Type 2 diabetes patients who underwent bariatric surgery appear to require significantly less medication and incur considerably lower health costs, says a report published in this month's issue of Archives of Surgery, a JAMA/Archives journal. Bariatric surgery is a surgical procedure on the stomach and/or intestines to help extremely obese people lose weight - it is an option for patients with a BMI ( body mass index) above 40.
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The authors write, as background information in their report:
The rapidly growing epidemics of obesity and diabetes threaten to overburden the world's health care systems. From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent."
The authors note that bariatric surgery use, that results in long-term weight loss, significantly better lifestyle and lower death risk, has tripled during the last five years.
Martin A. Makary, M.D., M.P.H., and team at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, examined data on 2,235 U.S. adults (average age 48.4) with type 2 diabetes who had undergone bariatric surgery between the years 2002 and the end of 2005 (four year period). Claims data was used to measure pre- and post-surgery diabetes medication use, as well as health care costs per year.
The study revealed that of the 2,235 patients:
85.8% (1,918) were taking at least one diabetes drug before surgery (average 4.4 medications per patient).
6 months after surgery, 74.7% (1,669) of patients had stopped taking their diabetes medications altogether.
Of the 1,847 patients with available data one year after surgery, 80.6% (1,489) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was detected in all classes of diabetes medications.
The researchers wrote:
We observed that independence from diabetes medication was almost immediate within the initial months after surgery and did not correlate with the gradual weight loss expected. This supports the theory that the resolution of diabetes is not due to weight loss alone but is also mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide and pancreatic polypeptide. As a known mediator of insulin regulation, glucagonlike peptide levels have been noted to increase immediately after bariatric surgery and may explain why surgeons have noted complete resolution of diabetes in some cases within days after surgery.
Health care costs:
In the two years before surgery health care costs averaged $6,376 annually
The median/midpoint cost of surgery and hospitalization was $29,959
Total yearly health care costs rose by $616 (9.7%) in the year after the bariatric surgery
Total yearly health care costs dropped by $2,179 (34.2%) in year two after surgery
Total yearly health care costs dropped by $4,498 (70.5%) in year three after surgery
The scientists concluded:
Based on these data, we have identified several important implications for health care delivery and public policy. Foremost, eligible obese patients should be properly informed of the risks and benefits of bariatric surgery compared with non-surgical health management. Health care providers should consider discussing bariatric surgery in the treatment of obese patients with type 2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health.
Arch Surg
Published August. 2010;145[8]:726-731.
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