Weight loss surgery is the best treatment for people with obesity and the most severe type 2 diabetes – and has the potential to save the UK NHS millions of pounds, according to a new study published last night.
The new large-scale study by the British Obesity and Metabolic Surgery Society (BOMSS) and the Population Health Research Institute at St Georges, University of London, UK concludes that offering bariatric surgery to this group of patients not only improves their health but also reduces their reliance on medication.
This type of surgery has benefitted people with early or mild type 2 diabetes, but small studies had suggested that it might be less effective for patients with more advanced type 2 diabetes and have a higher chance of developing diabetes complications including blindness, limb amputation and heart disease.
For this study, which is published in the latest edition of PLOS Medicine, the researchers used data from the National Bariatric Surgical Registry to analyse the outcomes of nearly 2,000 patients with obesity and type 2 diabetes requiring insulin, all of whom had surgery between 2009 and 2017.
They found that two out of three patients no longer needed insulin at one year after their surgery, while type 2 diabetes was eradicated in one in three patients one year after their surgery. Patients also lost on average about a quarter of their bodyweight.
The annual cost to the NHS for treating type 2 diabetes and its complications is £10 billion. When the researchers looked at the overall costs in people who had surgery compared with a similar group who did not, they established that each operation costs about £6000, which was less than the cost of their medication.
When costs of avoiding the complications of diabetes were also considered, the average patient treated with surgery was expected to save the NHS £4,229 over five years.
Dr Gul Bano, consultant endocrinologist and obesity physician at St George’s University Hospitals NHS Foundation Trust, said: “This study not only demonstrates the clinical benefit of weight loss surgery in patients with obesity and severe type 2 diabetes, but the clear cost savings that surgery can provide.
“Indeed, based on current projections offering surgery to this cohort of patient could potentially save the NHS up to £240 million over five years.”
Lead study author Mr Omar Khan, bariatric surgeon from St George’s, University of London, added: “Patients with obesity and severe diabetes have not previously been prioritised for surgery, but our findings suggest that offering weight loss surgery to this group of patients not only leads to improved health, but by reducing the need for multiple daily medications, benefits the taxpayer.”
Nikki Joule, policy manager at Diabetes UK, said the study strengthens existing evidence that bariatric surgery can help some people with obesity and insulin-treated type 2 diabetes.
“Despite the known clinical benefits of bariatric surgery for type 2 diabetes, we know that people who meet the current NHS criteria are often not offered this treatment,” she said.
“We urge the NHS to take action to increase the provision and take-up of bariatric surgery so that more people have the chance of putting their type 2 diabetes into remission.”
The research team said their findings are also pertinent to the COVID-19 era because it is known that patients with diabetes and obesity have a higher risk of dying if they contract the virus.
PLoS Medicine 7 December 2020
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