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Introduction <p>Metabolic bariatric surgery (MBS) lowers long-term health expenditures among patients with type 2 diabetes (T2D). MBS resources are scarce however, and it is unknown which subgroups of patients with diabetes are most likely to see reduced expenditures.</p> Methods <p>We conducted stratified analyses of total, medication, outpatient, and inpatient expenditures from 3 years pre- to 5.5 years post-MBS in a retrospective cohort study of 6,657 patients with T2D and obesity from 2012 to 2019 and 19,059 matched non-surgical patients. Patients were stratified into three groups based on diabetes severity, using the validated Advanced-DiaRem measure. Advanced-DiaRem scores range from 0 to 21, with higher scores indicating greater severity. Expenditures were estimated in 6-month intervals and analyzed using generalized linear models.</p> Results <p>Patients with high Advanced-DiaRem scores (13–21) had higher hemoglobin A1c, greater insulin use, and longer diabetes duration compared to those with moderate (8–12) and low scores (0–7). In the 6 months pre-surgery, patients with high scores had higher mean total expenditures (US$6,418 non-surgical, $6,896 surgical) than patients with moderate scores ($4,332 non-surgical, $5,373 surgical) and low scores ($2,995 non-surgical, $3,469 surgical). Post-MBS, estimated total expenditures for surgical patients declined across all Advanced-DiaRem subgroups, with the greatest reductions observed in patients with high scores. At 5.5 years post-surgery, total expenditures for surgical patients were $1,240/6-months lower than for non-surgical patients (95% confidence interval 679, 1,771). Savings were mainly driven by reduced medication expenditures.</p> Conclusions <p>Expenditure reductions after MBS in patients with T2D appear to be driven by those with high-severity diabetes.</p>

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Type 2 Diabetes Severity Modifies Long-Term Health Expenditures After Metabolic Bariatric Surgery

  • 期刊论文

  • 发表日期：

    2026年3月31日

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  • Caroline E Sloan,
  • Lindsay Zepel,
  • Valerie A Smith,
  • David E Arterburn,
  • Aileen Baecker,
  • Aniket A Kawatkar,
  • Julietta H Chang,
  • Amy G Clark,
  • Matthew L Maciejewski

摘要

Introduction

Metabolic bariatric surgery (MBS) lowers long-term health expenditures among patients with type 2 diabetes (T2D). MBS resources are scarce however, and it is unknown which subgroups of patients with diabetes are most likely to see reduced expenditures.

Methods

We conducted stratified analyses of total, medication, outpatient, and inpatient expenditures from 3 years pre- to 5.5 years post-MBS in a retrospective cohort study of 6,657 patients with T2D and obesity from 2012 to 2019 and 19,059 matched non-surgical patients. Patients were stratified into three groups based on diabetes severity, using the validated Advanced-DiaRem measure. Advanced-DiaRem scores range from 0 to 21, with higher scores indicating greater severity. Expenditures were estimated in 6-month intervals and analyzed using generalized linear models.

Results

Patients with high Advanced-DiaRem scores (13–21) had higher hemoglobin A1c, greater insulin use, and longer diabetes duration compared to those with moderate (8–12) and low scores (0–7). In the 6 months pre-surgery, patients with high scores had higher mean total expenditures (US$6,418 non-surgical, $6,896 surgical) than patients with moderate scores ($4,332 non-surgical, $5,373 surgical) and low scores ($2,995 non-surgical, $3,469 surgical). Post-MBS, estimated total expenditures for surgical patients declined across all Advanced-DiaRem subgroups, with the greatest reductions observed in patients with high scores. At 5.5 years post-surgery, total expenditures for surgical patients were $1,240/6-months lower than for non-surgical patients (95% confidence interval 679, 1,771). Savings were mainly driven by reduced medication expenditures.

Conclusions

Expenditure reductions after MBS in patients with T2D appear to be driven by those with high-severity diabetes.