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Bariatric Surgery Called Cure for Some Diabetes Patients

October 5th, 2015 | by Veronika Václavková
Bariatric Surgery Called Cure for Some Diabetes Patients
Treatment
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Emerging data show impressive results on glycemic control, but what about long-term results, safety, and high maintenance costs?

Bariatric surgery’s reputation as a diabetes fighter grows. It produces weight loss that eclipses medication therapy or lifestyle programs, and some experts even say that it can create an immediate reduction in hemoglobin A1c to a point where patients leave the hospital no longer needing antidiabetic medications.

The American Diabetes Association says, “Bariatric surgery produces near or complete normalization of glycemia in a range of 40% to 95% of patients with type 2 diabetes, often wiping out the need for antidiabetic therapy.”

Bariatric surgery is commonly a covered procedure for people with a BMI ≥40 who have failed a weight loss program or with a BMI ≥35 with a comorbidity related to obesity, such as diabetes.

The latest development is a claim that bariatric surgery can achieve the ADA’s definition of a cure for diabetes. That definition is A1c <6% and normal fasting glucose levels for five years without medication therapy. The benefits of obesity surgery are attributed, in part, to the surgery stimulating hormonal changes, incretin effects, and brain signaling that are separate from weight loss.

In spite of near miraculous results, bariatric surgery may be only halfway to establishing clinical credibility and gaining acceptance. It needs to conclusively demonstrate its long-term effect on micro- and macrovascular complications in diabetes, or a clear effect on chronic conditions such as sleep apnea. Then there are concerns about its safety, efficacy, and cost.

 

Does bariatric surgery reduce long-term costs?

Several studies have shown that bariatric surgery is cost-effective. Early studies of bariatric surgery showed long-term savings with a return on investment in three to seven years. However a study published in 2013 found almost equal costs between surgery patients and a 1:1 match comparison group in the six years after surgery, without recovering the cost of the surgery admission.

The study in JAMA Surgery involved 29,820 members of seven Blue Cross Blue Shield plans who had bariatric surgery from 2002 through 2008. The mean total cost of the surgical episode for all types of bariatric surgery was $29,517. In the six years after surgery the mean annual expenditures for bariatric surgery patients were comparable to those for the matched group, except in postoperative years two and three when the surgical group’s total costs were slightly higher. Laparoscopic surgery patients had lower costs in the first few years after surgery but those differences did not persist.

The comparison group had significantly higher pharmacy costs in years 1 through 6 while the surgery group had significantly higher inpatient costs. The professional office and outpatient costs were comparable between surgical and nonsurgical groups. The overall conclusion was that there is no evidence that any one type of surgery is more likely to reduce long-term costs. In this study, 24.9% of patients in the surgery group had diabetes. The published study did not provide a cost comparison specifically for diabetes patients.

References:
Managed Care [Internet]. Medimedia USA (Pennsylvania). Vol. 39, No. 1, January 2014 – [cited 2015 Oct 5]
Available from: http://www.managedcaremag.com/linkout/2014/1/39

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