Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Table 3 Indications for metabolic surgery in obesity along with presence of diabetes

Condition	Glycemic status	Recommendation for metabolic surgery	Evidence category
Diabetes and BMI ≥ 40 kg/m2 (≥ 37.5 kg/m2 for Asians)	Any	Strong recommendation	A
Diabetes and BMI 35-39.9 kg/m2 (32.5-37.4 kg/m2 for Asians)	Uncontrolled despite optimal treatment	Moderate recommendation	B
Diabetes and BMI 30-34.9 kg/m2 (27.5-32.4 kg/m2 for Asians)	Uncontrolled despite optimal treatment	Weak recommendation	C, E
Diabetes and obesity (BMI – not defined) with comorbidities: Poorly controlled hypertension; Non-alcoholic fatty liver disease; Obstructive sleep apnea; Obesity hypoventilation syndrome; Osteoarthritis of the knee or hip; Urinary stress incontinence; Polycystic ovary syndrome; Gastro-esophageal reflux disease; Idiopathic intracranial hypertension; Severe venous stasis disease; Obesity-related limited mobility; Obesity-related poor quality of life	Any	Weak recommendation	E

BMI: Body mass index.