Weight loss surgery has been shown to be highly effective in resolving diabetes in many obese patients, but new research indicates that early surgical intervention is important for long-term remission. The new study, published in the journal Obesity Surgery, involved more than 4400 Roux-en-Y gastric bypass patients, 68 percent of which achieved diabetes remission following surgery. Of the patients who initially experienced complete diabetes remission, 35 percent re-developed diabetes within five years. The study used data on patients who had the procedure from 1995 to 2008 in three integrated health care delivery systems, one in Minnesota and two in California. The researchers found that the median duration of remission was 8.3 years.
The factors that most influenced relapse were longer diabetes duration, insulin use and poor preoperative glycemic control. These factors are all markers of severe diabetes, highlighting the finding that patients with diabetes who seek surgical intervention earlier are more likely to benefit from gastric bypass surgery. Dr. Jaime Ponce, bariatric surgeon and president of American Society for Metabolic & Bariatric Surgery said, “The biggest message is early intervention in diabetic patients with obesity. Evaluate them for bariatric surgery at BMI of 35, and at 30 to 35 with diabetes requiring more medications.” Patients who wait until their diabetes is more advanced will have a lesser chance of long-term remission.
While weight loss surgery requires a larger initial cost, the costs associated with treating diabetes over a long period of time are not insignificant. Just this month the American Diabetes Association released new research demonstrating just how much type 2 diabetes is costing the United States. The report estimated that the total cost of diagnosed diabetes was $245 billion in 2012, up from $174 billion in 2007–representing a 41 percent jump. Robert Ratner, MD, Chief Scientific & Medical Officer, American Diabetes Association, explained that the “cost of diabetes is rising at a rate higher than overall medical costs with more than one in 10 health care dollars in the country being spent directly on diabetes and its complications, and more than one in five health care dollars in the U.S. going to the care of people with diagnosed diabetes.” Additionally, the research showed that medical expenditures for people with diabetes are 2.3 times higher than for those without diabetes and the primary driver of increased costs is the increasing prevalence of diabetes in the U.S. population. As much as 26 million Americans have diabetes, and another 79 million have pre-diabetes and are at risk of developing the disease. Diabetes rates have grown in tandem with obesity rates over the past several decades.
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