Abstract
AIMS: This study examined rates of metabolic/bariatric surgery (MBS) among adults with type 2 diabetes and obesity (T2D + O). The study also compared glucose-lowering medication (GLM) use, costs, comorbidities and medical events for individuals with T2D + O who underwent MBS (cases) to those who did not have MBS (controls). MATERIALS AND METHODS: Optum Market Clarity US data were used. Annual rates of MBS were examined for adults with T2D + O. MBS cases were matched 1:1 without replacement to controls based upon patient demographics and baseline body mass index (BMI) and followed for a 3-year post-period. Differences in outcomes were examined between cases and controls. RESULTS: From 2013 through 2022, 0.5% of adults with T2D + O (0.3%, 0.5% and 0.9% for class 1-3 obesity, respectively) underwent MBS. The matched cohort consisted of 5485 cases and 5485 controls. The mean age was 52.9 years (SD = 10.2) and 69.2% were female. Cases, compared with controls, used significantly fewer GLMs, had significantly lower all-cause drug costs, and generally had lower rates of incident comorbidities in the 3-year post-period. MBS was associated with significantly higher all-cause acute care, outpatient and total costs. MBS was also generally associated with higher rates of post-period medical events, such as vitamin D deficiency (56.8%) and endoscopy (41.2%). CONCLUSIONS: MBS was performed relatively infrequently in adults with T2D + O. Cases, compared with controls, used fewer GLM, had significantly lower post-period all-cause drug costs, and lower rates of incident comorbidities, but had significantly higher post-period all-cause total medical costs and higher rates of medical events.