Bariatric Surgery: A New Standard Treatment for Patients with Diabetes?

Meghan Ross, Senior Associate Editor
Published Online: Wednesday, June 8th, 2016
Bariatric surgery, or metabolic surgery, hasn’t traditionally been included as a standard intervention for patients with type 2 diabetes.

However, new guidelines presented at the 2nd Diabetes Surgery Summit may lead more retail clinicians and physicians to encourage patients with diabetes to consider it.

At the international summit, leading diabetes organizations came to the conclusion that there’s enough evidence to support metabolic surgery as an antidiabetes intervention for obese patients. 

The summit involved 48 clinicians and scholars from across the world, and around three-quarters of those involved were nonsurgical professionals. Three questionnaires were used to analyze participants’ thoughts on 32 data-based conclusions.

A joint statement published in Diabetes Care stated that the gastrointestinal tract is a prime target for managing diabetes, considering the tract’s role in metabolic regulation. The guidelines advised that metabolic surgery should be recommended for patients with a body mass index (BMI) ≥40 kg/m2.

For patients who have a BMI between 35 kg/m2 to 39.9 kg/m2 and hyperglycemia that isn’t controlled by medication and lifestyle factors, metabolic surgery should be considered. Another patient population that may benefit from surgery would be those with a BMI of 30 kg/m2 to 34.9 kg/m2, if hyperglycemia can’t be controlled with oral or injectable medication.

For Asian-Americans, whose ethnicity is considered a risk factor for diabetes, the BMI thresholds can be lowered by 2.5 kg/m2.

“Ongoing and long-term monitoring of micronutrient status, nutritional supplementation, and support must be provided to patients after surgery, according to guidelines for postoperative management of bariatric/metabolic surgery by national and international professional societies,” the researchers noted.

In terms of patient safety, the guidelines pointed out that metabolic surgery has become less dangerous over the last 2 decades, and minimally invasive surgery has been refined. The mortality rate associated with metabolic surgery is around 0.1% to 0.5%, which is similar to the rates for cholecystectomy and hysterectomy.

However, the rate of major complications is 2% to 6%, and the rate of minor complications is around 15%. Patients may have long-term nutritional deficiencies, and they may need to take vitamins or nutritional supplementation for the rest of their lives.

One benefit of metabolic surgery is it’s cost-effectiveness for patients with diabetes, according to previous research.

These guidelines were endorsed by 45 diabetes-related organizations, specialists, and researchers.

The guideline authors noted that previous clinical trials have shown that metabolic surgery can help improve glycemic control and reduce cardiovascular risk factors.

“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,” they concluded, noting that health care regulators should begin to form reimbursement policies.

In addition, they recommended that diabetes care providers and patients become more informed about indications, benefits, and risks of surgical treatments for diabetes.

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