Literature Review Compares Bariatric Surgery to Non-Surgical Interventions among Non-Morbidly Obese Patients with Diabetes
Bariatric surgical procedures are being advocated as a treatment for diabetes in less-obese individuals (BMI 30-35); however, this practice remains controversial. For example, in 2006 the Centers for Medicare & Medicaid Services would not approve coverage for patients with lower BMI and diabetes, whereas the FDA has approved gastric banding for individuals with a BMI of 30 to 35 who have an obesity-related comorbidity. Given the lack of consistency, as well as uncertainties regarding the comparative effectiveness of different procedures, investigators conducted a systematic review of the relative risks and benefits associated with surgical and non-surgical therapies for treating diabetes or impaired glucose tolerance in patients with a BMI of less than 35. Literature databases were searched for study results that were published from 1985 through September 2012. Of more than 1,200 articles screened, investigators included 32 surgical studies, 11 systematic reviews on non-surgical treatments, and 11 large non-surgical studies published after those reviews.
- For patients with diabetes and a BMI of 30 to 35, current evidence suggests that bariatric surgery is associated with greater short-term weight loss and improvements in HbA1c, fasting blood glucose levels, blood pressure, and hyperlipidemia than non-surgical interventions such as medication, diet, and behavioral changes. However, the evidence was insufficient to reach definitive conclusions about long-term outcomes.
- Major surgical complications were uncommon (1.8% to 7.4%), but these events often required significant intervention. Reported mortality rates also were very low (0.3 to 0%); however, the literature in this review represents a narrow segment of the patients undergoing bariatric surgery.
- Only four studies included in this review had follow-up periods that were longer than two years. And in these studies, small sample sizes or poor follow-up preclude definitive conclusions.
- Many of the studies were from single surgeons at single academic institutions and may not be representative of results in a general population of patients and surgeons.
Drs. Maggard-Gibbons, Livhits, Li, and Shekelle are part of the VA Greater Los Angeles Healthcare System. Dr. Shekelle also is part of HSR&D's Center for the Study of Healthcare Provider Behavior, Sepulveda, CA.
Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher A, Hu J, Li Z, and Shekelle, P. Bariatric Surgery for Weight Loss and Glycemic Control in Non-Morbidly Obese Adults with Diabetes. JAMA June 5, 2013;309(21):2250-61.