Published: 17-09-2015 09:10 | Updated: 17-09-2015 11:09

Type 2 diabetic patients should be prioritised for obesity surgery

A new Swedish study suggests that when considering overall costs of healthcare, obese patients with type 2 diabetes should be prioritised for obesity surgery over those who do not suffer from this disease. Many patients see a reversal of diabetes after surgery, and therefor do not need expensive diabetes medications or treatment for future complications. The findings are being published in the journal The Lancet Diabetes & Endocrinology.

The research is based on the Swedish Obese Subjects (SOS) study from Sahlgrenska Academy in Gothenburg and performed in collaboration with Dr Martin Neovius, Karolinska Institutet, Dr Lena Carlsson, Chief SOS Investigator, University of Gothenburg, and Dr Catherine Keating, Deakin University and Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

Currently most healthcare systems prioritise access to obesity surgery based on a person’s body-mass index (BMI), and in general, those with the highest BMI are prioritised. Patients with lower BMIs and comorbidities such as type 2 diabetes can also be considered eligible for surgery, but different countries have different guidelines. Several groups have recommended that a person’s diabetes status (rather than BMI alone), be used to prioritise obese patients to receive bariatric surgery. But so far, the long-term effect of bariatric surgery (relative to conventional therapy) on healthcare costs in obese patients according to their diabetes status has not been assessed using real-world data.

Accumulated drug costs

The data used from the SOS study included 2010 adults who underwent obesity surgery and 2037 matched controls recruited between 1987 and 2001. The analysis showed that accumulated drug costs over 15 years did not differ between the surgery and control group in patients without diabetes at the time of surgery, but were lower in surgery patients who had prediabetes (on average, -US$3329 per patient) or diabetes (-$5487 per patient). However, hospital costs were higher in all patients who had surgery. No differences in outpatient costs were observed.

Compared with patients treated conventionally, total healthcare costs (accounting for costs of surgery, inpatient and outpatient hospital care and prescription drugs) were higher in surgery patients who did not have diabetes at the beginning of the study (by $22,390 per patient) or who had prediabetes ($26,292), but not in patients with diabetes, most likely because the remission of diabetes that often occurs after bariatric surgery means that patients need fewer diabetes medications and hospital appointments in the subsequent years. Remission of diabetes also means that diabetes complications are lessened, further reducing future healthcare costs.

The study was funded by AFA Försäkring, the Swedish Research Council, and Diabetesfonden, amongst others. This news article is an edited version of a press release from The Lancet Diabetes & Endocrinology.


Health-care costs over 15 years after bariatric surgery for patients with different baselina glucose statuses: results from the Swedish Obese Subjects study
Catherine Keating, Martin Neovius, Kajsa Sjöholm, Markku Peltonen, Kristina Narbro, Jonas K. Eriksson, Lars Sjöström, Lena M.S. Carlsson
Lancet Diabetes & Endocrinology online 17 September 2015,