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Bariatric surgery effects on diabetes ‘support lower BMI thresholds’

Bariatric surgery may be beneficial for control of diabetes at lower BMIs thresholds than are currently recommended, according to a US study.

The trial, published in the New England Journal of Medicine, included 150 people with type 2 diabetes and BMIs of between 27 and 43.

Patients assigned to bariatric surgery achieved a greater reduction in HbA1C levels from baseline than patients who received only medical therapy.

Among patients who completed the five years of follow up, 29% of those who received a gastric bypass achieved an HbA1C of 6% or less, compared with 5% of patients who received medical therapy alone.

The researchers noted that reductions in HbA1C levels were similar between patients with BMIs of between 27 and 35, and those with BMIs of 35 and over.

The researchers concluded: ‘The current five-year follow-up of patients in our trial showed that the beneficial effects of bariatric surgery on glycaemic control were durable, even among patients with mild obesity (BMI of 27 to 34).’

NICE guidelines currently recommend that people with type 2 diabetes and a BMI of 35 and over should be offered bariatric surgery, although they say it can also be considered for patients with recent-onset diabetes at a BMI of between 30 and 34.9.

But the surgery has been restricted to higher BMI thresholds in some areas by cash-strapped CCGs, with some even attempting to ban access to the surgery altogether apart from in ‘exceptional’ cases.

Anna Morris, head of research at Diabetes UK, said: ‘We’re beginning to see real evidence that bariatric surgery could also benefit people outside of the current criteria, and may be more effective at controlling type 2 diabetes than certain medications.’

But she added that more research is needed ‘to be sure of the best treatment options for people living with Type 2 diabetes, and to understand if weight loss surgery can reduce the risk of complications like cardiovascular disease’.

N Engl J Med 2017; available online 16 February

 

Readers' comments (1)

  • Azeem Majeed

    The number of people potentially eligible for bariatric surgery in England far exceeds the bariatric surgery capacity the NHS. If the aim of bariatric surgery is to reduce mortality and morbidity among obese patients, then the focus should be on selecting patients for surgery based on the presence of the conditions that have the greatest detrimental effect on health status. Given the significant benefits for people with type 2 diabetes that bariatric surgery offers and the resulting major improvements in their health status, there is a strong case that type 2 diabetes should be considered as the preferred comorbidity when selecting patients for surgery.

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