Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Brief Communication
  • Published:

Bariatric Surgery

Use of primary bariatric surgery among patients with obesity and diabetes. Insights from the Diabetes Collaborative Registry

International Journal of Obesity volume 46, pages 2163–2167 (2022)Cite this article

Subjects

Abstract

Despite its cardiometabolic benefits, bariatric surgery has historically been underused in patients with obesity and diabetes, but contemporary data are lacking. Among 1,520,182 patients evaluated from 2013 to 2019 within a multicenter, longitudinal, US registry of outpatients with diabetes, we found that 462,033 (30%) met eligibility for bariatric surgery. After a median follow-up of 854 days, 6310/384,859 patients (1.6%) underwent primary bariatric surgery, with a slight increase over time (0.38% per year [2013] to 0.68% per year [2018]). Patients who underwent bariatric surgery were more likely to be female (63% vs. 56%), white (87% vs. 82%), have higher body mass indices (42.1 ± 6.9 vs. 40.6 ± 5.9 kg/m2), and depression (23% vs. 14%; p < 0.001 for all). Over a median (IQR) follow-up after surgery of 722 days (364–993), patients who underwent bariatric surgery had lost an average of 11.8 ± 18.5 kg (23% of excess body weight), 10.2% were on fewer glucose-lowering medications, and 8.4% were on fewer antihypertensives. Despite bariatric surgery being safer and more accessible over the past two decades, less than one in fifty eligible patients with diabetes receive this therapy.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Annual rate of bariatric surgery in patients with diabetes and obesity.
Fig. 2: Change in weight over time after bariatric surgery.

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from Veradigm upon reasonable request.

Code availability

Statistical analyses were performed using SAS version 9.4 software (SAS Institute, Inc., Cary, NC). Statistical code used to generate results available on request from authors.

References

  1. Gregg EW, Jakicic JM, Blackburn G, Bloomquist P, Bray GA, Clark JM, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2016;4:913–21.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rothberg AE, McEwen LN, Kraftson AT, Ajluni N, Fowler CE, Nay CK, et al. Impact of weight loss on waist circumference and the components of the metabolic syndrome. BMJ Open Diabetes Res Care. 2017;5:e000341.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115:1447–63.

    Article  PubMed  Google Scholar 

  4. Van Gaal L, Scheen A. Weight management in type 2 diabetes: current and emerging approaches to treatment. Diabetes Care. 2015;38:1161–72.

    Article  PubMed  Google Scholar 

  5. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989.

    Article  CAS  PubMed  Google Scholar 

  6. American Diabetes Association. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes—2018. Diabetes Care 2018; 41(Supplement 1): S65–S72.

  7. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aminian A, Zajichek A, Arterburn DE, Wolski KE, Brethauer SA, Schauer PR, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322:1271–82.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  11. Martin M, Beekley A, Kjorstad R, Sebesta J. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010;6:8–15.

    Article  PubMed  Google Scholar 

  12. Encinosa WE, Bernard DM, Steiner CA, Chen CC. Use and costs of bariatric surgery and prescription weight-loss medications. Health Aff. 2005;24:1039–46.

    Article  Google Scholar 

  13. Campos GM, Khoraki J, Browning MG, Pessoa BM, Mazzini GS, Wolfe L. Changes in utilization of bariatric surgery in the United States From 1993 to 2016. Ann Surg. 2020;271:201–9.

    Article  PubMed  Google Scholar 

  14. American Diabetes Association. Obesity management for the treatment of type 2 diabetes. Diabetes Care. 2020;43:S89–S97. Suppl 1

    Google Scholar 

  15. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European guidelines for obesity management in adults. Obes Facts. 2015;8:402–24.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ammori BJ, Skarulis MC, Soran H, Syed AA, Eledrisi M, Malik RA. Medical and surgical management of obesity and diabetes: what’s new? Diabetic Med. 2020;37:203–10.

    Article  CAS  PubMed  Google Scholar 

  17. Arnold SV, Inzucchi SE, McGuire DK, Mehta SN, Goyal A, Sperling LS, et al. Evaluating the quality of comprehensive cardiometabolic care for patients with type 2 diabetes in the U.S.: The Diabetes Collaborative Registry. Diabetes Care. 2016;39:e99–e101.

    Article  PubMed  Google Scholar 

  18. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21:S1–27. Suppl 1

    Article  CAS  PubMed  Google Scholar 

  19. Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care. 2015;38:150–8.

    Article  PubMed  Google Scholar 

  20. Mentias A, Aminian A, Youssef D, Pandey A, Menon V, Cho L, et al. Long-term cardiovascular outcomes after bariatric surgery in the medicare population. J Am Coll Cardiol. 2022;79:1429–37.

    Article  PubMed  Google Scholar 

  21. Wharton S, Serodio KJ, Kuk JL, Sivapalan N, Craik A, Aarts MA. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity. Clin Obes. 2016;6:154–60.

    Article  CAS  PubMed  Google Scholar 

  22. Gasoyan H, Tajeu G, Halpern MT, Sarwer DB. Reasons for underutilization of bariatric surgery: the role of insurance benefit design. Surg Obes Relat Dis. 2019;15:146–51.

    Article  PubMed  Google Scholar 

  23. Chhabra KR, Fan Z, Chao GF, Dimick JB, Telem DA. The role of commercial health insurance characteristics in bariatric surgery utilization. Ann Surg. 2021;273:1150–6.

    Article  PubMed  Google Scholar 

  24. Gasoyan H, Soans R, Ibrahim JK, Aaronson WE, Sarwer DB. Do insurance-mandated precertification criteria and insurance plan type determine the utilization of bariatric surgery among individuals with private insurance? Med Care. 2020;58:952–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440–50.

    Article  PubMed  Google Scholar 

Download references

Funding

VH, MBT, and RAG are supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (T32HL110837). DCR was previously funded by AstraZeneca and Boehringer Ingelheim and is currently managed by Veradigm. Corporate sponsors had no role in data analysis or interpretation, manuscript development, or in publication review or approval for this study.

Author information

Authors and Affiliations

  1. Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA

    Priya Jain, Vittal Hejjaji, Merrill B. Thomas, Raul Angel Garcia, Kevin F. Kennedy, Jonathan R. Enriquez & Suzanne V. Arnold

  2. Emory School of Medicine and Rollins School of Public Health, Atlanta, GA, USA

    Abhinav Goyal & Laurence Sperling

  3. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Sandeep R. Das

  4. Joslin Diabetes Center and Harvard School of Medicine, Boston, MA, USA

    Samar Hafida

Authors
  1. Priya Jain
    View author publications

    Search author on:PubMed Google Scholar

  2. Vittal Hejjaji
    View author publications

    Search author on:PubMed Google Scholar

  3. Merrill B. Thomas
    View author publications

    Search author on:PubMed Google Scholar

  4. Raul Angel Garcia
    View author publications

    Search author on:PubMed Google Scholar

  5. Kevin F. Kennedy
    View author publications

    Search author on:PubMed Google Scholar

  6. Abhinav Goyal
    View author publications

    Search author on:PubMed Google Scholar

  7. Laurence Sperling
    View author publications

    Search author on:PubMed Google Scholar

  8. Sandeep R. Das
    View author publications

    Search author on:PubMed Google Scholar

  9. Samar Hafida
    View author publications

    Search author on:PubMed Google Scholar

  10. Jonathan R. Enriquez
    View author publications

    Search author on:PubMed Google Scholar

  11. Suzanne V. Arnold
    View author publications

    Search author on:PubMed Google Scholar

Contributions

PJ: Conceptualization, Data Interpretation, Writing Original Draft; VH: Conceptualization, Methodology, Data Interpretation, Writing Original Draft; MBT: Methodology, Data Interpretation, Writing Review & Editing, Supervision; RAG: Data Interpretation, Writing Review & Editing, Supervision; KFK: Methodology, Formal analysis, Writing Review & Editing; AG: Data Interpretation, Writing Review & Editing; LS: Data Interpretation, Writing Review & Editing; SRD: Data Interpretation, Writing Review & Editing; SH: Data Interpretation, Writing Review & Editing; JRE: Data Interpretation, Writing Review & Editing, Supervision; SVA: Conceptualization, Methodology, Formal analysis, Data Interpretation, Writing Original Draft, Supervision.

Corresponding author

Correspondence to Suzanne V. Arnold.

Ethics declarations

Competing interests

VH, MBT, and RAG, are supported by the National Heart, Lung, and Blood Institutes of Health Under Award Number T32HL110837; the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, P., Hejjaji, V., Thomas, M.B. et al. Use of primary bariatric surgery among patients with obesity and diabetes. Insights from the Diabetes Collaborative Registry. Int J Obes 46, 2163–2167 (2022). https://doi.org/10.1038/s41366-022-01217-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41366-022-01217-w

Search

Advanced search

Quick links