A new study recently published in the journal The Lancet Diabetes & Endocrinology indicates that obese patients with type 2 diabetes should be prioritized over obese patients without the disease for weight loss surgery. The study was conducted by an international research team and is entitled “Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study.” The research was based on the Swedish Obese Subjects (SOS) study from Sahlgrenska Academy in Sweden.
Obesity is known to increase the likelihood of a person developing type 2 diabetes, the most common form of diabetes in which individuals do not produce enough insulin or do not use it properly, leading to insulin resistance and eventually higher blood sugar levels (hyperglycemia).
Bariatric surgery is a weight loss surgery, through a reduction in stomach’ size, that has been shown to promote a substantial weight loss in obese patients, and to contribute to health improvements and decrease the incidence of medical conditions like diabetes, heart attack, stroke and cancer.
Currently, the majority of the healthcare systems prioritize access to obesity surgery according to the patient’s body mass index (BMI), with individuals with higher BMIs being usually treated first. Patients with lower BMIs and comorbidities like type 2 diabetes can also be considered eligible for obesity surgery, however different countries have their own different guidelines.
The selection of patients according to their diabetes status, rather than their BMI alone, has been previously suggested by several groups to be a better approach to prioritize obese patients to undergo bariatric surgery. However, up to now, the long-term effect of bariatric surgery in comparison to conventional therapy in obese diabetic patients according to their diabetes status has not been evaluated.
The Swedish SOS study included 2,010 adults who underwent bariatric surgery and 2,037 matched controls, all recruited between 1987 and 2001. Researchers found that the drug costs accumulated over the 15 year interval analyzed were not different between the control group and the obesity surgery group in patients without diabetes at the time the surgery was performed. Interestingly, however, the costs were found to be lower in surgery patients who had prediabetes, with an average of $3,329 per patient, or diabetes, average of $5,487 per patient. In terms of hospital costs, these were of course higher in patients who were submitted to surgery.
The team reported that overall, and in comparison to patients under conventional treatment, the total healthcare costs (including surgery, drugs, inpatient and outpatient hospital care) were higher in surgery patients without diabetes at the start of the study (by $22,390 per patient) or with prediabetes ($26,292), but not in diabetic patients. Researchers believe that this fact is possibly linked to the remission of diabetes often observed after bariatric surgery, so that patients require fewer expensive diabetes drugs and hospital appointments in the years following the procedure. Furthermore, diabetes remission can also be reflected in a decline in complications associated to the disease, further decreasing the healthcare costs with these patients.
“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,” said the research team according to a news release. “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 research team concluded that the overall total healthcare costs indicate that obese patients with type 2 diabetes — in particular the ones with recent disease onset — should be prioritized for bariatric surgery over obese individuals without type 2 diabetes.
Dr. Ricardo Cohen, Director of the Center of Excellence for Metabolic and Bariatric Surgery, Hospital Oswaldo Cruz, São Paulo, Brazil, commented on this study, “BMI should…not be the only indication for bariatric surgery. Thus, individuals that do not have their diabetes under control with the best pharmacological approach and lifestyle interventions should be prioritized for bariatric surgery, irrespective of their BMI.”