OBJECTIVE(S):
Small case series suggest bariatric surgery may be effective treatment for diabetes in patients who do not meet criteria for morbid obesity (BMI < 35 kg/M²), but large multi-institutional series, which allow better assessment of the safety / efficacy of treatment, have not been reported.
METHODS:
Data from 66,264 research-consented patients with a surgery encounter in BOLD were queried to identify patients with BMI > 30 but < 35 kg/m2 (1.2%, n=794) and diabetes (DM) requiring any medication (29% of group).
RESULTS:
235 patients met inclusion criteria. The 2 most common procedures (adjustable gastric banding AGB, n=109 and gastric bypass, n=109) were compared. Laparoscopic access was utilized in 92% of procedures. Gender (77% female), race (80% Caucasian), and age (mean 52.6 + 10.4 yrs) did not differ between procedure groups.
Table: Data reported at baseline (BL) and at intervals < 12 months following surgery. (*p<0.05 vs. BL, α p<0.05 bypass vs. band)
CONCLUSIONS:
Remission (cessation of medications) of DM was reported in 47.8% of patients within 6-12 months of surgery. Gastric bypass provided superior weight loss and DM remission, but demonstrated more frequent complications (90-day AE: 12% vs. 3%, p<0.05). No mortalities were reported. The data suggest successful surgical treatment of diabetes in patients not meeting criteria for morbid obesity. Gastric bypass provides more effective early treatment for DM within 6-12 months.

	n		BMI		# DM meds		% DM remission
	AGB	Bypass	AGB	Bypass	AGB	Bypass	AGB	Bypass
BL	109	109	33.9±1.2	33.7±1.1	1.34±1.14	1.51±1.15	-	-
0-3 mos	90	88	31.6±2.5*	30.6±3.0* α	0.96±1.11*	0.76±1.02*	21.1	37.5* α
3-6 mos	63	44	31.0±2.7*	27.2±3.8* α	0.76±1.04*	0.39±0.65*α	31.8*	50.0*
6-12 mos	40	29	30.9±2.9*	27.1±4.5*α	0.60±0.81*	0.48±0.69*	27.5*	55.2*α