TYPE 2 DIABETES AND OBESITY: TWIN EPIDEMICS

FACT SHEET Hamiltn TYPE 2 DIABETES AND OBESITY: TWIN EPIDEMICS CONTACT: Amber 212-266-0062 OVERVIEW Type 2 diabetes accunts fr 95% f the 25.8 millin diabetes cases in the U.S 1 Obesity is a majr independent risk factr fr develping the disease, and mre than 90% f type 2 diabetics are verweight r bese 2 Mdest weight lss, as little as 5% f ttal bdy weight, can help t imprve type 2 diabetes in patients wh are verweight r bese 3 Metablic and bariatric surgery may result in reslutin r imprvement f type 2 diabetes independent f weight lss 4 PREVALENCE Diabetes affects 8.3% f the ttal U.S. ppulatin (25.8 millin peple) 5 18.8 millin peple have been diagnsed 7 millin peple are unaware they suffer frm the disease Abut 95% f the diabetes ppulatin has type 2 diabetes 6 Increases in type 2 diabetes cases acrss the cuntry assciated with higher besity rates and rising age f ppulatin 7 Mre than ne-third (35.7%) f adults are bese; 8 rate nearly tripled between 1960-2010 9 While children and adlescents are increasingly being diagnsed with type 2 diabetes, the CDC ntes is it difficult t estimate the disease s prevalence in this ppulatin because it can g undiagnsed fr lng perids f time 10,11 The rise in diabetes diagnses is attributed t increasing childhd besity rates, which have tripled since the 1980s, with apprximately 17% (r 12.5 millin) f children aged 2-19 suffering frm besity 12 African-Americans and the elderly are disprprtinately affected by diabetes 13 18.7% f all African-Americans ver twenty years ld have diabetes, cmpared t 10.2% f whites 26.9% f Americans age 65 and lder have diabetes, cmpared t 11.3% f adults ver 20 Pre-diabetes Abut 79 millin Americans, r 35% f peple 20 r lder have pre-diabetes, 14 while half f adults ver 65 are affected by the disease 15 Up t 70% f patients with pre-diabetes eventually develp diabetes 16 Peple with pre-diabetes are als at risk fr heart disease and strke 17 -mre-

HEALTH RISKS OF TYPE 2 DIABETES -2- Peple with diabetes have duble the mrtality risk f similar-aged peple withut diabetes, and the disease is the seventh leading cause f death in the U.S. 18 Diabetes is the leading cause f kidney failure, nn-traumatic lwer-limb amputatins, new cases f blindness amng adults, and it is assciated with increased risk f: Heart disease and strke High bld pressure Nervus system disease Kidney disease Blindness Amputatins Dental disease Pregnancy cmplicatins IMPACT OF METABOLIC & BARIATRIC SURGERY ON TYPE 2 DIABETES Meta-analysis f 22,000 bariatric surgery patients in 136 studies (1990-2003) fund bariatric mean excess weight lss was 61.2%, and 86% f patients saw imprvement r reslutin f type 2 diabetes 19 Gastric bypass may result in reslutin r imprvement f type 2 diabetes independent f weight lss by decreasing levels f ghrelin appetite stimulating hrmne secreted by the stmach 20 Peple with mrbid besity wh had gastric bypass surgery significantly reduced lng-term mrtality frm diabetes by 92% and frm any cause by 40% 21 (NEJM, 2007) Surgical Treatment vs. Medical Therapy Cmparative Studies Meta-analysis f 796 participants in 11 studies cmparing metablic and bariatric surgery t nnsurgical treatment fr besity fund surgery results in greater weight lss and higher type 2 diabetes remissin rates 22 (BMJ, 2013) Studies with mre than six mnths fllw up shwed surgical patients lst an average f 57 mre punds than participants in nnsurgical weight lss prgrams, and were 22 times mre likely t see their type 2 diabetes abate Head-t-head studies cmparing bariatric surgery t medical therapy fund bariatric surgery superir t medical treatment in prducing type 2 diabetes remissin, even befre weight lss Cleveland Clinic study shwed within ne year, diabetes remissin rates with bariatric surgery were abut 40% (42% gastric bypass, 37% gastric sleeve) cmpared t abut 12% fr patients treated with the best pharmactherapy available; patients had BMI between 27 and 43 23 (NEJM, 2012) Cathlic University/New Yrk-Presbyterian/Weill Crnell Medical Center shwed remissin rates were abut 85% fr bariatric surgery (75% gastric bypass, 95% bilipancreatic diversin) and zer fr medical therapy in patients with BMI greater than 35, after tw years 24 (NEJM, 2012) In surgical grups, bth weight lss and preperative BMI were nt predictrs f diabetes cntrl, suggesting such surgical prcedures may be independent f weight lss 73% f gastric band patients with type 2 diabetes experience remissin tw years after surgery, a 5 times higher reslutin rate than thse receiving cnventin therapy 25 (JAMA, 2008) Cnventinal therapy includes access t general physician, nurse and diabetes educatr and medical therapies including pharmaceutical agents, individual lifestyle mdificatin prgrams and physical activity Authrs nte weight regain after surgery may put patients at risk fr type 2 diabetes relapse -mre-

Lng-Term Results f Surgical Treatment 24% f patients wh have bariatric surgery experience cmplete, lng-term five years r mre remissin f their type 2 diabetes; 26% experience partial remissin and 34% imprve frm baseline 26 (Annals f Surgery, 2013) Six years after surgery, 62% f gastric bypass patients with severe besity BMI 35 r higher experienced type 2 diabetes remissin, cmpared t 6-8% in cntrl grups 27 (JAMA, 2012) -3- Ten years after interventin, 7% f surgery patients have type 2 diabetes, cmpared t 24% f nnsurgically treated patients 28 (NEJM, 2004) Surgery in Patients with Lwer BMIs Cmpared t nnsurgical treatments, bariatric surgery fr patients with mild-t-mderate besity BMIs between 30 and 35 and type 2 diabetes prduces better intermediate glucse utcmes ne-t-tw years fllwing treatment 29 (JAMA, 2013) Fr patients with type 2 diabetes and mild-t-mderate besity, laparscpic gastric band surgery is a mre effective treatment than nn-surgical therapy 30 (Annals f Internal Medicine, 2006) After tw years, nly 3% f surgical patients cntinued t have metablic syndrme, cmpared t 24% f nn-surgical patients, wh were treated with very-lw-calrie diets, pharmactherapy and lifestyle change COSTS ASSOCIATED WITH TYPE 2 DIABETES Ttal csts f diagnsed diabetes rse 41% in five years, frm $174 billin in 2007 t $245 billin in 2012 31 Mre than 1-in-5 health care dllars in the U.S. are spent n diabetes care with half directly attributable t treatment 32 Indirect csts, including absenteeism, reduced wrk prductivity, inability t wrk and lst wrkers due t premature death, accunt fr $68.6 billin Diabetes patients incur average medical csts f $7,900 fr treatment; ttal medical expenses are 2.3 times higher than fr peple withut diabetes 33 Metablic surgery has been shwn t be assciated with reductins in verall health care csts in patients with type 2 diabetes 34 Annual health care csts decreased 34.2% after tw years and by 70.5% after three years Assciated with eliminatin f diabetes medicatin in nearly 85% f patients tw years after surgery GUIDELINES & RECOMMENDATIONS American Diabetes Assciatin recmmends bariatric surgery be cnsidered fr adults with type 2 diabetes wh have a BMI greater than 35, in particular if diabetes r assciated cmrbidities are difficult t cntrl with lifestyle and pharmaclgic therapy 35 Ntes there is insufficient evidence fr adults with BMI less than 35 utside f a research prtcl 2011 statement frm Internatinal Diabetes Federatin said surgery was effective, safe and cst-effective therapy fr patients with besity and type 2 diabetes, nting it significantly imprves glycemic cntrl in severely bese patients with the disease 36 (Diabetes Medicine, 2011) ###

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30 O Brien P.E., Dixn J.B., Laurie C., et. al. (2006). Treatment f Mild t Mderate Obesity with Laparscpic Adjustable Gastric Banding r an Intensive Medical Prgram. Annals f Internal Medicine. p. 625. Accessed frm http://www.rima.rg/web/medline_pdf/anninternmed2006_625-33.pdf Octber, 2013 31 American Diabetes Assciatin (2013). Ecnmic Csts f Diabetes in the U.S. in 2012 Diabetes Care. p. 1. Accessed frm http://care.diabetesjurnals.rg/cntent/early/2013/03/05/dc12-2625.full.pdf+html Octber, 2013 32 American Diabetes Assciatin. (2012). The Cst f Diabetes. Advcate. Accessed frm http://www.diabetes.rg/advcate/resurces/cst-f-diabetes.html Octber, 2013 33 American Diabetes Assciatin. (2012). The Cst f Diabetes. Advcate. Accessed frm http://www.diabetes.rg/advcate/resurces/cst-f-diabetes.html Octber, 2013. 34 Makary M., Clarke J., Shre A., et al. (2010). Medicatin Utilizatin and Annual Health Care Csts in Patients with Type 2 Diabetes Mellitus Befre and After Bariatric Surgery. Archives f Surgery. 145(8) pp. 726-731 35 American Diabetes Assciatin. (2013). Diabetes Management Guidelines. Accessed frm http://www.ndei.rg/ada-2013-guidelines- Obesity-Treatment.aspx Nvember, 2013 36 Dixn J.B., Zimmet P., Alberti K.G., et. al. (2011). Bariatric Surgery: An IDF Statement fr Obese Type 2 Diabetes. Diabetes Medicine. Accessed frm http://www.ncbi.nlm.nih.gv/pmc/articles/pmc3123702/ Octber, 2013. Updated Nvember 2013