Today, in the United States, we are in the midst of an epidemic of Diabetes. Between 2000 and 2030 the number of people, world-wide, with Diabetes is expected to more than double. Most of this increase will be due to obesity-related Type 2 Diabetes. The National Institutes of Health most recent estimates are that nearly 24 million people, almost 8% of the population in the US now have Diabetes. Of these patients, 90 to 95% suffer from Type 2 Diabetes and is most often obesity-related.
Like for obesity itself, dietary, behavioral and medication therapies to manage Type 2 Diabetes have a very high failure rate. Despite all of these efforts, less than half of all patients achieve adequate control; defined by the American Diabetes Associate as a Hemoglobin A1C of less than 7%. (Hemoglobin A1C is like a monthly average of your blood sugar levels.)
Diabetes is associated with an increased risk for heart disease, stroke, blindness, kidney disease, nervous system disease, limb amputations and complications during pregnancy. Having diabetes doubles your risk of death.
Patients struggling with obesity-related Type 2 Diabetes Mellitus and their Bariatric surgeons have known for years that diabetic medication requirements can decrease very quickly after Bariatric surgery. Often, patients who enter the hospital on multiple diabetic medications leave the hospital several days later after undergoing Roux-en-Y Gastric Bypass surgery on little or no medication at all! Clearly this benefit is independent from the weight loss that Bariatric surgery will eventually provide, since it occurs almost immediately.
Those patients who still require some medication can see further benefit over the following one to two years as their weight loss progresses; and the benefits appears to last, extending out for years.
Doctors from the Johns Hopkins University School of Medicine have recently published a new research study that shows just how significant this improvement can be. This landmark study examined over 2200 patients from seven different states, all with Type 2 Diabetes Mellitus, who underwent Bariatric surgery.
At the time of surgery each patient was on an average of more than four daily diabetic medications. Six months after surgery 75% of all of the patients were off of all their Diabetic medications; two years after surgery 85% of all patients were free of medication.
Most of the patients in this study underwent Roux-en-Y Gastric Bypass; a surgical procedure that re-routes the pathway that food takes through the digestive system. Only a few of the studied patients underwent procedures that do not alter this pathway. Bariatric surgeons believe that it is this altered pathway, diverting the food from traveling through the first part of the small intestine, called the duodenum, which is responsible for the dramatic improvement in Type 2 Diabetes even before a patient has had time to lose any weight.
Not only were patients healthier, but as a result they spent a lot less on healthcare. The current cost of treating Diabetes in the U.S. is estimated to be over $175 Billion a year, about one in every five dollars currently spent on health care. The annual cost of Diabetes drugs alone has more than doubled in the last ten years. The research study showed that after undergoing Bariatric surgery, a patient's annual health care costs decreased by 70% three years after surgery.
This study demonstrates the prominent role that Bariatric surgery can play in addressing our increasingly critical national goals of improving health while decreasing health care costs overall.
And Diabetes is but only one of the many serious health conditions that are associated with the obesity epidemic. These other conditions include heart disease, hypertension, pulmonary disease, degenerative joint disease and higher rates of many forms of cancer; all of which have been shown to have dramatic improvements after Bariatric surgery.
The authors of the study concluded that "Until a successful non-surgical means for preventing and reversing obesity is developed, Bariatric surgery appears to be the only intervention that can result in a sustained reversal of both obesity and type 2 Diabetes...."
Quite simply, current research indicates that Bariatric weight reduction surgery results in a significant lowering of health care costs for all of us; both the patients and the rest of us who share in our nation's health care costs. Bariatric weight reduction surgery must be a covered benefit of all insurance plans for these, and many other reasons.
"Coverage of Bariatric surgery should be available to all obese patients who meet criteria regardless of their degree of coverage....."
Steven C. Simon, MD, FACS Arizona Weight Loss Solutions
Makary et. al. Arch Surg. 2010;145(8):726-731
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