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 Researchers found that for people with diabetes, total healthcare
costs did not rise in the years following weight-loss surgery,
largely because of overall savings from less use of healthcare and
medications.
For people with normal or merely elevated blood sugar below the
cut-off for diabetes, the surgery was linked to higher costs
afterward.
Though previous research has found that weight loss procedures,
known as bariatric surgery, can lower blood sugar so much that
diabetes essentially disappears, operations are still typically
recommended only for extremely obese patients.
“Greater weight should be given to preoperative blood sugar status
to help identify the patients who have the most benefit from
bariatric surgery,” study co-author Martin Neovius of the Karolinska
Institute in Stockholm said by email. “We have shown previously that
this makes sense from a health outcomes perspective, and now we show
that it makes sense also from an economic perspective.”
Globally, 1.9 billion adults are overweight or obese, according to
the World Health Organization (WHO). Obesity increases the risk of
heart disease, diabetes, joint disorders and certain cancers.
Roughly one in nine adults have diabetes, according to the WHO. Most
of these people have Type 2 diabetes, which happens when the body
can't properly use or make enough of the hormone insulin to convert
blood sugar into energy.
Left untreated, diabetes can lead to nerve damage, amputations,
blindness, heart disease and strokes.
A growing number of extremely obese patients have turned to surgery
after failing to achieve significant weight loss through diet,
exercise or medication – strategies that can also manage diabetes.
Like all surgery, it isn’t risk free, and bariatric operations in
particular carry a risk of malnutrition.
Clinical guidelines used in many parts of the world only recommend
bariatric surgery for patients who are extremely obese, based on a
measure of weight relative to height known as body mass index (BMI).
An obese adult who is 5 feet 9 inches tall would weigh at least 203
pounds and have a BMI of 30 or more, for example. Only adults with a
BMI greater than 40 should get bariatric surgery, according to
widely followed recommendations from the U.S. National Institutes of
Health, although some patients with serious health problems,
including diabetes, may be candidates with a BMI over 35.
For the current study, Neovius and colleagues followed 4,030
patients for about 15 years. Roughly half of them received bariatric
surgery, while the rest did not.
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Within each group at the start of the study, many patients didn’t
have diabetes, while some had elevated blood sugar that suggested
they might be at risk for developing the disease and others already
had full-blown diabetes.
When people without full-blown diabetes got bariatric surgery, their
treatment costs including the operations and follow-up care were
higher than similar patients who didn’t have the procedures.
But for diabetics, the costs for the surgery group and the
nonsurgical group were roughly the same after 15 years. The cost of
surgery was largely offset by less use of healthcare and lower
prescription drug costs, the study found.
One limitation of the study is that it relied in part on
self-reported drug costs, and lacked data on costs related to
nonprescription drugs, nursing homes, medical equipment and certain
services like dieticians and psychologists, the authors acknowledge
in The Lancet Diabetes and Endocrinology.
The findings suggest that bariatric surgery should be considered for
diabetics who don’t succeed at controlling their blood sugar with
drugs and lifestyle changes, regardless of their BMI, argues Ricardo
Cohen, of the Center for Obesity and Diabetes at the Hospital
Oswaldo Cruz in Sao Paulo, Brazil, in an accompanying editorial.
Bariatric surgery guidelines should be “unchained from BMI alone,”
Cohen told Reuters Health in an email. “Patients should not have any
barrier to the surgical treatment of diabetes when there are several
studies that show when diabetes is not under control with
medication, surgery offers good clinical and economical outcomes.”
SOURCE: http://bit.ly/1NMWy53 and http://bit.ly/1KBQJ5V The Lancet
Diabetes and Endocrinology, online September 16, 2015.
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