HIQA recommends metabolic surgery programme as part of the type 2 diabetes treatment pathway

The Health Information and Quality Authority (HIQA) has published a health technology assessment (HTA) recommending the introduction of a metabolic surgery programme as part of the clinical pathway for type 2 diabetes in Ireland. HIQA undertook this HTA at the request of the HSE.

Bariatric surgery involves changing how the stomach and small intestine process food, resulting in weight loss and improvements in obesity-related health complications. Traditionally, it is used as a weight-loss intervention in patients with obesity. The term metabolic surgery refers to the use of bariatric surgery procedures with the aim of improving type 2 diabetes control in patients with comorbid (both) type 2 diabetes and obesity.

Standard care options for patients with comorbid type 2 diabetes and obesity include patient education programmes, behavioural interventions (such as, dietary changes, physical activity and smoking cessation advice), interventions to reduce the risk of cardiovascular disease, and diabetes medications. Weight loss is an important part of the management of type 2 diabetes. Successful weight loss can result in lower cardio-metabolic risk factors and less chance of complications.

While metabolic surgery is not currently offered as part of standard care in Ireland, many diabetes and obesity organisations recommend it as an accepted treatment option for people with comorbid type 2 diabetes and obesity. HIQA’s review included evidence from 24 randomised controlled trials examining metabolic surgery with short- to medium-term follow-up (maximum 10 years).

Dr Conor Teljeur, HIQA’s Chief Scientist, said: “When reviewing the evidence, we found that metabolic surgery is safe and very effective in patients with comorbid type 2 diabetes and obesity. It results in improved blood sugar control, weight loss, and reduced use of anti-hyperglycaemic medications. Overall, we found that providing metabolic surgery as part of the type 2 diabetes clinical care pathway would be an efficient and highly cost-effective use of healthcare resources.”

HIQA’s report noted that demand for metabolic surgery is difficult to predict as not everyone with comorbid type 2 diabetes and obesity will want surgery or be a surgical candidate.

Dr Teljeur concluded: “Patients that undergo metabolic surgery require long-term follow-up. If metabolic surgery is provided by the HSE, it should be in the context of a programme providing end-to-end care; this will need to balance patient management between primary and secondary care resources.”