Discontinuation of diabetes and lipid-lowering medications after bariatric surgery at Veterans Affairs medical centers.
BACKGROUND
Bariatric surgery has largely been performed on middle-age female populations and been associated with significant medication discontinuation; however, it is unknown whether similar medication discontinuation rates could be achieved in men. The purpose of the present analysis was to examine the discontinuation rate of diabetes or lipid-lowering medications and the patient factors associated with medication discontinuation among veterans undergoing bariatric surgery.


METHODS
We identified the demographic and health status information for 284 veterans with diabetes and 298 veterans with hyperlipidemia who had undergone bariatric surgery at 1 of 12 Veterans Affairs bariatric centers in 2000 to 2006 from the Veterans Affairs National Surgical Quality Improvement Program data. We also identified the medications that had been prescribed and discontinued using the Veterans Affairs administrative data. Medication discontinuation was estimated using a logistic regression model.


RESULTS
Of the 284 veterans with diabetes and 298 with hyperlipidemia, 52% and 40% had discontinued their medications at 1 year, respectively. The veterans with diabetes were more likely to discontinue medication if they had been taking oral hypoglycemic agents alone (odds ratio 2.77, P <.001) than were those taking insulin or oral hypoglycemic agents and insulin. The veterans with hyperlipidemia were more likely to discontinue medication if they had only been taking fibrates (odds ratio 6.15, P <.01) than were those veterans taking statins and fibrates.


CONCLUSIONS
Bariatric surgery led to significant medication discontinuation within 1 year for high-risk veterans with diabetes or hyperlipidemia.
Maciejewski
Matthew L
ML
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA. matthew.maciejewski@va.gov
Livingston
Edward H
EH
Kahwati
Leila C
LC
Henderson
William G
WG
Kavee
Andrew L
AL
Arterburn
David E
DE
D000368:Aged; D050110:Bariatric Surgery; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D050171:Dyslipidemias / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data
D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents