Bariatric surgery reduces need for diabetes drugs

Adults with obesity who underwent bariatric surgery were more likely to discontinue and less likely to initiate treatment with antidiabetes medications, including insulin, 6 years after surgery compared with adults with obesity who did not undergo surgery, according to findings from a long-term prospective cohort study.

Anne Fagot-Campagna, MD, PhD, of the department of statistics at Nationale d’Assurance Maladie des Travailleurs Salariés in France, and colleagues evaluated health care reimbursement data from the French national health insurance database from 2008 to 2015 on 15,650 adults who underwent bariatric surgery (mean age, 38.9 years; 84.6% women; BMI 40-49.9 kg/m2, 59.6%; 10.4% on antidiabetes therapies) and 15,650 adults with obesity who did not undergo surgery (controls; mean age, 39.4 years; 84.6% women; BMI 40-49.9 kg/m2, 59.6%; 10.4% on antidiabetes therapies). Researchers sought to determine associations between bariatric surgery and rates of continuation, discontinuation or initiation of antidiabetes therapies 6 years after surgery compared with the control group.

Adjustable gastric band was the most common procedure performed (48.5%) followed by gastric bypass (27.7%), sleeve gastrectomy (22%) and other procedures (1.8%).

The rate of antidiabetic drug use at 6 years decreased more in the bariatric surgery group compared with the control group (–49.9% vs. –9%; P < .001). In particular, insulin use decreased in the bariatric surgery group (–40%), whereas it increased in the control group (119.8%; P < .001).

Compared with the control group, drug discontinuation rates were greater in those who underwent gastric bypass (OR = 16.7; 95% CI, 13-21.4), sleeve gastrectomy (OR = 7.3; 95% CI, 5.5-9.5) and adjustable gastric band (OR = 4.3; 95% CI, 3.3-5.6) procedures.

Antidiabetes therapy initiation rates at 6 years were lower in the bariatric surgery group compared with the control group (1.4% vs. 12%; P < .001).

Risk factors for initiation of antidiabetes therapies in all participants included higher BMI (OR = 2.04; 95% CI, 1.68-2.47 for 50 kg/m2 vs. 30-39.9 kg/m2; OR = 1.68; 95% CI, 1.49-1.9 for 40-49.9 kg/m2 vs. 30-39.9 kg/m2), male sex (OR = 1.92; 95% CI, 1.69-2.17), antihypertensive treatment (OR = 1.49; 95% CI, 1.33-1.67), low income (OR = 1.43; 95% CI, 1.26-1.62) and older age (OR = 1.04; 95% CI, 1.03-1.05 per year).

“This large-scale nationwide study based on health care reimbursement data found significant improvement in the frequency and complexity of antidiabetes treatment 6 years after bariatric surgery, with a marked association for patients undergoing [gastric bypass],” the researchers wrote. “In parallel, we demonstrated a low rate of antidiabetes treatment initiation 6 years after bariatric surgery. However, patients and physicians should be aware that morbid obesity remains a chronic disease even after bariatric surgery because 50.1% of patients with preexisting antidiabetes treatment remained on treatment 6 years after surgery. Our study highlights the message that these patients require careful lifelong follow-up to monitor obesity complications.” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.

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Source:

Thereaux J, et al. JAMA Surg. 2018;doi:10.1001/jamasurg.2017.6163.