Medical events and costs associated with metabolic bariatric surgery among adults with type 2 diabetes: A retrospective, matched cohort study

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.