title: The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) has gained pandemic proportions becoming a global threat within the last few decades. In parallel to the increasing prevalence, healthcare costs have become a huge economic burden for the hospital and governments. Bariatric surgery has been proven to induce glycemic control in obese type 2 diabetics. However, the cost effectiveness of metabolic surgery in overweight, obese and morbidly obese individuals has not been documented. We aimed to demonstrate the efficacy and reduced diabetic-medication cost after diverted sleeve gastrectomy with ileal interposition (DSIT) in type 2 diabetic individuals followed more than 1 year.
  
  
  METHODS
  Records of 116 type 2 diabetic patients operated by DSIT at a dedicated metabolic surgery clinic between October 2011 and April 2013 were retrospectively reviewed. A comparison was made between the annual diabetic medication cost before and after surgery using the paired t test. The alterations in BMI and HbA1c were recorded and analyzed.
  
  
  RESULTS
  Diverted sleeve gastrectomy with ileal interposition led to a marked reduction in BMI and improved glycemic control after 1 year follow-up. Mean HbA1c levels decreased from a mean of 8.9 ± 1.7 to 6.6 ± 1.1 1 year after surgery (p < 0.001). Mean preoperative BMI declined from 32.9 ± 4.3  to 24.7 ± 2.7 kg/m(2) (p < 0.001). Cost of diabetic medication decreased from a mean 660.08 USD/year to 65.12 USD 1 year after surgery (p < 0.001).
  
  
  CONCLUSIONS
  Our results have shown that DSIT operation leads to a significantly better glycemic control and lower diabetic medication costs at 1 year.
authors: Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Sokak Kent Pasaji No: 2/2, Sisli, Istanbul, Turkey.
authors: Alper
authors: 0000-0003-2084-5871
authors: A
authors: Celik
authors: Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Sokak Kent Pasaji No: 2/2, Sisli, Istanbul, Turkey.
authors: Muharrem
authors: M
authors: Asci
authors: Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Sokak Kent Pasaji No: 2/2, Sisli, Istanbul, Turkey.
authors: Bahri Onur
authors: BO
authors: Celik
authors: Bariatric and Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India.
authors: Surendra
authors: S
authors: Ugale
keywords: Cost saving; DSIT; Surgery; Type 2 diabetes