Regional differences in the coverage and uptake of bariatric-metabolic surgery: A focus on type 2 diabetes.
BACKGROUND
There is high-quality evidence that bariatric-metabolic surgery (BMS) generates positive health outcomes in patients with obesity and type 2 diabetes (T2D).


OBJECTIVES
To understand the regional variations in the coverage and uptake of BMS, with a focus on T2D.


SETTING
An Australian diabetes research institute.


METHODS
A survey was conducted via a questionnaires sent to national leaders in BMS. The respondents provide their nations' BMS annual numbers, general and any T2D-specific indications for surgery, and source of surgical funding. The total population and adult diabetes prevalence (age 20-70 yr) of the countries were used to model the uptake of BMS for those with T2D.


RESULTS
Data were provided from 22 countries, representing approximately 75% of BMS procedures performed in 2014. BMS uptake varied from 885 per million total population per year in Belgium to 2 per million per year in Japan. The estimated proportion of eligible individuals with diabetes treated annually varied from 1.9% in The Netherlands to<.01% in China and Japan. Few countries treat>1% of estimated eligible patients annually. Of 22 countries, 19 have national guidelines for BMS, and all incorporate BMI in the selection criteria. Several countries have specific criteria for patients with T2D.


CONCLUSION
Results indicated that BMS has a negligible impact on the global burden of T2D. The low uptake indicates that BMS has not become an established treatment for T2D and emphasizes the need to define when it should be recommended as a standard of care. BMS needs to be integrated into the clinical pathways for managing T2D.