The International Diabetes Federation Recommends the Consideration of Bariatric Surgery for Less Obese Individuals with Type 2 Diabetes
In late March, the International Diabetes Federation (IDF) released a "position statement" recommending the consideration of bariatric surgery to treat type 2 diabetes for less obese individuals. Specifically, the IDF suggested that people with a BMI (a combined measure of height and weight) between 30-35 kg/m2 with uncontrolled diabetes (A1c >7.5%) be "eligible for surgery" and those with a BMI between 35-40 kg/m2 be "prioritized for surgery." For context, an individual with a height of 5'7" and a weight of roughly 190 pounds would have a BMI of 30 kg/m2 (you can calculate your BMI using a BMI calculator here). The IDF's position statement marks a departure from the widely accepted guidelines (established in 1991), which recommended that bariatric surgery be considered primarily as a last resort for people with a BMI of at least 40 kg/m2 (e.g., 5'7", 250 pounds), or 35-40 kg/m2 if excess weight is accompanied by other health-related conditions such as diabetes. The IDF's position statement highlights the potential use of bariatric surgery to treat less obese indivduals with type 2 diabetes; however, it's important to note that the IDF statement is one of many consensus statements on bariatric surgery, most of which still follow the 1991 guidelines.
For readers not familiar with surgery for weight loss, "bariatric surgery" is a term that refers to a group of surgical procedures intended to help people lose weight; the two primary procedures performed in the US are the "gastric band" and the "gastric bypass". These procedures also have profound effects on improving diabetes (more so with gastric bypass than with gastric banding). In one study, about one in three people with diabetes who underwent bariatric surgery were in remission (their glucose was under control and they did not require any diabetes medications, including insulin) 10 years post-operation. While the potential benefits of bariatric surgery are high, so are its risks. Complications associated with the procedures include: leaks from the gastrointestinal tract, wound infections, lung complications, and hemorrhage (bleeding from ruptured blood vessels), in 1-3% of people who undergo the procedures. Unfortunately, long-term surgical complications and the need for surgical revisions are not uncommon, and the short-term mortality is not trivial (about one out of every 1,000 people who undergo gastric banding and one out of every 200 people who undergo gastric bypass die within 30 days of the surgery). Thus, the fact remains that the risks and benefits of bariatric surgery must be carefully weighed; those interested in exploring bariatric surgery should engage in a series of conversations with their primary care physicians and bariatric specialists.
While there is no clear consensus on whether it is appropriate to lower the bar for bariatric surgery for diabetic patients, it is certainly a trend, given that its benefits on diabetes are becoming more clearly established. We will be keeping our eyes and ears out for any further advances in this field; in the mean time, researchers are working hard to understand the specific mechanisms by which bariatric surgery improves blood glucose control in hopes of developing drugs that can confer the same benefit. –ST
