Journal 2

Patients With Diabetes May Need Fewer
Medications After Bariatric Surgery

ScienceDaily (Aug. 29, 2010) — Bariatric surgery appears to be associated with reduced use of
medications and lower health care costs among patients with type 2 diabetes, according to a
report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
"The rapidly growing epidemics of obesity and diabetes threaten to overburden the world's
health care systems," the authors write as background information in the article. "From an
epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary,
pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical
management of diabetes is also often unsuccessful. Despite many efforts to improve the control of
glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half
of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation
of a hemoglobin A1C level of less than 7 percent."
The use of bariatric surgery -- that results in long-term weight loss, improved lifestyle and
decreased risk of death -- has tripled in the past five years, the authors note. Martin A. Makary, M.D.,
M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins
University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2
diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used
claims data to measure the use of diabetes medications before and after surgery, along with health care
costs per year.
Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before
surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235
patients (74.7 percent) had eliminated their diabetes medications. Of the 1,847 patients with available
data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of
1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.
"We observed that independence from diabetes medication was almost immediate within the
initial months after surgery and did not correlate with the gradual weight loss expected," the authors
write. "This supports the theory that the resolution of diabetes is not due to weight loss alone but is also
mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide
and pancreatic polypeptide. As a known mediator of insulin regulation, glucagonlike peptide levels have
been noted to increase immediately after bariatric surgery and may explain why surgeons have noted
complete resolution of diabetes in some cases within days after surgery."
Health care costs averaged $6,376 per year in the two years before surgery, and the median or
midpoint cost of the surgery and hospitalization was $29,959. Total annual health care costs increased
by 9.7 percent ($616) in the year following the procedure, but decreased by 34.2 percent ($2,179) in
year two and by 70.5 percent ($4,498) in year three.
"Based on these data, we have identified several important implications for health care delivery
and public policy," the authors conclude. "Foremost, eligible obese patients should be properly informed
of the risks and benefits of bariatric surgery compared with non-surgical health management. Health
care providers should consider discussing bariatric surgery in the treatment of obese patients with type
2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate
candidates, recognizing a potential annualized cost savings in addition to the benefit to health."
REACTION
This article is very helpful for those patients with type 2 diabetes because their health is safer
not only from complications but also for the cost of medications. Medications itself is so stressful in the
pocket of patients with type 2 diabetes, so with this findings, patients would be able to save some
money by undergoing in this type of surgery. Also, with this surgery, it would decrease the risk for death
to those patients with type 2 diabetes and it would also improve their lifestyle.

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Patients With Diabetes May Need Fewer

Medications After Bariatric Surgery

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