Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to “consider” or “recommend” BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
Highlights
A large number of randomized clinical trials and highquality prospective matched cohort studies over the past years have demonstrated the potential of bariatric or alternatively metabolic surgery to induce sustainable weight loss and provide substantial metabolic benefits in patients with obesity and type 2 diabetes mellitus (T2DM) [1,2,3,4,5,6,7,8]
bariatric surgery (BS) should be further considered as an option to treat T2DM in patients with a body mass index (BMI) 30–34.9 kg/m2, if adequate glycaemic control cannot be achieved despite maximally intensified antidiabetic treatment, including injectable agents [16]
The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of patients with T2DM visiting diabetes outpatient clinics of large university hospitals who meet the BS eligibility criteria proposed by DSS-II, (ii) how many of the eligible patients have been informed by their physicians about the option of BS, and (iii) what are the demographic, anthropometric and clinical characteristics associated with eligibility and awareness of BS among T2DM patients
Summary
A large number of randomized clinical trials and highquality prospective matched cohort studies over the past years have demonstrated the potential of bariatric or alternatively metabolic surgery to induce sustainable weight loss and provide substantial metabolic benefits in patients with obesity and type 2 diabetes mellitus (T2DM) [1,2,3,4,5,6,7,8]. In June 2016, a number of leading international diabetes organizations focused on T2DM and issued new guidelines for the treatment of patients with obesity and T2DM, integrating BS into the proposed T2DM treatment algorithm These guidelines were developed during the second Diabetes Surgery Summit (DSS-II), an international consensus conference, and were endorsed by numerous scientific societies all around the world [16]. According to these guidelines, BS should be recommended to treat T2DM in patients with a BMI ≥40 kg/m2 (grade III obesity), regardless of their level of glycaemic control or complexity of glucose-lowering regimens, and in patients with a BMI 35–39.9 kg/m2 (grade II obesity), if hyperglycemia cannot be controlled despite optimal lifestyle and medical treatment. Beyond BMI and glycaemic control criteria as determined by the DSS-II, eligibility for BS further requires the absence of serious life-threatening health conditions such as irreversible cardiopulmonary or other endorgan failure, metastatic or inoperable malignancy, active drug or alcohol abuse, and severe untreated psychiatric illness [17]
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