishing LLC"}}] type: Contained Element Adaptation path: identifier content type: Primitive Element classifier: string Datatype path: status component summary: final type: Original Resource Content Components - Summary Type Classifier * final Compared Resource Content string Datatype component type: Comparison of Resources Content classifier: Same component type: Suggested Change to Resource Content content type: Object Element classifier: Manage as CodeableConcept path: type component type: Original Resource Content component summary: {"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"EvidenceReport","display":"EvidenceReport"}],"text":"EvidenceReport"} type: Original Resource Content JSON component type: Compared Resource Content classifier: Manage as CodeableConcept Components - Summary Type * {"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"EvidenceReport","display":"EvidenceReport"}],"text":"EvidenceReport"} Original Resource Content JSON component type: Comparison of Resources Content classifier: Same component type: Suggested Change to Resource Content component summary: {"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"EvidenceReport","display":"EvidenceReport"}],"text":"EvidenceReport"} type: Contained Element Adaptation path: type content type: Array Element classifier: Manage as CodeableConcept path: category component type: Original Resource Content component summary: [{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"Recommendation","display":"Recommendation"}]}] type: Original Resource Content JSON component type: Compared Resource Content classifier: Manage as Array of CodeableConcept Components - Summary Type * [{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"Recommendation","display":"Recommendation"}]}] Original Resource Content JSON component type: Comparison of Resources Content classifier: Same component type: Suggested Change to Resource Content component summary: [{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"Recommendation","display":"Recommendation"}]}] type: Contained Element Adaptation path: category content type: Primitive Element classifier: string Datatype path: date component summary: 2023-11-24T19:36:33.794Z type: Original Resource Content Components - Summary Type Classifier * 2023-11-28T15:35:24.114Z Compared Resource Content string Datatype component type: Comparison of Resources Content classifier: Different component type: Suggested Change to Resource Content content type: Array Element classifier: Manage as Reference path: author component type: Original Resource Content component summary: [{"display":"Brian S. Alper"}] type: Original Resource Content JSON component type: Compared Resource Content classifier: Manage as Array of Reference Components - Summary Type * [{"display":"Joanne Dehnbostel"}] Original Resource Content JSON component type: Comparison of Resources Content classifier: Different component type: Suggested Change to Resource Content component summary: [{"display":"Brian S. Alper"}] type: Contained Element Adaptation path: author content type: Primitive Element classifier: string Datatype path: title component summary: Recommendation: ADA Obesity Management Recommendation 8.16 type: Original Resource Content Components - Summary Type Classifier * Recommendation: ADA Obesity Management Recommendation 8.16-adapted Compared Resource Content string Datatype component type: Comparison of Resources Content classifier: Different component type: Suggested Change to Resource Content content type: Object Element classifier: Manage as Reference path: custodian component type: Original Resource Content component summary: {"reference":"Organization/118079","type":"Organization","display":"Computable Publishing LLC"} type: Original Resource Content JSON component type: Compared Resource Content classifier: Manage as Reference Components - Summary Type * {"reference":"Organization/118079","type":"Organization","display":"Computable Publishing LLC"} Original Resource Content JSON component type: Comparison of Resources Content classifier: Same component type: Suggested Change to Resource Content component summary: {"reference":"Organization/118079","type":"Organization","display":"Computable Publishing LLC"} type: Contained Element Adaptation path: custodian content type: Array Element classifier: Manage as BackboneElement path: section component type: Original Resource Content component summary: [{"title":"Recommendation Specification","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"recommendation-specification","display":"Recommendation Specification"}],"text":"Recommendation Specification"},"section":[{"title":"Recommendation Statement","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"recommendation-statement","display":"Recommendation Statement"}],"text":"overallSummary"},"text":{"status":"generated","div":"8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans) and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. A"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]},{"title":"Recommendation Rating System","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"rating-system","display":"Rating System"}]},"text":{"status":"generated","div":"ADA Level of Evidence"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]},{"title":"Strength of Recommendation Rating","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"strength-of-recommendation","display":"Strength of Recommendation"}],"text":"strengthOfRecommendationRating"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]},{"title":"Direction of Recommendation","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"direction-of-recommendation","display":"Direction of Recommendation"}],"text":"directionOfRecommendation"},"text":{"status":"generated","div":"Favors intervention"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]},{"title":"Other Recommendation Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"overallRatings"},"text":{"status":"generated","div":"A"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]},{"title":"Overall Recommendation Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"overallRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Discussion","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"discussion","display":"Discussion"}]},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Population","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"population","display":"Population"}],"text":"population"},"text":{"status":"generated","div":"Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates."},"entry":[{"reference":"Group/32139","type":"Group","display":"RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)"}]},{"title":"Action","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"action","display":"Action"}],"text":"action"},"text":{"status":"generated","div":"Metabolic surgery is recommended."},"entry":[{"reference":"PlanDefinition/179468","type":"PlanDefinition","display":"PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16"}]},{"title":"Opposite Action","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"opposite-action","display":"Opposite Action"}],"text":"oppositeAction"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Structured Data","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"data-source","display":"Data Source"}],"text":"relatesToDerivedFrom"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Evidence","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"evidence","display":"Evidence"}],"text":"Evidence"},"section":[{"title":"Summary of Findings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"summary-of-findings","display":"Summary of Findings"}],"text":"summaryOfFindingsSummary"},"text":{"status":"generated","div":"ADA Level of Evidence A. A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions."},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}],"section":[{"title":"Summary of Findings Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"summaryOfFindingsRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Summary of Findings Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"summaryOfFindingsRelatedItems"},"text":{"status":"generated","div":"JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]}]},{"title":"Desirable Effects","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"desirable-effects","display":"Desirable Effects"}],"text":"desirableSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Desirable Effects Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"desirableRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Desirable Effects Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"desirableRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Undesirable Effects Summary","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"undesirable-effects","display":"Undesirable Effects"}],"text":"undesirableSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Undesirable Effects Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"undesirableRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Undesirable Effects Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"undesirableRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Discussion","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"discussion","display":"Discussion"}]},"text":{"status":"generated","div":"A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions. In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement."},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]},{"title":"Data Source","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"data-source","display":"Data Source"}]},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Net Effect","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"net-effect","display":"Net Effect"}],"text":"Net Effect"},"section":[{"title":"Net Effect (Balance of Benefits/Harms) 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Summary","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"justification","display":"Justification"}],"text":"overallJustificationSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Overall Justification Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"overallJustificationRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Overall Justification Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"overallJustificationRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Problem Importance Summary","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"problem-importance","display":"Problem Importance"}],"text":"problemImportanceSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Problem Importance Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"problemImportanceRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Problem Importance Related 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[[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. 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Recommendation: ADA Obesity Management Recommendation 8.16-adapted
This Comparison Profile shows a comparison of top-level elements between two Resources and classifies each element pairing as Same or Different based on whether the content is a match.
Comparison: Original and Adapted Recommendation: ADA Obesity Management Recommendation 8.16
Comparison: Original and Adapted Recommendation: ADA Obesity Management Recommendation 8.16 [Database Entry: FHIR ArtifactAssessment Resource]. Contributors: In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179700. Revised 2025-05-12. Available at: https://fevir.net/resources/ArtifactAssessment/179700. Computable resource at: TBD#json.
Recommendation: ADA Obesity Management Recommendation 8.16
Rationale for Change to Resource Content
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A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions."},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}],"section":[{"title":"Summary of Findings Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"summaryOfFindingsRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Summary of Findings Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"summaryOfFindingsRelatedItems"},"text":{"status":"generated","div":"JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]}]},{"title":"Desirable Effects","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"desirable-effects","display":"Desirable Effects"}],"text":"desirableSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Desirable Effects Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"desirableRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Desirable Effects Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"desirableRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Undesirable Effects Summary","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"undesirable-effects","display":"Undesirable Effects"}],"text":"undesirableSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Undesirable Effects Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"undesirableRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Undesirable Effects Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"undesirableRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Discussion","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"discussion","display":"Discussion"}]},"text":{"status":"generated","div":"A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions. 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These disclosures are discussed at the outset of each Standards of Care revision meeting. Members of the committee, their employers, and their disclosed conflicts of interest are listed in 'Disclosures: Standards of Medical Care in Diabetes—2021' (https://doi.org/10.2337/dc21-SPPC). The ADA funds development of the Standards of Care out of its general revenues and does not use industry support for this purpose. 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[[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates."},"entry":[{"reference":"Group/32139","type":"Group","display":"RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)"}]},{"title":"Action","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"action","display":"Action"}],"text":"action"},"text":{"status":"generated","div":"Metabolic surgery is recommended."},"entry":[{"reference":"PlanDefinition/179468","type":"PlanDefinition","display":"PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16"}]},{"title":"Opposite Action","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"opposite-action","display":"Opposite Action"}],"text":"oppositeAction"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Structured Data","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"data-source","display":"Data Source"}],"text":"relatesToDerivedFrom"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Evidence","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"evidence","display":"Evidence"}],"text":"Evidence"},"section":[{"title":"Summary of Findings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"summary-of-findings","display":"Summary of Findings"}],"text":"summaryOfFindingsSummary"},"text":{"status":"generated","div":"ADA Level of Evidence A. A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions."},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}],"section":[{"title":"Summary of Findings Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"summaryOfFindingsRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Summary of Findings Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"summaryOfFindingsRelatedItems"},"text":{"status":"generated","div":"JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations"},"entry":[{"reference":"ArtifactAssessment/179469","type":"ArtifactAssessment"}]}]},{"title":"Desirable Effects","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"desirable-effects","display":"Desirable Effects"}],"text":"desirableSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Desirable Effects Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"desirableRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Desirable Effects Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"desirableRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Undesirable Effects Summary","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"undesirable-effects","display":"Undesirable Effects"}],"text":"undesirableSummary"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]},"section":[{"title":"Undesirable Effects Ratings","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"ratings","display":"Ratings"}],"text":"undesirableRatings"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}},{"title":"Undesirable Effects Related Items","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"related-items","display":"Related Items"}],"text":"undesirableRelatedItems"},"emptyReason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/list-empty-reason","code":"notstarted","display":"Not Started"}]}}]},{"title":"Discussion","code":{"coding":[{"system":"https://fevir.net/resources/CodeSystem/179423","code":"discussion","display":"Discussion"}]},"text":{"status":"generated","div":"A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions. In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. 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