Bariatric surgery is already reimbursed for patients with severe or massive obesity, with the objective of weight loss. For those who also suffer from type 2 diabetes, this intervention has observed favorable effects on the regulation of carbohydrate metabolism, so it is called metabolic surgery. Also, the High Authority for Health (HAS) has assessed the advisability of also reimbursing metabolic surgery in diabetics who suffer from moderate obesity (i.e. with a BMI of between 30 and 35kg/m2).
According to the meta-analysis carried out by the HAS, patients with moderate obesity, suffering from type 2 diabetes and benefiting from metabolic surgery, have at least 2 to 3 times more likely to present a remission of their diabetes than a patient following conventional medical care. The three techniques used in bariatric surgery for patients with more severe obesity can be performed:
- adjustable perigastric band (LAGB)
- sleeve gastrectomy (SG)
- Roux-en-Y gastrojejunal bypass (RYGB).
Surgery should only be offered as a last resort
However, the HAS recommends offering this technique only as a last resort, “when the patient’s glycemic objectives are not reached, despite medical management, in particular diabetological and nutritional, including appropriate physical activity well conducted for at least less than 12 months”.
The decision to undergo this surgical operation must be taken after a multidisciplinary meeting including a diabetologist and after having informed and involved the attending physician in the patient’s journey. The latter must also be informed of the advantages and disadvantages of the chosen technique, its possible psychological impact and the need for post-operative follow-up which includes supplementation of vitamins, minerals and trace elements which is not covered. by health insurance.
To note : too few data on overweight patients (i.e. with a BMI of 25 to 30 kg/m2) are available to estimate the risk-benefit balance, so HAS does not plan to offer these patients metabolic surgery.
Source : Press release from the High Authority for HealthOctober 12, 2022
