Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus

Tang, Qi; Sun, Zhipeng; Zhang, Nengwei; Xu, Guangzhong; Song, Peipei; Xu, Lingzhong; Tang, Wei

doi:10.1097/md.0000000000003522

Cited by 66 publications

(87 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the remission rate decreased to 50% in patients with BMI <30 kg/m 2 [16]. Many reports have been published from different areas of Asia [1718192021222324252627282930]. Table 1 summarizes the reported T2DM remission rate according to different criteria and follow-up years.…”

Section: Efficacy Of Different Metabolic Proceduresmentioning

confidence: 99%

“…Six RCTs about metabolic surgery had been published from Asia [31217252829]. Table 4 listed the detail of each studies.…”

Section: Randomized Control Trialsmentioning

confidence: 99%

“…The other two studies found similar efficacy between RYGB and LSG in the treatment of T2DM [1728]. One RCT compared cost effectiveness between LSG and RYGB with 2-year follow-up [29]. The author concluded that LSG is as effective as RYGB and is slightly more cost-effective than RYGB.…”

Section: Randomized Control Trialsmentioning

confidence: 99%

See 2 more Smart Citations

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Lee

Aung

2016

Diabetes Metab J

View full text Add to dashboard Cite

Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m2). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m2. Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.

show abstract

Section: Efficacy Of Different Metabolic Proceduresmentioning

confidence: 99%

“…Six RCTs about metabolic surgery had been published from Asia [31217252829]. Table 4 listed the detail of each studies.…”

Section: Randomized Control Trialsmentioning

confidence: 99%

See 1 more Smart Citation

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Lee

Aung

2016

Diabetes Metab J

View full text Add to dashboard Cite

show abstract

Section: Surgical Intervention For Obesity In T2dmmentioning

confidence: 99%

“…Bariatric surgery is considered the most sustainable and effective management for obesity (class III) [21]. Several studies purport that weight loss through bariatric surgery is cost-effective compared to nonsurgical management [22,23,11].Following RYGB surgery NEFA levels initially increase with fat deployment through rapid weight loss, levels of NEFA normalise as weight loss plateaus Dirksen et al [24]. SG and RYGB affect pancreatic β cell function, NEFA levels and insulin sensitivity thus enhancing glucose metabolism Thomas et al [25].…”

mentioning

confidence: 99%

Review of the Pharmacological and Bariatric Surgery for Diabesity

Eligar

Gruchy

2017

MOJDDT

View full text Add to dashboard Cite

Whilst some drugs are specifically licensed and targeted at weight loss there are also other classes of drugs that can elicit weight loss despite their primary usage or original design being for a different outcome. Table 2 highlights the efficacy of the most common drugs prescribed for weight loss as an adjunct therapy for T2DM.A new treatment being explored is the use of Botulinum Toxin, the premise being that Botox injections into the stomach wall inhibit vagus nerve afferents thus interrupting the brain-gut axis communication pathway resulting in weight loss [17]. Phase two of clinical trial is currently being conducted to assess the efficacy and safety of Botulinum Toxin as a weight loss intervention; this may offer a new innovative treatment for obesity in T2DM. Hypoglycaemia, headaches, diarrhoea [7] 5.8-5.9kg [7] 51-73% [7] Review of the Pharmacological interventions and Bariatric surgery for Diabesity 3/5Copyright: ©2017 Gruchy et al. Citation Surgical Intervention for Obesity in T2DMBariatric surgery is also called gastrointestinal surgery for obesity. Surgery changes the digestive process which elicits weight loss through reduction of nutrient absorption and thus lessens calorie intake [18]. The most common types of bariatric surgery are Adjustable Gastric Banding (AGB), Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB). RYGB is currently considered the gold standard of weight loss surgery [18]. The mechanism of weight loss and differences in outcomes of these procedures can be seen in Table 3. Indications for bariatric surgery are people with a BMI of 40 kg/m 2 or greater, or those with a BMI of 35 kg/m 2 or greater with co morbidities, such as T2DM (NICE, 2014). The NICE guidelines [19] advice that people diagnosed with T2DM in the past 10 years should receive expedited referrals without the need of having tried lifestyle management interventions first, due to improvements in quality of life and reduced risk of mortality that bariatric surgery can offer. Explored the effects of bariatric surgery during different stages of T2DM progression [20]. The results demonstrated that bariatric surgery during early onset of T2DM elicited highest rates of T2DM remission and reduced micro and macrovascular complications, whereas bariatric surgery on people with T2DM with existing micro or macrovascular complications produced no improvements in life expectancy or regression of microvascular complications [20]. Bariatric surgery is considered the most sustainable and effective management for obesity (class III) [21]. Several studies purport that weight loss through bariatric surgery is cost-effective compared to nonsurgical management [22,23,11].Following RYGB surgery NEFA levels initially increase with fat deployment through rapid weight loss, levels of NEFA normalise as weight loss plateaus Dirksen et al. [24]. SG and RYGB affect pancreatic β cell function, NEFA levels and insulin sensitivity thus enhancing glucose metabolism Thomas et al. [25].A meta-analysis by Buchwald et al. [26] demonstrated re...

show abstract

Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Bariatric surgery is recommended for patients with severe obesity (body mass index Ն40) and type 2 diabetes (T2D). However, the most cost-effective treatment remains unclear and may depend on the patient's T2D severity. OBJECTIVETo estimate the cost-effectiveness of medical therapy, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) among patients with severe obesity and T2D, stratified by T2D severity. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used a microsimulation model to project health and cost outcomes of medical therapy, SG, and RYGB over 5 years. Time horizons varied between 10 and 30 years in sensitivity analyses. Model inputs were derived from clinical trials, large cohort studies, national databases, and published literature. Probabilistic sampling of model inputs accounted for parameter uncertainty. Estimates of US adults with severe obesity and T2D were derived from the National Health and Nutrition Examination Survey. Data analysis was performed from January 2020 to August 2021. EXPOSURES Medical therapy, SG, and RYGB. MAIN OUTCOMES AND MEASURESQuality-adjusted life-years (QALYs), costs (in 2020 US dollars), and incremental cost-effectiveness ratios (ICERs) were projected, with future cost and QALYs discounted 3.0% annually. A strategy was deemed cost-effective if the ICER was less than $100 000 per QALY. The preferred strategy resulted in the greatest number of QALYs gained while being costeffective. RESULTSThe model simulated 1000 cohorts of 10 000 patients, of whom 16% had mild T2D, 56% had moderate T2D, and 28% had severe T2D at baseline. The mean age of simulated patients was 54.6 years (95% CI, 54.2-55.0 years), 61.6% (95% CI, 60.1%-63.4%) were female, and 65.1% (95% CI, 63.6%-66.7%) were non-Hispanic White.

show abstract

Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus

Cited by 66 publications

References 37 publications

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Review of the Pharmacological and Bariatric Surgery for Diabesity

Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes

Contact Info

Product

Resources

About