When primary prevention fails, surgery has a modest but critical role in managing type 2 diabetes with and without associated obesity. About 75% of patients attending Westmead Hospital Obesity Clinic meet current criteria for bariatric surgery. One third of patients seen need bariatric surgery because it is the only treatment that will allow them to lose enough weight to improve their comorbidities.
Metabolic surgery is readily available for the privately insured, but the majority of patients who require it are of lower socioeconomic background. We know that 65% of patients who attend the Clinic cannot afford surgery if they must pay for it. Until recently the bariatric surgery standard was lap banding which required hospital admission for implantation of a $4,000 device and lifelong follow up.
The current standard operations for severe obesity with co-morbidities are now laparoscopic sleeve gastrectomy and gastric bypass, which require a skilled surgical team performing a surgical procedure, but no expensive implant.
Surgery is highly effective in producing durable glycaemic control and disease remission with reductions of 31% to 88% in diabetes related mortality. With appropriate patient selection by an MDT process the cost of surgery to the LHD can expect to be recovered in 1-2 years from reduced medical costs.