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Patients with diabetes may require fewer medications after bariatric surgery

Makary MA. Arch Surg. 2010;145:726-731.

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Bariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes.

Of 2,235 patients who underwent surgery, 74.7% eliminated their diabetes medications 6 months after surgery — an improvement from the 85.8% of patients who were taking at least one diabetes medication before surgery.

Medication use further improved as time progressed: 80.6% of the 1,847 surgery patients with available data eliminated medications at 1 year, and 84.5% of the 1,072 with available data eliminated medications at 2 years.

At baseline, patients were taking an average 4.4 medications. According to the researchers, reductions in medication use were observed in all classes of diabetes medications, including metformin, sulfonylureas and thiazolidinediones.

Martin A. Makary, MD, MPH, and colleagues at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University School of Medicine studied 2,235 U.S. adults (mean age, 48.4 years) with type 2 diabetes who underwent bariatric surgery from 2002 to 2005. The researchers used claims data to measure the use of diabetes medications before and after surgery, as well as health care costs per year.

“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 researchers wrote. “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.”

Health care costs averaged $6,376 per year in the 2 years before surgery, and the average cost of the surgery and hospitalization was $29,959. Total annual health care costs increased by 9.7% ($616) 1 year after the procedure, but decreased by 34.2% ($2,179) in year 2 and by 70.5% ($4,498) in year 3.

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