Increasing Eligibility for Bariatric Surgery

Recent research supports an aggressive bariatric BMI-based surgery selection.

Bariatric surgery is the most effective treatment for overweight and obese diabetic patients who have failed lifestyle and pharmacotherapy interventions. It decreases cardiovascular risk factors, improves diabetes control, and increases quality adjusted life years cost effectively.

Beginning in 1991, guidelines set by the National Institutes of Health (NIH) focused on benchmark body mass index values as exclusive indications for bariatric surgery. At that time, NIH recommended surgical treatment for healthy patients with a body mass index (BMI) value of 40 or more and patients with one or more comorbidities and a BMI value of at least 35.

By 2009, experts at the first Diabetes Surgery Summit were proposing aggressive bariatric surgery selection (diabetics with a BMI greater than 30) and the research published since then supports this recommendation.

The journal Obesity Surgery published an article in its August 2016 issue recognizing the Diabetes Surgery Summit II guidelines incorporated disease severity and control, instead of BMI alone, into bariatric surgery indications.

The summit gathering, a meeting of 48 key opinion leaders, compared randomized controlled trials to draft a disease-based guideline including bariatric surgery. The summit surveyed the burgeoning body of evidence to determine glycemic effect durability, surgical risk, impact on cardiovascular risk factors, and cost-effectiveness of bariatric surgery.

Short and mid-term outcomes following bariatric surgery were comparable independent of BMI. Surgery improved diabetes control by both weight-dependent and independent mechanisms.

The Diabetes Surgery Summit II guidelines suggested providers consider surgical options for poorly controlled class I obese diabetic patients. Most diabetics have a BMI values less than 35; this recommendation broadens the indicated population greatly.

More than 40 medical and surgical societies endorsed these guidelines.

Bariatric surgery aids obese diabetic patients who were ineligible under the 1991 NIH recommendations. Future studies should clarify specific criteria for surgery and the effect on macro- and microvascular diabetic complications.

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