Research suggests change in priorities for weight loss surgery for type 2 diabetics

by Barbara Hewitt on September 18, 2015

Obese people with type 2 diabetes, especially those who have recently been diagnosed, should be given priority for surgery to reduce their weight, it is suggested.

This is because many of these type of patients see a reversal of their diabetes after surgery and thus need fewer expensive diabetes medications or treatment for complications in the future, according to new research.

diabetesOBESITY200Researchers from Sweden and Australia looked into the decision making process for weight loss surgery and found that most healthcare systems prioritise surgery on the basis of body mass index (BMI).

People with lower BMI and comorbidities such as type 2 diabetes are also considered eligible for surgery, but the guidelines vary enormously from country to country.

Several groups have recommended that a person’s diabetes status rather than BMI alone should be used to prioritise obese patients to receive bariatric surgery. But so far, the long term effect of bariatric surgery, relative to conventional therapy, on healthcare costs in obese patients according to their diabetes status has not been assessed using real world data.

Now the research, based on the Swedish Obese Subjects (SOS) study from Sahlgrenska Academy in Gothenburg, Sweden examined over 2,000 adults who underwent obesity surgery and 2000 matched controls recruited between 1987 and 2001.

The data showed that accumulated drug costs over 15 years did not differ between the surgery and control group in patients without diabetes at the time of surgery, but were lower in surgery patients who had prediabetes, on average US$3,329 per patient and US$5,487 for those with diabetes.

However, the study also found that hospital costs were higher in all patients who had surgery, but no differences in outpatient costs were observed.

Compared with patients treated conventionally, total healthcare costs, accounting for costs of surgery, inpatient and outpatient hospital care and prescription drugs, were higher in surgery patients who did not have diabetes at the beginning of the study by $22,390 per patient, or $26,292 for those who had prediabetes, but not in patients with diabetes.

The research suggest that this was most likely because the remission of diabetes that often occurs after bariatric surgery means that patients need fewer diabetes medications and hospital appointments in the subsequent years. Remission of diabetes also means that diabetes complications are lessened, further reducing future healthcare costs.

“To our knowledge, this is the first prospectively controlled study to assess long term healthcare costs in obesity surgery patients according to their preoperative diabetes status versus matched controls,” the research report said.

The report also suggests that because previous studies have assessed the entire eligible obese population, they have likely underestimated the cost benefits of obesity surgery for those with type 2 diabetes, while overestimating them for patients without type 2 diabetes.

“We show that for obese patients with type 2 diabetes, the upfront costs of bariatric surgery seem to be largely offset by prevention of future health care and drug use. This finding of cost neutrality is seldom noted for health-care interventions, nor is it a requirement of funding in most settings,” the report explained. “Usually, buying of health benefits at an acceptable cost, for example £20 000 per quality adjusted life year in the UK, is the economic benchmark adopted by payers when new interventions are assessed. Bariatric surgery should be held to the same economic standards as other medical interventions.”

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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