Remission, less complications and medications drive interest in bariatric surgery among diabetes patients

20170112140500, Roshini Claire Anthony

The desire to undergo bariatric surgery is driven by the hope for diabetes remission, reduction of medication, and prevention of complications in diabetes patients in Singapore, a recent study found.

A desire to achieve remission (Likert scale 4.7 ± 0.7), to prevent complications (Likert scale 4.5 ± 0.9), and to reduce medications (Likert scale 4.3 ± 1.1) were the reasons behind wanting bariatric surgery. On the other hand, reluctance to undergo bariatric surgery was put down to fear of surgery (Likert scale 4 ± 1.5) and satisfaction with current treatment (Likert scale 3.7 ± 1.6). [Ann Acad Med Singapore 2016;45:495-506]

Multivariate analysis showed that a higher level of education (diploma and higher; odds ratio [OR], 2.3, 95 percent confidence interval [CI], 1.2–4.4; p=0.012), use of insulin (OR, 2.1, 95 percent CI, 1.1–4.1, p=0.03), and a shorter duration of diabetes (OR, 0.4, 95 percent CI, 0.2–1.0; p=0.043) were independent predictors of interest in bariatric surgery as a treatment for diabetes.

“It is likely that those with higher educational levels have a better understanding of metabolic surgery and awareness of the complications from diabetes mellitus, thus making them more inclined to be interested in considering surgery,” said the researchers.

Individuals who were not interested in undergoing surgery expressed concern over recovery time (p=0.022) and desired “a longer duration of benefits” (8.7 vs 6.1 years; p<0.001) compared with those who were interested in surgery.

Study participants were 150 patients (mean age 49.7 years, mean body mass index [BMI] 29.6 kg/m2) who were undergoing follow-up at a specialized diabetic outpatient clinic between January and April 2013. After being shown information sheets detailing the risks and benefits of currently available metabolic (bariatric) surgeries, the participants completed a Likert scale-based questionnaire which contained questions designed to assess their concerns and perceptions of bariatric surgery as a treatment for diabetes. Sixty-one percent of participants viewed bariatric surgery in a favourable light.

“Our study showed that although only a minority of diabetic patients had heard about surgical options for diabetes [14.7 percent], over 60 percent of them were keen on surgery after brief descriptions were given,” said the researchers.

Previous studies have demonstrated high levels of remission in obese, diabetes patients who underwent bariatric surgery (75–95 percent) vs regular medical therapy, as well as reductions in cardiovascular events and deaths. [N Engl J Med 2012;366:1577-1585; JAMA 2012;307:56-65]

According to the authors, the success of bariatric surgery has led to an increased interest in surgical treatment for diabetes. They recommended that further study be done on a larger population and advocated for sufficient training for bariatric surgeons and a multidisciplinary approach in order to improve the quality of surgery and address patients concerns on risks.