title: Rapid Reduction in Use of Antidiabetic Medication after Laparoscopic Sleeve Gastrectomy: The Newfoundland and Labrador Bariatric Surgery Cohort (BaSCo) Study.
abstract: BACKGROUND
  Patients who have undergone bariatric surgery generally need fewer medications as they experience improvement in, or even resolution of, various medical conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia. Published data on changes in medication use after laparoscopic sleeve gastrectomy, a type of bariatric surgery that is growing in popularity, are limited.
  
  
  OBJECTIVE
  To determine whether patients took fewer medications for management of type 2 diabetes, hypertension, and dyslipidemia after laparoscopic sleeve gastrectomy, relative to preprocedure medications.
  
  
  METHODS
  In this prospective, single-centre cohort study, a nurse practitioner used standard medication reconciliation and study data-extraction forms to interview adult patients who had undergone laparoscopic sleeve gastrectomy and determine their medication use and pertinent demographic data. The data were analyzed using generalized estimating equations and standard statistical software. Outcome measures included changes in the use of antidiabetic, antihypertensive, and antilipemic medications at 1, 3, and 6 months after the surgery.
  
  
  RESULTS
  A total of 65 patients who underwent laparoscopic sleeve gastrectomy between May 2011 and January 2014 met the study inclusion criteria. Before surgery, the 30 patients with type 2 diabetes were taking an average of 1.9 antidiabetic medications. One month after the procedure, 15 (50%) had discontinued all antidiabetic medications, with a further decline at 3 and 6 months (p < 0.001 at each time point). Among the patients who were taking antihypertensives (n = 48) and antilipemics (n = 33) before surgery, the decline in use occurred at a more modest rate, with 6 (12%) and 2 (6%), respectively, discontinuing these medication classes within 1 month, and 12 (25%) (p = 0.001) and 8 (24%) (p = 0.015) having discontinued by 6 months.
  
  
  CONCLUSIONS
  These findings suggest that patients with a history of type 2 diabetes mellitus, hypertension, and/or dyslipidemia who undergo laparoscopic sleeve gastrectomy are less likely to require disease-specific medications shortly after surgery.
authors.affiliation: BScPharm, ACPR, PharmD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Carla
authors.initials: C
authors.lastname: Dillon
authors.affiliation: BScPharm, PharmD, is with the School of Pharmacy, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Justin
authors.initials: J
authors.lastname: Peddle
authors.affiliation: BA, MSc, PhD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Laurie
authors.initials: L
authors.lastname: Twells
authors.affiliation: BSc, MSc, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Kendra
authors.initials: K
authors.lastname: Lester
authors.affiliation: PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: William
authors.initials: W
authors.lastname: Midodzi
authors.affiliation: RN, is with Eastern Health, St John's, Newfoundland and Labrador.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Manning
authors.affiliation: NP, MSc(A), BSc, is with Eastern Health, St John's, Newfoundland and Labrador.
authors.forename: Raleen
authors.initials: R
authors.lastname: Murphy
authors.affiliation: BSc, MBA, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: David
authors.initials: D
authors.lastname: Pace
authors.affiliation: BSc(Hons), MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Chris
authors.initials: C
authors.lastname: Smith
authors.affiliation: BMedSc, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Darrell
authors.initials: D
authors.lastname: Boone
authors.affiliation: BN, MSc, PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gregory
keywords: antihypertensive agents; bariatric surgery; drug utilization; hypoglycemic agents; hypolipidemic agents; obesity