Discontinuation of diabetes and lipid-lowering medications after bariatric surgery at Veterans Affairs medical centers
Received 6 November 2009; accepted 11 July 2010. published online 30 July 2010. Uncorrected Proof
Abstract
Background:
Bariatric surgery has largely been performed on middle-age female populations and been associated with significant medication discontinuation; however, it is unknown whether similar medication discontinuation rates could be achieved in men. The purpose of the present analysis was to examine the discontinuation rate of diabetes or lipid-lowering medications and the patient factors associated with medication discontinuation among veterans undergoing bariatric surgery.
Methods:
We identified the demographic and health status information for 284 veterans with diabetes and 298 veterans with hyperlipidemia who had undergone bariatric surgery at 1 of 12 Veterans Affairs bariatric centers in 2000 to 2006 from the Veterans Affairs National Surgical Quality Improvement Program data. We also identified the medications that had been prescribed and discontinued using the Veterans Affairs administrative data. Medication discontinuation was estimated using a logistic regression model.
Results:
Of the 284 veterans with diabetes and 298 with hyperlipidemia, 52% and 40% had discontinued their medications at 1 year, respectively. The veterans with diabetes were more likely to discontinue medication if they had been taking oral hypoglycemic agents alone (odds ratio 2.77, P <.001) than were those taking insulin or oral hypoglycemic agents and insulin. The veterans with hyperlipidemia were more likely to discontinue medication if they had only been taking fibrates (odds ratio 6.15, P <.01) than were those veterans taking statins and fibrates.
Conclusion:
Bariatric surgery led to significant medication discontinuation within 1 year for high-risk veterans with diabetes or hyperlipidemia.
aCenter for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
bDivision of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
cDivision of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
dVeterans Affairs North Texas Health Care System, Dallas, Texas
eBiomedical Engineering, University of Texas, Arlington, Texas
fNational Center for Health Promotion and Disease Prevention, Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs, Durham, North Carolina
gDenver Veterans Affairs Medical Center, Denver, Colorado
hDepartment of Biostatistics, University of Colorado School of Public Health, Aurora, Colorado
iColorado Health Outcomes Program, University of Colorado, Aurora, Colorado
jGroup Health Research Institute, Seattle, Washington
kDepartment of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington
Reprint requests: Matthew L. Maciejewski, Ph.D., Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Mail Stop 152, Durham, NC 27705
Supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs (IIR 05-201) and has been reviewed and approved by the Surgical Quality Data Use Group (SQDUG), Office of Patient Care Services.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, Duke University, University of Texas Southwestern Medical Center, University of Texas, University of Colorado, Group Health Research Institute, or University of Washington.
ABSTRACT