Bariatric weight-loss surgery frees most obese type 2 diabetics from insulin dependence
– Insurance companies urged to cover bariatric surgery

Results of a large national study in the United States show that nearly three-quarters of obese patients with type 2 diabetes who undergo weight-loss surgery are able to stop insulin and other anti-diabetes drugs within six months.

In the Johns Hopkins study of insured, obese, diabetic patients, researchers also found that in the third year following surgery, average annual health care costs per patient decreased by more than 70%. The study is published in the August 2010 issue of Archives of Surgery.

“The cost to care for the average obese diabetic person in America is $10,000 a year, which could be cut to $1,800 with a very safe operation that eliminates more than 80% of the medications these individuals have depended on,” says Marty Makary, MD, MPH, an associate professor of surgery at the Johns Hopkins University School of Medicine and the study’s leader. “The results show that bariatric surgery has huge implications for public health and control of health care costs.”

Dr Makary and his colleagues studied 2,235 adults with health insurance from across throughout the United States who had type 2 diabetes and underwent bariatric surgery during a four-year period from 1 January 2002 to 31 December 2005. The average age of those in the study was 48 years old and 74.5% were women. More than 23% of participants were insulin dependent while more than 50% took metformin hydrochloride to keep their diabetes in check.

Dr Makary and his colleagues found that within one year following surgery, the number of patients dependent on insulin dropped from 524 (23.4%) to 101 (5.5%). Those on metformin dropped from 1,129 (50.5 %) to 156 (8.4%).

Bariatric surgery reduces stomach capacity, typically by stapling off the stomach and creating a much smaller pouch. Studies show it results in long-term weight loss, improved lifestyle and decreased mortality in some populations. In the US its use has increased 200% during the past five years, the authors note.

The risk of mortality from bariatric surgery is 0.3%. The health risks associated with diabetes and obesity are much greater, says Dr Makary.

Health insurance

He says more obese diabetic people should be offered a surgical weight-loss option. Although speaking in context of the US population, his comments are applicable to many countries around the world where health insurance fails to cover bariatic surgery.

“Our results suggest that insurance companies would do well to more readily cover bariatric surgery because it improves health and cuts health care costs,” he says.

Dr Makary says that while bariatric surgery has been shown to result in longterm weight loss, improved lifestyle and decreased mortality in many patients, its impact on diabetes has not been widely studied.

The weight loss that results from the surgery is one explanation for why diabetes symptoms subside, but for some patients, markers of the disease disappear even before significant amounts of weight are lost. One theory is that stomach hormones are somehow altered by the surgery and those changes allow for better natural control of blood glucose levels almost immediately.

“Until a successful nonsurgical means for preventing and reversing obesity is developed, bariatric surgery appears to be the only intervention that can result in a sustained reversal of both obesity and type 2 diabetes in most patients receiving it,” Dr Makary says.

ate of upload: 25th Sep 2010

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