In a study of more than 2,200 U.S. adults, Johns Hopkins University researchers found that two years after the operation, almost 85 percent were off diabetes medications as a result of improved blood glucose levels.

And although the surgery is expensive, the researchers found that because of the reduction in type 2 diabetes medications and related health care costs, the surgery appeared to be a cost-effective option, reducing health care costs by more than $6,000 annually.

“We’ve got a new epidemic in the world replacing smoking — it’s obesity. And, the number one health consequence of obesity is type 2 diabetes. Now, we have an effective surgical intervention for two major health problems,” said the study’s lead author, Dr. Martin Makary, a surgeon and associate professor of surgery and of public health at Johns Hopkins University School of Medicine.

But, he cautioned, the surgery isn’t a quick fix solution and it isn’t for everyone. “This surgery is for the right candidates — to qualify for bariatric surgery you have to have a body mass index greater than 30. And, it’s something that needs to be considered when all other interventions have failed.”

Results of the study were published in the August issue of the Archives of Surgery.

Diabetes can be a debilitating and expensive disease. A recent report from the Agency for Healthcare Research and Quality found that the United States spends $83 billion each year on hospital costs related to diabetes. The same report estimates that nearly 8 percent of the U.S. population has diabetes.

Several years ago, surgeons realized that when they performed weight-loss surgery that reduces the stomach’s capacity, some people were able to go off insulin or other diabetes medications within days of surgery. The current study was designed to look at how the surgery correlates with a reduction in diabetes medication use, and the costs of the procedure versus the continued need for diabetes medications and other related health care expenses.

Makary and his colleagues examined 2,235 adults with type 2 diabetes from seven different states who had undergone bariatric weight-loss surgery over a four-year period between January 1, 2002 and December 31, 2005. The risk of death from this surgery is 0.3 percent, according to Makary.

Of the participants, 85.8 percent were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. The researchers found that within six months of surgery, 1,669 (74.7 percent) of the surgical patients were able to stop taking their diabetes medications. After one year, 80.6 percent were off diabetes medications and at two years, 84.5 percent were no longer taking them.

Even many of those who previously needed to take insulin, which indicates more advanced disease, were able to stop taking it.

The average cost of surgery for this type of procedure is nearly $30,000, according to the study. The average annual health care cost for each person with type 2 diabetes was estimated to be about $6,376 in the two years preceding the surgery. Total annual health care costs increased by nearly 10 percent in the year following the surgery, but dropped by 34.2 percent by year two and by 70.5 percent by year three, when health care costs declined by nearly $4,500 annually.

“This is not just a surgery that addresses obesity, but it also eliminates the need for diabetes medications in the vast majority. There are enormous implications for health care utilization and policies. This surgery is not only in the patient’s best health interest, but will also result in a significant reduction in resources,” said Makary.

Because the surgery causes such a rapid reduction in the need for diabetes medication, Makary said it’s not just the weight loss that’s causing the change in diabetes, but likely a shift in certain hormones in the body.