Benefits of Bariatric Surgery in Class I Obesity and Difficult-to-Manage T2D

Type 2 diabetes (T2D) is often seen in people classified as overweight or obese. For patients with difficult-to-manage T2D––where HbA1c levels stay above target despite lifestyle and medication interventions––bariatric surgery may be offered. This surgical approach modifies the gastrointestinal tract and has demonstrated notable benefits for patients with class II or III obesity – including weight loss, quality-of-life improvement, reduced mortality risk, and potential diabetes remission. Evidence suggests these outcomes may also extend to those with class I obesity. 

The goal of a study was to evaluate bariatric surgery's effectiveness, safety, cost-effectiveness, and budget impact for publicly funded cases in Ontario – specifically targeting adults with class I obesity and difficult-to-manage diabetes. 

This study involved a health technology assessment and a systematic review of clinical and economic literature. In clinical analysis, bariatric surgery led to significantly higher diabetes remission rates, reduced body mass index, and lower medication use than medical management. Economic review findings indicated that bariatric surgery, although more costly, offered more effectiveness in terms of quality-adjusted life years (QALY)––showing a 0.339 QALY increase per person over a lifetime horizon.

Budget impact projections revealed that public funding for bariatric surgery in Ontario would result in a budget increase of $7.63 million over five years. Patient feedback showed positive perceptions of bariatric surgery’s effectiveness for managing weight and diabetes – though postsurgical complications require consideration. 

In inference, bariatric surgery in cases with class I obesity and challenging diabetes management may be a viable and cost-effective treatment.

Source: Ontario Health (Quality). Ont Health Technol Assess Ser. 2023;23(8):1-151. Published 2023 Dec 5.