Surgery improves advanced type 2 diabetes and saves the NHS thousands of pounds per patient

Published: 08 December 2020

A new study has shown that patients with obesity and the severest form of type 2 diabetes can have their diabetes improved or put into remission by weight loss surgery. Not only is surgery the best treatment for people living with obesity and type 2 diabetes but it also leads to cost savings for the NHS.

These are the findings according to a new large-scale collaborative study between the British Obesity and Metabolic Surgery Society (BOMSS) and the Population Health Research Institute at St Georges, University of London, published in PLOS Medicine.

Background

For some time now, weight loss operations such as gastric bypass and sleeve gastrectomy have been known to improve or put early or mild type 2 diabetes into remission in patients with obesity. However, small studies had previously suggested that surgery might be less effective for patients with more advanced type 2 diabetes (i.e. those who require insulin injections) who have a higher chance of developing diabetes complications including: blindness, limb amputation and heart disease.

To investigate the effects of surgery for these patients, researchers used a nationwide registry (National Bariatric Surgical Registry) to analyse the outcomes of nearly 2,000 patients living with obesity and type 2 diabetes requiring insulin who had surgery between 2009 and 2017.

Of these:

• 2 out of 3 patients no longer needed insulin at 1 year after their surgery
• Type 2 diabetes completely disappeared in 1 in 3 patients 1 year after their surgery
• Patients on average lost around a quarter of their body-weight

These findings are of particular relevance in the Covid-19 era, since it is known that patients with diabetes and obesity are at higher risk of dying if they contract the virus. Weight loss surgery which reverses diabetes and obesity could also decreases deaths from Covid-19.

Treating type 2 diabetes and its complications costs the NHS £10 billion yearly, so next the researchers looked at the overall costs in people who had surgery compared to a similar group of people who did not

Although each operation costs the NHS around £6,000, researchers found that this figure was less than the costs for medications to treat their type 2 diabetes. 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 a 5-year timeframe.

Mr Omar Khan, bariatric surgeon and lead author of the study from St George’s, University of London, said: “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: “This study strengthens existing evidence that bariatric surgery can help some people with obesity and insulin-treated type 2 diabetes to go into remission, and in turn, that this approach can save the NHS vital funds compared to the best alternative non-surgical treatments."

She continued: “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. 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.”