Flow Chart jamasurg-153-526-s001

Flow Chart jamasurg-153-526-s001.pdf (54K) GUID:?6B1949CE-23A0-4787-91A0-55C6B0062695 Key Points Question What are the rates of discontinuation or initiation of antidiabetes treatment 6 years after bariatric surgery? Findings In this nationwide population-based cohort study of more than 30?000 adults, bariatric surgery was associated with a significantly higher 6-year postoperative antidiabetes treatment discontinuation rate compared with an obese control group, as well as with a low antidiabetes treatment initiation rate, with gastric bypass being the most effective procedure. Meaning Patients and physicians should be aware that morbid obesity remains a chronic disease even after bariatric surgery because 50.1% of patients with preexisting antidiabetes treatment remained on treatment 6 years after surgery. Abstract Importance Few large-scale long-term prospective cohort studies have assessed changes in antidiabetes treatment after bariatric surgery. Objective To describe the association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years after bariatric surgery compared with a matched control obese group. Design, Setting, and Participants This nationwide observational population-based cohort study extracted health care reimbursement data from the French national health insurance database from January 1, 2008, to December 31, 2015. compared with an obese control group, as well as with a low antidiabetes treatment initiation rate, with gastric bypass being the most effective procedure. Meaning Patients and physicians should be aware that morbid obesity remains a chronic disease even after bariatric surgery because 50.1% of patients with preexisting antidiabetes treatment remained on treatment 6 years after surgery. Abstract Importance Few large-scale long-term prospective cohort studies have assessed changes in antidiabetes treatment after bariatric surgery. Objective To describe the association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years after bariatric surgery compared with a matched control obese group. Design, Setting, and Participants This nationwide observational population-based cohort study extracted GPR35 agonist 1 health care reimbursement data from the French national health insurance database from January 1, 2008, to December 31, 2015. All patients undergoing primary bariatric surgery in France between January 1 and December 31, 2009, were matched on age, NMDAR2A sex, body mass index category, and antidiabetes treatment with control patients hospitalized for obesity in 2009 2009 with no bariatric surgery between 2005 and 2015. Exposures Bariatric surgery, including flexible gastric banding (AGB), gastric bypass (GBP), and sleeve gastrectomy (SG). Main Outcome and Measure Reimbursement for antidiabetes drugs. Mixed-effects logistic regression models estimated factors of discontinuation or initiation of antidiabetes treatment over a period of 6 years. Results In 2009 2009, a total of 15?650 patients (mean [SD] age, 38.9 [11.2] years; 84.6% female; 1633 receiving antidiabetes treatment) underwent primary bariatric surgery, with 48.5% undergoing AGB, 27.7% undergoing GBP, and 22.0% undergoing SG. Among patients receiving antidiabetes treatment at baseline, the antidiabetes treatment discontinuation rate was higher 6 years after bariatric surgery than in controls (?49.9% vs ?9.0%, [code of obesity (eTable 1 in the Supplement) were identified. An obese control group included patients with no history of bariatric surgery during 2005 to 2015, as well as no cancer, pregnancy, chronic infectious disease, or serious acute or chronic disease, such as pulmonary embolism GPR35 agonist 1 or heart failure, in 2008 to 2009. Patients with obesity with or without bariatric surgery with no health care reimbursement (medical visit, treatment, laboratory assessments, hospitalization, etc) for each of the 6 follow-up years during 2010 to 2015 were also excluded. Those patients were likely to have been out of the country during that time or to have voluntarily opted out of national health insurance and would thus be likely to have poor adherence to the recommended bariatric surgery or obesity follow-up and treatment. Patients in the bariatric surgery group were then matched 1:1 on age (5 years), sex, body mass index (calculated as weight in kilograms divided by height in meters squared) category, and antidiabetes treatment at baseline with control patients hospitalized for obesity in 2009 2009 with no bariatric surgery between 2005 and 2015. Several bariatric surgery patients could be matched to the same control patient. Data Collection and Definitions Data were extracted from the SNIIRAM database from January 1, 2008, to December 31, 2015. Patient follow-up was established on the basis of 12-month data, with the shortest follow-up being from January 1, 2008, to December 31, 2014, and the longest follow-up being from December 31, 2008, to December 30, 2015. Age and sex were obtained from the SNIIRAM database. Body mass index (BMI) was not reported in outpatient data but was available at the time of hospitalization based on the following 3 categories: 30.0 to 39.9, 40.0 to 49.9, and 50.0 or higher. Precarity was evaluated using 2 variables, including universal health insurance coverage for low-income families (Couverture Maladie Universelle) and a validated geographic socioeconomic deprivation index (Indice Gographique de Dfavorisation).31 Medications were GPR35 agonist 1 identified by reimbursements as those treatments not available over the counter and directly paid by health insurance when dispensed to the patient by a pharmacy. Medications were classified based on Anatomical Therapeutic Chemical code, described online by the World Health Business (http://www.whocc.no) (eTable 2 in the Supplement). For the purposes of this scholarly study, we considered individuals to become treated with antidiabetes medicines (including insulin) over summer and winter if they received at least 3 medication reimbursements at differing times more than a 12-month period. Antidiabetes remedies had been stratified in to the pursuing 3 exclusive classes predicated on the last.