A new study reports that metabolic and bariatric surgery was nearly three times more common among U.S. adults with obesity and diabetes than those with obesity but without diabetes from 2016 to 2020.

Published in BMJ Open Diabetes Research & Care, researchers analyzed over 900,000 metabolic and bariatric surgery (MBS) procedures using data from the U.S. Nationwide Inpatient Sample and Nationwide Ambulatory Surgery Sample.

The age- and sex-adjusted incidence rate of MBS per 1,000 adults with obesity was 5.9 for those with diabetes, compared to 2.0 for those without diabetes. Women and individuals with class III obesity (BMI ≥40) underwent MBS at higher rates regardless of diabetes status, with the highest incidence among adults aged 30-49 years and in the Northeast region.

From 2016 to 2019, MBS incidence increased annually by 5.7%, with similar trends observed in both adults with and without diabetes. However, procedures declined in 2020 due to the COVID-19 pandemic. Sleeve gastrectomy was the most common procedure (71.4%), followed by Roux-en-Y gastric bypass (RYGB). Patients with diabetes were more likely to undergo RYGB (33.6%) than those without (23.3%).

Private insurance covered 61.9% of MBS procedures, followed by Medicaid (17.6%) and Medicare (13.0%). The majority of patients (86.9%) lived in metropolitan areas, with 75.0% of procedures performed in metro teaching hospitals. While the South region had the largest number of procedures, the Northeast had the highest incidence.

The study found that non-Hispanic White individuals accounted for 60.1% of procedures, followed by non-Hispanic Black (18.9%) and Hispanic (16.0%) patients. MBS procedures were distributed fairly evenly across income quartiles, suggesting relatively equal access across socioeconomic levels.

"Continued monitoring of the trends in use of MBS and other obesity treatment modalities can enhance our understanding of treatment accessibility and guide prevention efforts aimed at reducing obesity and diabetes as well as improving diabetes management," said Yiling J Cheng from the Division of Diabetes Translation, Centers for Disease Control and Prevention.

The authors declared no conflicts of interest.