Long-term Impact of Laparoscopic Sleeve Gastrectomy on Drug Costs of Japanese Patients with Obesity and Type 2 Diabetes Mellitus.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery in Japan, and it is the only such procedure covered by national health insurance. The long-term cost of bariatric surgery in Japan has not yet been analyzed. We aimed to evaluate the long-term impact of LSG on the drug treatment costs of patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: We retrospectively analyzed data from 230 patients who had undergone LSG at our institution for their obesity and T2DM between 2007 and 2018. The clinicopathological data included age, sex, body mass index (BMI), as well as preoperative and postoperative medications for T2DM, hypertension, and dyslipidemia. We then calculated the drug treatment costs for T2DM, hypertension, and dyslipidemia before and after LSG; and we evaluated the remission rates of these obesity-related diseases. RESULTS: The median preoperative body weight and BMI of the 230 patients who underwent LSG were 115 kg and 40.6 kg/m2, respectively. Preoperative drug treatment costs per month per patient for T2DM, hypertension, and dyslipidemia were ¥3795 (¥0-40285), ¥3269 (¥0-14577), and ¥1428 (¥0-19464). Post-operation, the median drug treatment costs for all these diseases became nil. The remission rates of T2DM, hypertension, and dyslipidemia 5 years after LSG were 82.8%, 50%, and 43.8%, respectively. In Japan, the cost of an LSG operation corresponds to 4.75 years of median drug costs to treat T2DM and hypertension. CONCLUSION: In the long term, LSG in Japan is effective both physically and cost-wise for patients with obesity and T2DM.

Bariatric surgery versus medical treatment in mildly obese patients with type 2 diabetes mellitus in Japan: Propensity score-matched analysis on real-world data.

AIMS/INTRODUCTION: To compare glycemic control 1 year after treatment in patients with mildly obese (body mass index 27.5-34.9 kg/m2 ) type 2 diabetes mellitus who underwent bariatric surgery (BS) to those who received medical treatment (MT) in Japan. MATERIALS AND METHODS: A retrospective study using real-world data was carried out in electronic medical records from a tertiary care hospital and in the Japanese Medical Data Center Inc. claim database from 2008 to 2019. Each patient was propensity score-matched between the BS and the MT group by age, sex, body mass index, glycated hemoglobin and type 2 diabetes mellitus duration, and compared from the index date to the 1 year post-index. RESULTS: The study included 78 patients in the BS group and 238 patients in the MT group. The mean body mass index in the BS and the MT group was 32.1 and 32.0 kg/m2 , respectively. In the BS group, the patients underwent either laparoscopic sleeve gastrectomy with or without duodenojejunal bypass. The diabetes remission rate (glycated hemoglobin <6.5% without diabetes medication) at 1 year was 59.0% in the BS group and 0.4% in the MT group (P < 0.0001). Optimal glycemic control of glycated hemoglobin <7.0% was achieved in 75.6% in the BS group and in 29.0% in the MT group (P < 0.0001). The median monthly drug costs for metabolic syndrome decreased from $US126.5 (at baseline) to $US0.0 (at 1 year) in the BS group, whereas it increased from $US52.4 to $US58.3 in the MT group. CONCLUSIONS: BS for mildly obese patients with type 2 diabetes mellitus is more clinically- and cost-effective than MT in Japan.

Five-Year Outcomes of Laparoscopic Sleeve Gastrectomy in Japanese Patients with Class I Obesity.

BACKGROUND: Bariatric surgery is being recognized increasingly as an effective treatment for obesity and related comorbidities. In Japan, the cost of laparoscopic sleeve gastrectomy (LSG) is covered by the national health insurance for adults with a body mass index (BMI) ≥ 35 kg/m2 and specific comorbidities (type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), and obstructive sleep apnea syndrome (OSAS)). However, only 0.6% of the adult population have a BMI ≥ 35 kg/m2. In contrast, 4.3% have class I obesity (a BMI of 30-34.9 kg/m2). The BMI of Asians with central obesity-induced diabetes and other metabolic disorders is much lower than that of Westerners. OBJECTIVES: To evaluate the medium-term (up to 5 years) outcomes of LSG performed in Japanese patients with class I obesity. METHODS: One hundred eighteen consecutive patients with class I obesity treated by LSG at our center between August 2007 and December 2018 were included in a retrospective study. Mean preoperative body weight (BW) and BMI were 88.6 ± 10.3 kg and 32.8 ± 1.6 kg/m2, respectively. Weight loss, comorbidity status, and adverse events were assessed. RESULTS: Mean BW/BMI at 1, 3, and 5 years after LSG decreased significantly to 66.6 ± 11.2 kg/24.6 ± 2.8 kg/m2, 68.0 ± 14.0 kg/25.4 ± 4.0 kg/m2, and 69.1 ± 12.9 kg/26.5 ± 3.0 kg/m2, respectively. Mean total weight loss at 1, 3, and 5 years was 24.7 ± 8.2%, 21.8 ± 12.1%, and 18.5 ± 9.7%, respectively. Metabolic disorders such as T2DM, HT, and DL improved significantly. There was no mortality. CONCLUSION: LSG is safe, yields excellent weight loss, and improves obesity-related comorbidities in Japanese patients with class I obesity.

The Effects of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Japanese Patients with BMI < 35 kg/m2 on Type 2 Diabetes Mellitus and the Prediction of Successful Glycemic Control.

BACKGROUND: Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) is a combination of sleeve gastrectomy and proximal intestinal bypass through duodenal exclusion. This technique has shown excellent weight loss and anti-diabetic effects in severely obese patients. In this retrospective study, we examined the clinical effects of LSG-DJB on mildly obese patients (body mass index (BMI) < 35 kg/m2) with type 2 diabetes mellitus (T2DM) and analyzed factors contributing to the successful postoperative glycemic control. METHODS: Seventy-two consecutive Japanese patients with T2DM with a BMI of < 35 kg/m2 who underwent LSG-DJB in a single institution from September 2007 to March 2015 were included for the study. Weight loss, safety, and the impact on T2DM and metabolic syndrome were examined at 1 year after surgery when weight loss reaches an expected plateau. In addition, pre- and postoperative factors between those who achieved diabetes remission (remitters) and non-remitters were compared. RESULTS: The follow-up rate at 1 year after surgery was 93%. The mean percent total weight loss (%TWL) was 31.6 ± 8.8%, and the mean glycosylated hemoglobin (HbA1c) dropped from 8.9 ± 1.5 to 6.4 ± 1.0%. There were four early- and seven late-severe complications (grade III-A or more based on the Clavien-Dindo classification), which account for the 1-year morbidity rate of 15%. There was no mortality. The complete (HbA1c of < 6% without diabetes medication) and partial (HbA1c of < 6.5% without diabetes medication) remission of T2DM was achieved in 31 and 49% of the patients, respectively. Positive impacts were also observed on hypertension and dyslipidemia. Consequently, the ratio of those who achieved the composite endpoint (HbA1c of < 7%, low-density lipoprotein cholesterol < 100 mg/dL, systolic blood pressure < 130 mmHg) significantly increased from 4.2 to 22% (p = 0.003). Duration of T2DM and preoperative use of anti-hypertensive drugs were independent predictors of diabetes remission. Patients with a higher ABCD score were also at a higher rate of success in T2DM remission. CONCLUSIONS: LSG-DJB for T2DM patients with a BMI of < 35 kg/m2 is a feasible and effective surgical method in achieving moderate weight loss and excellent improvement of glycemic control, metabolic syndrome, and cardiovascular risk although the T2DM remission rate was lower compared with severely obese individuals. Proper patient selection for candidates of the procedure is imperative to effectively predict poor responders.

Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus.

BACKGROUND: Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown. OBJECTIVE: The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM. METHODS: In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m2, respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery. RESULTS: The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period. CONCLUSION: Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.