Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes: Data from the IFSO Global Registry 2015–2018

Abstract

Background Comparative international practice of patients undergoing bariatric-metabolic surgery for type 2 diabetes mellitus (T2DM) is unknown. We aimed to ascertain baseline age, sex, body mass index (BMI) and types of operations performed for patients with T2DM submitted to the IFSO Global Registry. Materials and Methods Cross-sectional analysis of patients having primary surgery in 2015–2018 for countries with ≥90% T2DM data completion and ≥ 1000 submitted records. Results Fifteen countries including 11 national registries met the inclusion criteria. The rate of T2DM was 24.2% (99,537 of 411,581 patients, country range 12.0–55.1%) and 77.1% of all patients were women. In every country, patients with T2DM were older than those without T2DM (overall mean age 49.2 [SD 11.4] years vs 41.8 [11.9] years, all p < 0.001). Men were more likely to have T2DM than women, odds ratio (OR) 1.68 (95% CI 1.65–1.71), p < 0.001. Men showed higher rates of T2DM for BMI <35 kg/m2 compared to BMI ≥35.0 kg/m2, OR 2.76 (2.52–3.03), p < 0.001. This was not seen in women, OR 0.78 (0.73–0.83), p < 0.001. Sleeve gastrectomy was the commonest operation overall, but less frequent for patients with T2DM, patients with T2DM 54.9% vs without T2DM 65.8%, OR 0.63 (0.63–0.64), p < 0.001. Twelve out of 15 countries had higher proportions of gastric bypass compared to non-bypass operations for T2DM, OR 1.70 (1.67–1.72), p < 0.001. Conclusion Patients with T2DM had different characteristics to those without T2DM. Older men were more likely to have T2DM, with higher rates of BMI <35 kg/m2 and increased likelihood of food rerouting operations.

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

“…Long-term studies (10 years) have also reported the nutritional issues associated with DS, particularly with fat-soluble vitamins ( 29 , 30 ). Thus, although the effectiveness of DS is undisputed, it is not commonly performed owing to the high prevalence of complications ( 2 , 31 ).…”

“…SG can be considered the foundation of most bariatric and metabolic surgeries, as many of the procedures consist of SG. Standalone SG is currently the most commonly performed procedure worldwide, with excellent results ( 2 , 31 ). As mentioned previously, when compared with GB, SG was found to be comparable regarding metabolic improvements as well as having a lower risk of nutritional deficiency ( 12 , 13 , 16 , 23 , 24 ).…”

“…Bariatric and metabolic surgeries have resulted in significant improvements and remissions in type 2 diabetes mellitus and other metabolic comorbidities ( 1 , 2 ). However, the mechanisms underlying these effects remain unclear.…”

Formulation and interpretation of the Chinese Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes Mellitus

“…In light of the satisfactory outcomes achieved by LSG in terms of weight loss and remission of diabetes mellitus, the frequency of LSG has increased in recent years. According to the Fourth IFSO Global Registry Report 2018 (18), LSG has surpassed RYGB (46% vs. 38.2%) on a global scale and it has become the most commonly adopted surgical procedure for metabolic syndrome, accounting for 67% of all such procedures in China. Therefore, the Chinese Guidelines have listed LSG as the procedure of choice.…”

Managing the Unpredictable: Mechanistic Analysis and Clinical Recommendations for Lamotrigine Treatment after Bariatric Surgery

“…Importantly, some antiepileptics are glucuronidation inducers (phenytoin, phenobarbital and carbamazepine) or inhibitors (sodium valproate), so a pharmacokinetic drug-drug interaction may affect lamotrigine levels. Among the bariatric patients, over 75% are females, and the average age of the operated patient is 42, so many of these patients are of childbearing potential [ 43 ]. Therefore, while valproate (along with lamotrigine) is a first line anticonvulsant for various different epileptic disorders, in many bariatric patients, valproate treatment should not be initiated in case of unsatisfactory lamotrigine treatment following the surgery, due to being highly teratogenic [ 42 ].…”