From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Sharples, Mullan, Hardy, Vergis).
Can J Surg. 2019 Aug 1;62(4):259-264. doi: 10.1503/cjs.005018.
More than half the diabetes-related health care costs in Canada relate to drug costs. We aimed to determine the effect of Roux-en-Y gastric bypass (RYGB) on the use of insulin and orally administered hypoglycemic medications in patients with diabetes. We also looked to determine overall cost savings with the procedure.
We reviewed the bariatric clinic records of all patients with a confirmed diagnosis of type 2 diabetes mellitus who underwent RYGB between 2010/11 and 2014/15. Percentage estimated weight loss was recorded at 1 year, along with reductions in glycated hemoglobin (HbA1c) level and use of oral hypoglycemic therapy and insulin. We estimated medication costs using Manitoba-specific pricing data.
Fifty-two patients with at least 12 months of complete follow-up data were identified. The mean percentage estimated weight loss was 50.2%. The mean HbA1c level decreased from 7.6% to 6.0%, the mean number of orally administered hypoglycemics declined from 1.6 to 0.2, and the number of patients receiving insulin decreased from 18 (35%) to 3 (6%) (all p < 0.001). The rate of resolution of type 2 diabetes was 71%. Estimated mean annual per-patient medication costs decreased from $508.56 to $79.17 (p < 0.001). Potential overall health care savings could total $3769 per patient in the first year, decreasing to $1734 at 10 years.
Roux-en-Y gastric bypass resulted in significant improvement in diabetic control, with a reduction in hypoglycemic medication use and associated costs in the early postoperative period. Potentially, large indirect and direct cost savings can be realized in the longer term.
加拿大超过一半的糖尿病相关医疗费用与药物费用有关。我们旨在确定 Roux-en-Y 胃旁路术（RYGB）对糖尿病患者胰岛素和口服降血糖药物使用的影响。我们还试图确定该手术的总体成本节约。
我们回顾了 2010/11 年至 2014/15 年间接受 RYGB 的确诊为 2 型糖尿病患者的减肥诊所记录。记录了 1 年后的估计体重减轻百分比，以及糖化血红蛋白（HbA1c）水平的降低、口服降糖治疗和胰岛素的使用减少情况。我们使用马尼托巴省特有的定价数据估算药物成本。
确定了 52 名至少有 12 个月完整随访数据的患者。估计体重减轻的平均百分比为 50.2%。HbA1c 水平从 7.6%降至 6.0%，口服降糖药的平均数量从 1.6 降至 0.2，接受胰岛素治疗的患者人数从 18 名（35%）降至 3 名（6%）（均 p<0.001）。2 型糖尿病的缓解率为 71%。估计每位患者每年的平均药物费用从 508.56 美元降至 79.17 美元（p<0.001）。在第一年，每位患者的潜在总体医疗保健节省总额可能为 3769 美元，10 年后降至 1734 美元。
Roux-en-Y 胃旁路术显著改善了糖尿病控制，在术后早期减少了降血糖药物的使用和相关费用。从长远来看，可能会实现大量的间接和直接成本节约。
