Support for bariatric surgery in people with insulin-dependent type 2 diabetes
medwireNews: Treatment with bariatric surgery is associated with clinical and cost-saving benefits among obese people with type 2 diabetes requiring insulin, researchers report.
These findings “challenge the popular view that bariatric surgery has limited clinical efficacy for patients with more advanced [type 2 diabetes],” say Omar Khan (Royal College of Surgeons of England, London, UK) and colleagues.
The researchers used the UK National Bariatric Surgical Registry to evaluate the outcomes of 1847 individuals with type 2 diabetes requiring insulin who underwent Roux-en-Y gastric bypass (RYGB; 71.1%), sleeve gastrectomy (21.5%), or adjustable gastric band (7.4%) surgery between 2009 and 2017. Participants had an average age of 51.1 years and an average BMI of 47.2 kg/m2 at baseline, and 64% were women.
As reported in PLOS Medicine, the average percentage weight loss 1 year after surgery was 27.4%. Only 32.7% of participants still required insulin at this time, while 33.5% were no longer recorded as having type 2 diabetes. Khan and colleagues say that “[t]here was significant variation in [diabetes] status by procedure,” with 71.7% of those in the RYGB group stopping insulin, compared with 64.5% of those in the sleeve gastrectomy group and just 33.6% of those with an adjustable gastric band.
In an analysis adjusting for baseline factors, people with an adjustable gastric band had a significant 54% lower likelihood of insulin cessation relative to those who underwent RYGB, whereas people in the sleeve gastrectomy group had a significant 9% lower likelihood. After further adjustment for percentage weight loss, people in the adjustable gastric band arm still had a significant 45% lower probability of insulin cessation than those in the RYGB group, but sleeve gastrectomy was no longer significantly associated with a reduced likelihood of this outcome.
“These findings support the notion that improvements in [type 2 diabetes] seen after bariatric surgery have both weight loss–dependent and weight loss–independent components,” remark Khan and team.
The researchers than carried out a cost-effectiveness modeling analysis, finding that bariatric surgery was cost-saving compared with best medical treatment (BMT), with 5-year costs of £ 22,057 (US$ 29,058; € 23,954) compared with £ 26,286 ($ 34,621; € 28,546) per patient, respectively.
They note that “the greatest savings stem from direct treatment costs,” as “bariatric surgery is significantly cheaper than the medications that would otherwise be prescribed to patients with severe [type 2 diabetes] over a 5-year period.”
“This is an important finding, given that the majority of previous economic evaluations concluded that the direct treatment costs of surgery exceeded those of BMT.”
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