Obese patients with type 2 diabetes, especially with recent disease onset, should receive priority for obesity surgery over those without type 2 diabetes, new research suggests. Findings from the study are published in The Lancet Diabetes & Endocrinology

Bariatric surgery is currently prioritized based on the patients with the highest body mass index (BMI). Patients with lower BMIs and comorbidities can also be eligible for surgery but guidelines differ for countries. 

Researchers conducted the SOS study within the Swedish healthcare system  that included 2,010 adults who underwent bariatric surgery and 2,037 matched controls between 1987-2001. Study data showed that drug costs over 15 years did not vary between the surgery vs. control group in patients without diabetes at time of surgery. However, accumulated drug costs were less in surgery patients who had prediabetes (average $3,329 per patient) or diabetes (average $5,487 per patient). Hospital costs were higher in all patients who had surgery, the study found. 

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Surgery patients who did not have diabetes or prediabetes at study onset had incurred higher total healthcare costs (eg, surgery cost, inaptietnand outpatient care, prescription drugs) compared to patients with diabetes. Researchers explain this may be due to remission of diabetes that happens after bariatric surgery where patients require fewer antidiabetic drugs and hospital appointments. 

Future healthcare costs can be reduced as diabetes complications are lessened through remission of diabetes, they concluded. Previous studies likely “underestimated the cost benefits of obesity surgery for those with type 2 diabetes, while overestimating them for patients without type 2 diabetes.” Dr. Ricardo Cohen, Director of the Center of Excellence for Metabolic and Bariatric Surgery, Hospital Oswaldo Cruz, Sao Paulo, Brazil, added that “individuals that do not have their diabetes under control with the best pharmacological approach and lifestyle interventions should be prioritized for bariatric surgery, irrespective of their BMI.”

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