Bariatric Surgery for the Treatment Of Type 2 Diabetes Mellitus

Jeffrey A. Tice, MD

Disclosures

CTAF 

In This Article

Recommendations of Others

Blue Cross Blue Shield Association (BCBSA)

The BCBSA Technology Evaluation Center (TEC) is currently performing two technology evaluations: 1) Bariatric Surgery for lower BMI thresholds; and 2) Bariatric Surgery for Diabetes Mellitus. Completion dates for these two topics are unknown.

In September 2003, BCBSA TEC published a special report: The Relationship between Weight Loss and Changes in Morbidity Following Bariatric Surgery for Morbid Obesity – which stated that "….compelling evidence for an improvement in comorbid conditions exists for diabetes….a large reduction in diabetes over a 5.5 year mean follow-up for the surgery group….

Canadian Agency for Drugs and Technologies in Health (CADTH)

In July 2010, CADTH published a Rapid Response Report: Change in Disease Status Following Bariatric Surgery: Clinical Evidence which stated "The two most commonly reported outcomes (of bariatric surgery) were improvement or resolution of type 2 diabetes."

National Institute for Health and Clinical Excellence (NICE)

NICE published the guideline: Obesity – guidance on prevention, identification, assessment and management of overweight and obesity in adults and children in December 2006. Recommendation 1.2.6.1 notes one of five criteria for bariatric surgery is "…a BMI of 40 kg/m2 or more, or between 35 kgm2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes….) that could be improved if (patients) lost weight."

Centers for Medicare and Medicaid Services (CMS)

CMS National Coverage Decision (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1) effective February 2009 notes the following procedures are covered for Medicare beneficiaries with body mass index > 35, have a t least one comorbidity related to their obesity, and have been previously unsuccessful with medical treatment of their obesity: open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB). These procedures are only covered if they are performed at facilities that are certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center, or certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence.

The CMS NCD 100.1 does not cover open or laparoscopic sleeve gastrectomy. On March 29, 2012, CMS issued a proposed decision memo to cover laparoscopic sleeve gastrectomy for BMI >= 35 and only in randomized controlled trials for five years. The final decision for coverage will be made by June 30, 2012. http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?&fromdb=true&NCAId=258&

Agency for Healthcare Research and Quality (AHRQ)

A search of AHRQ's National Guideline Clearinghouse found the 2008 guideline entitled

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. http://www.guideline.gov/content.aspx?id=13022&search=bariatric+surgery#Section420

Stated objectives of the guideline include:

  • An overview of the important principles of bariatric surgery as context for interpretation of subsequent evidence-based recommendations

  • An evidence-based resource for the perioperative nonsurgical management, especially nutritional and metabolic support, of the bariatric surgery patient

  • Specific recommendations regarding the selection of appropriate patients for bariatric surgery

  • Specific recommendations regarding the preoperative evaluation for the bariatric surgical patient

  • Specific recommendations regarding postoperative nonsurgical management of the bariatric surgery patient

  • Specific recommendations regarding the recognition and management of postoperative complications

  • Specific recommendations regarding selection of patients for a second (staged) bariatric surgical procedure or a revision or reversal of a previous bariatric surgical procedure

American College of Surgeons (ACS)

ACS was invited to send an opinion on this technology and to send a representative to the meeting.ACS did not provide an opinion but did not send a representative to the meeting.

American Gastrological Association (AGA)

AGA was invited to send an opinion on this technology and to send a representative to the meeting.AGA did not send an opinion nor send a representative to the meeting.

American Society for Metabolic and Bariatric Surgery (ASMBS)

ASMBS was invited to send an opinion on this technology and to send a representative to the meeting. ASBMSdid not provide an opinion but did send a representative to the meeting.

See AHRQ above for description of the jointly developed clinical guideline between AACE, TOS, and ASMBS.

American College of Gastroenterology (ACG)

The American College of Gastroenterology was invited to send an opinion on this technology and to send a representative to the meeting. ACG did not send an opinion nor send a representative to the meeting.

Society of Gastrointestinal and Endoscopic Surgeons (SAGES), CA Chapter AACE

SAGES was invited to send an opinion on this technology and to send a representative to the meeting. SAGES did not send an opinion nor send a representative to the meeting.

In March 2008, SAGES published a clinical guideline which was also endorsed by ASMBS entitled SAGES guideline for clinical application of laparoscopic bariatric surgery. http://www.sages.org/publication/id/30/

The American Association of Clinical Endocrinologists (AACE), Southern California Chapter

The AACE/So. CA Chapter was invited to send an opinion on this technology and to send a representative to the meeting. AACE/So. CA Chapter did not send an opinion nor send a representative to the meeting.

See AHRQ above for description of the jointly developed clinical guideline between AACE, TOS, and ASMBS.

The Endocrine Society

The Endocrine Society was invited to send an opinion on this technology and to send a representative to the meeting. The Endocrine Society did not send an opinion nor send a representative to the meeting.

The Obesity Society (TOS)

TOS was invited to send an opinion on this technology and to send a representative to the meeting. TOS did not send an opinion nor send a representative to the meeting.

See AHRQ above for description of the jointly developed clinical guideline between AACE, TOS, and ASMBS.

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