scholarly journals Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003228
Author(s):  
Emma Rose McGlone ◽  
Iain Carey ◽  
Vladica Veličković ◽  
Prem Chana ◽  
Kamal Mahawar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Time Horizon

Background Although bariatric surgery is well established as an effective treatment for patients with obesity and type 2 diabetes mellitus (T2DM), there exists reluctance to increase its availability for patients with severe T2DM. The aims of this study were to examine the impact of bariatric surgery on T2DM resolution in patients with obesity and T2DM requiring insulin (T2DM-Ins) using data from a national database and to develop a health economic model to evaluate the cost-effectiveness of surgery in this cohort when compared to best medical treatment (BMT). Methods and findings Clinical data from the National Bariatric Surgical Registry (NBSR), a comprehensive database of bariatric surgery in the United Kingdom, were extracted to analyse outcomes of patients with obesity and T2DM-Ins who underwent primary bariatric surgery between 2009 and 2017. Outcomes for this group were combined with data sourced from a comprehensive literature review in order to develop a state-transition microsimulation model to evaluate cost-effectiveness of bariatric surgery versus BMT for patients over a 5-year time horizon. The main outcome measure for the clinical study was insulin cessation at 1-year post-surgery: relative risks (RR) summarising predictive factors were determined, unadjusted, and after adjusting for variables including age, initial body mass index (BMI), duration of T2DM, and weight loss. Main outcome measures for the economic evaluation were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay threshold of GBP£20,000. A total of 2,484 patients were eligible for inclusion, of which 1,847 had 1-year follow-up data (mean age of 51 years, mean initial BMI 47.2 kg/m2, and 64% female). 67% of patients no longer required insulin at 1-year postoperatively: these rates persisted for 4 years. Roux-en-Y gastric bypass (RYGB) was associated with a higher rate of insulin cessation (71.7%) than sleeve gastrectomy (SG; 64.5%; RR 0.92, confidence interval (CI) 0.86–0.99) and adjustable gastric band (AGB; 33.6%; RR 0.45, CI 0.34–0.60; p < 0.001). When adjusted for percentage total weight loss and demographic variables, insulin cessation following surgery was comparable for RYGB and SG (RR 0.97, CI 0.90–1.04), with AGB having the lowest cessation rates (RR 0.55, CI 0.40–0.74; p < 0.001). Over 5 years, bariatric surgery was cost saving compared to BMT (total cost GBP£22,057 versus GBP£26,286 respectively, incremental difference GBP£4,229). This was due to lower treatment costs as well as reduced diabetes-related complications costs and increased health benefits. Limitations of this study include loss to follow-up of patients within the NBSR dataset and that the time horizon for the economic analysis is limited to 5 years. In addition, the study reflects current medical and surgical treatment regimens for this cohort of patients, which may change. Conclusions In this study, we observed that in patients with obesity and T2DM-Ins, bariatric surgery was associated with high rates of postoperative cessation of insulin therapy, which is, in turn, a major driver of overall reductions in direct healthcare cost. Our findings suggest that a strategy utilising bariatric surgery for patients with obesity and T2DM-Ins is cost saving to the national healthcare provider (National Health Service (NHS)) over a 5-year time horizon.

Insulin Dose Adjustment Following Bariatric Surgery, a Review of Available Literature

2021 ◽  
pp. 193229682110288
Author(s):  
Lynn E. Kassel ◽  
Jessica J. Berei ◽  
Jamie M. Pitlick ◽  
Joel E. Rand
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Appraisal Tool

Bariatric surgery is a known and effective treatment for type 2 diabetes mellitus. Patients with type 1 diabetes mellitus and exogenous insulin-requiring type 2 diabetes mellitus require adjusted insulin dosing after surgery to avoid hypoglycemia. This review describes insulin dose adjustments following a variety of bariatric procedures. After searching the available literature and assessing for eligibility, 8 articles were included. The Johns Hopkins Research Evidence Appraisal Tool for literature appraisal was used. The results of this review reveal insulin dose adjustment varies based upon surgical procedure type and time of follow-up from the procedure.

scholarly journals Safety, Effectiveness, and Cost Effectiveness of Metabolic Surgery in the Treatment of Type 2 Diabetes Mellitus

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Nestor Villamizar ◽  
Aurora D. Pryor
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness ◽  
Metabolic Surgery ◽  
Gastrointestinal Surgery ◽  
Diabetic Patients ◽  
Safety Effectiveness

Remission of type 2 diabetes mellitus with metabolic surgery is a field of active investigation and development. The extraordinary results obtained in diabetic patients with BMI > 35 kg/m2have led investigators to query if similar results could be achieved in patients with BMI < 35 kg/m2. A few studies have been recently conducted to evaluate the safety, effectiveness, and cost effectiveness of bariatric surgery in diabetic patients with BMI BMI < 35 kg/m2. However, stronger evidence would be required before insurance coverage is extended for bariatric surgery to all type 2 diabetic patients, in addition to those with BMI ≥ 35 kg/m2for whom eligibility is already established. In addition, the hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery are yet to be determined. This paper will review the evidence about safety, effectiveness, and cost effectiveness of bariatric surgery in type 2 diabetes mellitus remission and the potential socioeconomic impact of offering bariatric surgery to diabetic patients with BMI BMI < 35 kg/m2.

scholarly journals Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus

Medicine ◽  
2016 ◽  
Vol 95 (20) ◽  
pp. e3522 ◽  
Author(s):  
Qi Tang ◽  
Zhipeng Sun ◽  
Nengwei Zhang ◽  
Guangzhong Xu ◽  
Peipei Song ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness

scholarly journals Evaluation of weight loss and metabolic profile of obese patients with type 2 diabetes mellitus (dm2) versus non-dm2 subjects, one and three years after bariatric surgery

2010 ◽  
Vol 23 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Thiago Fraga Napoli ◽  
Mariana Furieri Guzzo ◽  
Douglas Kawashima Hisano ◽  
Paulo Gustavo Figueiredo Salgado Ribeiro ◽  
Vanessa Junqueira Guedes ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Profile ◽  
Weight Regain ◽  
Density Lipoprotein ◽  
Obese Patients

BACKGROUND: There is a debate over results obtained from type 2 diabetes mellitus (DM2) obese patients and non-DM2 patients, in reference to metabolic control and ponderal loss, after bariatric surgery. AIM: To evaluate weight loss and metabolic profile of obese patients with DM2 versus non-DM2 subjects, one and three years after bariatric surgery. METHODS: Data from 38 non-DM2 patients and 44 DM2 patients submitted to Roux-en-Y gastric-bypass were analysed retrospectively. For the pre-operatory, first and third year of post-operatory, were compared: weight, body mass index (BMI), fasting glucose (FG), high density lipoprotein (HDL) and triglycerides (TG). RESULTS: Preoperatively, both groups were statistically equivalent in regards to weight, BMI (P = 0.90) and HDL (P = 0.73). This was not the case when TG (P = 0.043) and FG (P<0.01) were analyzed. In PO1, both DM2 and non-DM2 groups showed a reduction in weight, BMI and TG, just as FG in the DM2 group (P < 0.05). HDL increased (P < 0.05) in PO1 in both groups. In the following period, between PO1 and PO3, only TG continued to decrease in the non-DM2 group (P = 0.039), while the other variables did not change. In the DM2 group mean A1c in PO3 was 6.2% +- 0.75 (P = 0.027). It was compared both group's post-operative data. HDL's and TG's variation between groups did not differ in PO1 or between PO1 and PO3. Weight in PO1 and PO3, just as BMI in PO1 and PO3, were not significantly different either. CONCLUSION: In PO1, weight loss and metabolic improvement was seen in both groups. This was sustained in PO3, with no significant weight regain or lipid/FG change. A1c found suggests a reasonable control of DM2 surgery. A trend towards a less intense weight loss could be noticed in the DM2 group (P = 0.053).

Bariatric surgery‐induced weight loss in patients with and without type 2 diabetes mellitus

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Thatiany A. Carvalho ◽  
Marcelo F. Ronsoni ◽  
Alexandre Hohl ◽  
Simone Sande‐Lee
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus

scholarly journals Mid-term effect of Roux-en-Y gastric bypass on type 2 diabetes mellitus: a retrospective single surgeon observational study with focus on anti-diabetic medication

2017 ◽  
Vol 7 (2) ◽  
pp. 40
Author(s):  
Ben Gys ◽  
Filip Haenen ◽  
Tobie Gys ◽  
Thierry Lafullarde
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Fasting Glucose ◽  
Term Outcome ◽  
Insulin Dependent

Background/purpose: Few studies evaluating the mid-term outcome of type 2 diabetes mellitus (t2DM) after Roux-en-Y Gastric Bypass (RYGB) are available at this time. The aim of this study is to assess mid-term impact of RYGB on t2DM regarding the need for anti-diabetic medication, biochemical response and associated weight loss. Methods: Retrospective analysis of prospectively collected data was performed for patients suffering from t2DM who underwent RYGB between 1/1/2000 and 1/1/2015. Patients were divided into 2 groups according to the preoperative need for insulin. Study parameters included Body Mass Index (BMI), %Excess Weight Loss (%EWL), Hemoglobin A1c (HbA1c) and fasting glucose at 1, 3, 6 and 10-year intervals after surgery. Results: 140 patients (97 women, 43 men) were included. Mean preoperative BMI was 42.8 kg/m² (range 35.0 - 75.0). Mean duration of t2DM before RYGB was 5,7 years (range 0,2 - 30,1). Preoperative need for anti-diabetic medication was seen in 102 patients (72,8%) of which 49 (48,0%) were insulin-dependent (ID-group).  Mean postoperative follow-up was 5,9 years (range 0,1 – 14,5). Remission of t2DM (fasting glucose < 126mg/dl and a HbA1c < 6.5% without the need of anti-diabetic medication for at least 6 months) was present in both groups: 46,7%, 48,1%, 45,0%, 50,0% (ID-group) and 59,1%, 62,2%, 53,3%, 33,3% (insulin independent patients) at respectively 1, 3, 6 and 10-years follow up. No significant correlation was proven between remission and %EWL. Conclusions: Bariatric surgery is useful in the mid-term management of uncontrolled t2DM.

scholarly journals Effects of Laparoscopic Roux-en-Y Gastric Bypass on Anthropometric Characteristics, Hypertension, Type 2 Diabetes Mellitus and Metabolic Syndrome: An Iranian Experience

2014 ◽  
Vol 3 (3) ◽  
pp. 167-75
Author(s):  
Morteza Ghoghaei ◽  
Elias Khajeh ◽  
Foad Taghdiri ◽  
Mohammad Mahdi Zamani ◽  
Soudeh Taghdiri ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Metabolic Syndrome ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Morbidly Obese ◽  
Obese Patients

 Background: Surgically induced weight loss is a treatment option for the management of obesity and the related common disorders. This study evaluated the beneficial effects of bariatric surgery on metabolic profile and the prevalence of metabolic syndrome (MetS) among Iranian patients.Materials and Methods: A prospective observational study was performed on 26 morbidly obese patients scheduled for bariatric surgery, using laparoscopic Roux-en-Y gastric bypass (LRYGB). The parameters of hypertension, type 2 diabetes mellitus (T2DM), hyperlipidemia, MetS prevalence, and anthropometric measurements of Iranian patients, were recorded, at the preoperative visit and in follow-ups. The follow-up was performed for a median of 12 months, and the change in MetS prevalence and its componnts were assesed.Results: LRYGB induced a mean weight loss of 69.0±21.2%, after 12 months. Preoperative MetS was diagnosed in 21 patients (84%) and decreased to 6 patients (24%) after LRYGB (P=0.001). Likewise, the prevalence of hypertension was significantly decreased from 76% (pre-LRYGB values) to 20% (post-LRYGB values) (P=0.001). The prevalence of T2DM was also decreased from 20% to 8% (P=0.5).Conclusion: According to our results, RYGB produced a rapid and significant weight loss and improvement in hypertension and MetS within one year but there was a controversy about the improvement of T2DM, in Iranian morbidly obese patients.

Sign in / Sign up

Export Citation Format

Share Document