A metabolic surgery programme should be introduced in Ireland as part of the clinical pathway for type 2 diabetes, the Health Information and Quality Authority (HIQA) has recommended.

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 has been 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 type 2 diabetes and obesity.

Currently in Ireland, access to bariatric surgery services is provided exclusively through the National Clinical Programme for Obesity or accessed through private healthcare systems in Ireland or abroad. Metabolic surgery is not currently provided as part of the clinical care pathway for type 2 diabetes.

Current standard care options for patients with comorbid type 2 diabetes and obesity include patient education programmes, diabetes medications and behavioural interventions, such as dietary changes and physical activity. 

However, 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 undertook a health technology assessment of the procedure to determine if this type of surgery should be recommended in Ireland as part of the clinical pathway for type 2 diabetes.

Its review included evidence from 24 randomised controlled trials examining metabolic surgery with short- to medium-term follow-up (maximum 10 years).

According to HIQA’s chief scientist, Dr Conor Teljeur, the assessment found metabolic surgery to be “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,” he explained.

HIQA estimates that the incremental budget impact of a metabolic surgery programme would be €7.4 million to provide 1,000 surgeries and follow-up care over five years. While an annual cohort of 200 patients was assumed, the budget impact would be directly proportional to the number of patients undergoing surgery.

The assessment has been submitted to the Minister for Health and the HSE for consideration.

Its publication was welcomed by the Irish Society for Clinical Nutrition and Metabolism (IrSEPN), which noted that many patients would see their type 2 diabetes going into remission as a result of metabolic surgery. For others, the risk of complications, such as kidney disease and heart issues, would be reduced.

This means that patients would use health services less, which would save the HSE money in the long-term, IrSPEN pointed out.

“We often hear patients tell us that despite their using the best medical treatment, unfortunately their diabetes is slowly getting worse and affecting their liver, kidneys or heart. Patients know if they can have diabetes surgery, they can get rid of the diabetes and their organs will then improve.

“More than a thousand patients with diabetes are having this lifesaving operation in France each year. All patients need is for the HSE to follow the advice of the government experts and allow patients to be helped,” commented obesity specialist at St Vincent’s University Hospital and UCD, Prof Carel Le Roux.

According to the executive director of the Irish Coalition for People living with Obesity (ICPO), Susie Birney, who had diabetes surgery herself and is now living without diabetes, this type of surgery is now considered to be the standard of care by the American Diabetes Association and European Association of Diabetes.

“With HIQA’s report showing that surgery is safe, effective and also extremely cost-effective, there should be few barriers to implementing this treatment. Ireland has the surgeons, doctors and hospitals to start doing this tomorrow.

“Diabetes surgery vastly improved my quality of life. I am now off all medications, with my retinopathy reversed for almost seven years now. This surgery directly saves the taxpayer money,” she said.