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@article{McGlone:2020:10.1371/journal.pmed.1003228,
author = {McGlone, ER and Carey, I and Velickovic, V and Chana, P and Mahawar, K and Batterham, RL and Hopkins, J and Walton, P and Kinsman, R and Byrne, J and Somers, S and Kerrigan, D and Menon, V and Borg, C and Ahmed, A and Sgromo, B and Cheruvu, C and Bano, G and Leonard, C and Thom, H and le, Roux CW and Reddy, M and Welbourn, R and Small, P and Khan, OA},
doi = {10.1371/journal.pmed.1003228},
journal = {PLoS Medicine},
pages = {1--22},
title = {Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses},
url = {http://dx.doi.org/10.1371/journal.pmed.1003228},
volume = {17},
year = {2020}
}

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TY  - JOUR
AB  - BackgroundAlthough bariatric surgery is well established as an effective treatment for patients with obesity and type 2 diabetes mellitus (T2DM), there exists reluctance to increase its availability for patients with severe T2DM. The aims of this study were to examine the impact of bariatric surgery on T2DM resolution in patients with obesity and T2DM requiring insulin (T2DM-Ins) using data from a national database and to develop a health economic model to evaluate the cost-effectiveness of surgery in this cohort when compared to best medical treatment (BMT).Methods and findingsClinical data from the National Bariatric Surgical Registry (NBSR), a comprehensive database of bariatric surgery in the United Kingdom, were extracted to analyse outcomes of patients with obesity and T2DM-Ins who underwent primary bariatric surgery between 2009 and 2017. Outcomes for this group were combined with data sourced from a comprehensive literature review in order to develop a state-transition microsimulation model to evaluate cost-effectiveness of bariatric surgery versus BMT for patients over a 5-year time horizon. The main outcome measure for the clinical study was insulin cessation at 1-year post-surgery: relative risks (RR) summarising predictive factors were determined, unadjusted, and after adjusting for variables including age, initial body mass index (BMI), duration of T2DM, and weight loss. Main outcome measures for the economic evaluation were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay threshold of GBP£20,000.A total of 2,484 patients were eligible for inclusion, of which 1,847 had 1-year follow-up data (mean age of 51 years, mean initial BMI 47.2 kg/m2, and 64% female). 67% of patients no longer required insulin at 1-year postoperatively: these rates persisted for 4 years. Roux-en-Y gastric bypass (RYGB) was associated with a higher rate of insulin cessation (71.7%) than sleeve gastr
AU  - McGlone,ER
AU  - Carey,I
AU  - Velickovic,V
AU  - Chana,P
AU  - Mahawar,K
AU  - Batterham,RL
AU  - Hopkins,J
AU  - Walton,P
AU  - Kinsman,R
AU  - Byrne,J
AU  - Somers,S
AU  - Kerrigan,D
AU  - Menon,V
AU  - Borg,C
AU  - Ahmed,A
AU  - Sgromo,B
AU  - Cheruvu,C
AU  - Bano,G
AU  - Leonard,C
AU  - Thom,H
AU  - le,Roux CW
AU  - Reddy,M
AU  - Welbourn,R
AU  - Small,P
AU  - Khan,OA
DO  - 10.1371/journal.pmed.1003228
EP  - 22
PY  - 2020///
SN  - 1549-1277
SP  - 1
TI  - Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses
T2  - PLoS Medicine
UR  - http://dx.doi.org/10.1371/journal.pmed.1003228
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000597934000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003228
UR  - http://hdl.handle.net/10044/1/90802
VL  - 17
ER  -

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Mr Ahmed R. Ahmed PhD FRCS

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