Less than 2% of outpatients with obesity and diabetes potentially eligible for bariatric surgery underwent the procedure, according to a study using data from the Veradigm Metabolic Registry (formerly the Diabetes Collaborative Registry), published in the International Journal of Obesity.

Priya Jain, MD, et al., found that among 1,544,163 patients from the Registry, 462,033 (30.4%) were BMI-eligible for bariatric surgery. Of those eligible (mean age, 59.4 years, 56% women; 82.1% White; mean BMI, 40.6 kg/m²; mean HbA1c, 7.1; insulin-treatment, 25.8%), only 6,310 patients (1.6%) received the therapy over a median follow-up of 854 days. Most (77%) had hypertension and nearly half were being treated with two or more antihypertensive drugs. Their mean LDL-C was 98.5 mg/dL and half were taking a statin and a quarter had coronary artery disease.

Patients who had bariatric surgery, compared with those who did not, 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%).

Results showed that patients who had bariatric surgery had an average weight loss of 11.8 ± 18.5 kg and their use of medications was reduced: 10.2% were on fewer glucose-lowering medications and 8.4% were on fewer antihypertensives. The median follow-up post surgery was 722 days.

The researchers note that while bariatric surgery has become safer and more accessible over the last two decades, its use continues to be low, with fewer than one of 50 patients with obesity and diabetes in this study receiving this treatment. “Given the large proportion of patients potentially eligible for metabolic surgery, our study demonstrates a substantial missed opportunity to impact weight loss, diabetes management, and cardiovascular risk factor control,” they write.

While the reason for this underuse is unclear, they note that physicians may be discounting some patients due to certain cardiovascular risk factors and comorbidities. “With improvement in safety of bariatric surgery, physicians may need to recalibrate the type of patient considered eligible for bariatric surgery, with a focus on net clinical benefit,” they write.

Clinical Topics: Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins, Hypertension

Keywords: Glucose, Registries, Insulins, Diabetes Mellitus, Physicians, Heart Disease Risk Factors, Hypertension, Weight Loss, Bariatric Surgery, Risk Factors, Depression, Coronary Artery Disease, Follow-Up Studies, Cardiovascular Diseases, Obesity, Morbid, Body Mass Index, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cholesterol, LDL, Antihypertensive Agents, Glycated Hemoglobin A, Diabetes Collaborative Registry, National Cardiovascular Data Registries

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