Fewer Medications Required for Diabetes Patients Who Undergo Bariatric Surgery

Patients with type 2 diabetes who underwent bariatric surgery appear to require significantly less medication and incur considerably lower health costs, according to a report published in the Archives of Surgery. Bariatric surgery is procedure performed on the stomach and/or intestines to aid extremely obese patients in losing weight.

Lead author Martin Makary, M.D. and his team note that bariatric surgery use that results in long-term weight loss, a significant lifestyle improvement and a reduced risk of death, has tripled in the last five years. The researchers examined data on over 2,000 U.S. adults with type 2 diabetes and had undergone bariatric surgery between the years 2002 and the end of 2005.

The study findings revealed that 85% of patients were taking at least one diabetes drug before surgery with the average being 4 medications per patient. Six months following surgery, nearly 75% of patients had stopped taking their diabetes medications altogether. Of the patients with available data after one year of surgery, over 80% had eliminated medications; after two years, nearly 85% had done so. This reduction was detected in all classes of diabetes medications.

According to the researchers, “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.”

In regards to health care costs, the researchers found that in the two years before surgery, health care costs averaged $6,300 annually. They found the average cost of surgery and hospitalization to be roughly $30,000. In the year following bariatric surgery, health care costs rose by nearly 10%. However, yearly health care costs dropped in the following second and third year by 32% and 70% respectively.

The study investigators conclude that, “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.”


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