Today’s Managing Health Care Costs Indicator is 8.3%
I’m struck by two studies published in the last week that use diametrically opposed approaches –and both appear to work. (Both studies are small, though , so it’s possible that the results will not be sustained in larger samples).
The NEJM published two studies showing that intensive surgical intervention helps. Italian researchers showed that bariatric surgery (the most invasive surgical treatments) could “cure” diabetes in 75-95% of those treated, compared to NO cures in the medically treated group. American researchers showed that those who had less-invasive surgical treatments were three times as likely to have an excellent diabetes control (Hemoglobin AIC of <6). The conclusion –for diabetics with morbid obesity, surgical treatment is strikingly effective. Other studies have shown that bariatric surgery can pay off in a few years in the general population – this set of studies provides further evidence that we should cover this expensive ($11-$26,000) procedure for those with morbid obesity.
The Annals of Internal Medicine published an elegant study which randomized 118 African American veterans with diabetes to usual care, financial rewards ($100-$200), and peer mentoring. The financial reward for better HbAIC led to a 0.4% average decrease in HbAIC, while the peer mentoring led to a 1.1% decrease in HbAIC.
There are often many roads that lead to the right outcome in health care – and these studies are all small and did not include similar groups – so shouldn’t be compared. It’s nice to know that both high tech and low tech solutions can have a substantial impact, and have the potential to decrease diabetic complications in our increasingly-obese population.
