Prompt reduction in use of medications for comorbid conditions after bariatric surgery.
BACKGROUND
Bariatric surgery leads to weight loss, but it is unclear whether surgery reduces conditions associated with obesity. We explored this by assessing the change in use of medications to treat diabetes mellitus, hypertension, and hyperlipidemia in the year following surgery.


METHODS
This is a cohort study using administrative data from 2002 to 2005 from seven Blue Cross/Blue Shield Plans. We compared the mean number of medications at the time of surgery and in the subsequent year. Medication usage by surgical patients was also compared to usage by matched enrollees without surgery but with a propensity score suggesting obesity. With Poisson and logistic regression, we tested for statistical differences in usage, accounting for repeated measures and controlling for age, sex, and diabetes. We also evaluated medications expected to be less influenced by surgery (antidepressants, thyroid replacement, and antihistamines).


RESULTS
Our cohort included 6,235 enrollees with bariatric surgery. Their mean age was 44 years with 82% women; 34% had diabetes. Medication use declined significantly by 3 months. By 12 months after surgery, medication use for diabetes, hypertension, and hyperlipidemia had declined by 76%, 51%, and 59%, respectively. In contrast, thyroid hormone, antihistamine, and antidepressant use decreased by only 6%, 15%, and 9%, respectively. Enrollees without surgery had a modest increase in medications for diabetes, hypertension, and hyperlipidemia of 4%, 8%, and 20%, respectively.


CONCLUSIONS
Medication use for three serious obesity-associated conditions decreased promptly following surgery. The clinical and economic benefits of reduced medication requirements should be considered when making decisions about the effects of bariatric surgery.
Segal
Jodi B
JB
Johns Hopkins University School of Medicine, 1830 E. Monument St. Room 8047, Baltimore, MD 21287, USA. jsegal@jhmi.edu
Clark
Jeanne M
JM
Shore
Andrew D
AD
Dominici
Francesca
F
Magnuson
Thomas
T
Richards
Thomas M
TM
Weiner
Jonathan P
JP
Bass
Eric B
EB
Wu
Albert W
AW
Makary
Martin A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D050110:Bariatric Surgery; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D013963:Thyroid Hormones / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000928:Antidepressive Agents; D013956:Antithyroid Agents; D006633:Histamine Antagonists; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D013963:Thyroid Hormones