-Reduction in cost of care associated with 15% weight loss
-Savings of €4000 per year per patient to the state
IrSPEN, the Irish Society for Clinical Nutrition and Metabolism, is advising people living with type 2 diabetes and obesity that they can reverse, or put their diabetes into remission if they can lose 15% of their body weight.i,ii This even applies to the people who are on insulin and have poor diabetes control. This guidance comes ahead of European Obesity Day which takes place on Saturday 19 May 2018.
Remission is achievable by half of people living with type 2 diabetes if they can lose 15% of their body weight. The research also showed that this is independent of the starting BMI making this relevant to any person living with type 2 diabetes who has a BMI over 30. This has clear benefits both to the people living with the condition, who can reverse their symptoms and stop or reduce their medication need, but also to the Department of Health in terms of savings to the health budget. A clinical audit showed that the treatment of an obese person with difficult to control diabetes in Donegal is approximately €4,000 per year, and after more than 15% weight loss following treatment at Letterkenny University Hospital, this cost reduced to approximately €500 per year in direct healthcare cost pertaining to their diabetes. When applied to the number of people living with diabetes for whom this is possible, the state will make back all the money spent on the treatment within 3-5 years and start saving money each year after that. The current cost of treating all obesity-related diseases is approximately €1.16 billion per annum, 35% of this cost is allocated to hospital care and medication costs and 65% is from indirect costs including productivity losses from absenteeism.
Ireland has one of the highest obesity rates in Europe and it affects more than one million people here. One in four adults are obese and one in four children are overweight or obese making them highly likely to become obese adults. Every year in Ireland approximately 2,000 deaths are attributable to obesity.[iii] According to the WHO, 65% of the diabetes burden, 23% of the heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity.[iv]
Commenting on the research Prof Carel le Roux from IrSPEN said, “This year’s theme of the European Obesity day is ‘Tackling Obesity Together’ as it is now apparent that there is no single silver bullet, but rather that multiple approaches have to be used to optimally treat patients who have complications of obesity. For people living with diabetes as a result of obesity, the disease usually requires the combination of specialist diets, specialist exercise and medication and or surgical treatments. Not every patient responds equally to these treatments however reversal of complications such as diabetes can be achieved in 2 in 10 people with the use of specialist diets, another 3 in 10 with the use of medication and another 5 in 10 with the use of surgical treatments.”
Mr John Conneely, Consultant Metabolic Surgeon, Mater Misericordiae University Hospital said, “European Obesity Day offers us an opportune time to remind people that type 2 diabetes can go into remission if the person is able to lose 15% of their body weight – this can be applied to people of any start weight above a BMI of 30. This is a really positive message to people living with the condition to consider all of the options available to support them with this goal including diet, exercise, medication and surgery. A lifetime dependency on medicine can be removed and the person effectively will no longer experience symptoms associated with the disease. Ireland is now starting to lead the world in the clinical trials that are being offered to understand how the complications of obesity such as sleep apnoea and diabetes can be put into remission, we are very fortunate to be part of these developments”
Mr John Kane from Dublin, who was diagnosed with sleep apnoea and prediabetes in 2017 said, “Being part of a specialist multidisciplinary service and participating in a clinical trial helped me to lose more than 15% of my weight. My prediabetes has been reversed and my sleep apnoea is much better. However, the real benefits are that I feel 10 years younger so am able to do things that I had stopped doing as a result of my disease and for that I’m truly grateful.”
Ms Laura Sloan from Letterkenny, was diagnosed with type 2 diabetes in 2004 and required maximum oral medication, insulin injections and a GLP-1 analogue injection, with the total cost of over €4000 per year. Despite best medical care Ms Sloan still had poorly controlled diabetes until she lost more than 15% of her bodyweight after a gastric bypass operation. Her diabetes is now in remission for almost a year and she requires no medication anymore. “This has been not just life changing but rather life saving for me. Since the day after my surgery I have been off all diabetic medicine, which is beyond words for me to be able to explain what that really means. I used worry about my health and the possibility of losing my eyesight. I will be forever grateful to the team in Letterkenny as this has really been the cure for me.”
Dr Anna Clarke of Diabetes Ireland said “if you are carrying excess weight, any weight loss is beneficial for your health as it will assist blood glucose, blood pressure and blood cholesterol control. Weight loss is best done as a combination of healthy eating with attention to portion size and regular physical activity. A weight loss of 15% will make substantial changes in these parameters and for any person with diabetes, would be best undertaken under medical supervision as medication change will be warranted as weight reduces”.
If you are living with type two diabetes and obesity, re-engage with your healthcare professional team to discuss ways that you might achieve 15% weight loss through diet, exercise, medical or surgical treatment. Further details of how to support European Obesity Day and where to find more information on obesity, and obesity prevention and treatment, are available on the European Obesity Day website: www.europeanobesityday.eu.
Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C, Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, Rodrigues AM, Rehackova L, Adamson AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Stefanetti R, Trenell M, Welsh P, Kean S, Ford I, McConnachie A, Sattar N, Taylor R. Lancet. 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140-6736(17)33102-1. Epub 2017 Dec 5.
Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, Aminian A, Pothier CE, Kim ES, Nissen SE, Kashyap SR; STAMPEDE Investigators.
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[iii] Obesity, N. T. o. Obesity the Policy Challenges- The Report of the National Taskforce on Obesity (2005).