Authors' objectives: Background: Obesity is strongly linked to diabetes and premature mortality, mainly from cardiovascular causes. In 2013, the prevalence of obesity (BMI ≥ 30 kg/m2) in adults in Sweden was 14 %. The prevalence of diabetes mellitus in Sweden is approximately 5 % with a slow increase due to an ageing population. In 2015, 73,225 patients in VGR had a diagnosis of diabetes mellitus. The treatment of overweight and obesity in adults is based on three principles: lifestyle changes, pharmacological treatment and surgery. Today, weight reducing (bariatric) surgery can be offered to individuals with BMI ≥40 kg/m2, and patients with BMI ≥35 kg/m2 with an obesity associated disease, in particular diabetes mellitus type 2 (T2D). Bariatric surgery in persons with BMI < 35 kg/m2 is currently not endorsed in Swedish national guidelines (National Board of Health and Welfare, 2015). Glycaemic stabilisation is reported to occur very early after surgery, before any significant weight loss. In a recent joint statement by several international diabetes organizations, it was proposed that bariatric surgery should be considered to be an option to treat T2D in patients with BMI 30.0–34.99 kg/m2 and inadequately controlled hyperglycaemia despite optimal medical treatment. Objective: To study if bariatric surgery in patients with T2D and a BMI <35 kg/m2 is superior to standard treatment with regard to diabetes control.

Authors' results and conclusions: This systematic review shows that bariatric surgery compared with medical treatment may increase the frequency of diabetes remission and probably results in improved glycaemic control in adults with overweight or obesity (BMI< 35 kg/m2 , mainly 30 – 34.99 kg/m2) during 1–3 years follow-up. The bariatric surgical procedures mainly performed in Sweden today (Roux-en-Y gastric bypass, vertical sleeve gastrectomy) were investigated in only half of the current studies. Data on long term efficacy and safety are lacking and there are no results indicating reduced risk of cardiovascular disease, cancer or death. No relevant health economic analyses are available.

Project Status: Completed

Year Published: 2016

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-327/native/2016_92%20HTA-rapport%20Bariatric%20surgery%20for%20diabetes%20mellitus%20type%202.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se