HIQA reviewing metabolic surgery as treatment for Type 2 diabetes and obesity

Date of publication:

The Health Information and Quality Authority (HIQA) has commenced work on a health technology assessment (HTA) of metabolic surgery for the treatment of type 2 diabetes (T2D) and obesity.

Bariatric surgery involves modifying the stomach and intestines to treat obesity. The term metabolic surgery refers to the use of these surgical procedures in the treatment of metabolic diseases, such as type 2 diabetes. A number of international diabetes associations, including the American Diabetes Association (ADA) and the International Diabetes Federation (IDF), recommend inclusion of metabolic surgery in the clinical care pathway for type 2 diabetes.

The aim of the assessment is to establish the clinical- and cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity in Ireland. The assessment will also estimate the budget impact, organisational and resource implications associated with introducing a metabolic surgery programme. The outcome of this assessment will be provided as advice to the Minister for Health to inform a decision on whether or not to introduce a metabolic surgery programme in addition to existing bariatric surgery services in Ireland.

Dr Conor Teljeur, HIQA’s Chief Scientist said: “Obesity and type 2 diabetes are significant public health concerns in Ireland and internationally. Obesity increases the risk of developing type 2 diabetes which can lead to long-term complications including damage to the heart, kidneys or eyes.”

Dr Teljeur continued: “It is important that effective treatment options are available for patients with both type 2 diabetes and obesity to reduce the burden of disease on the healthcare system. The benefits of metabolic surgery are not limited to weight-loss. Surgery may have additional benefits for people with type 2 diabetes such as improvements in blood sugar control. This assessment will consider whether or not metabolic surgery should be incorporated into the clinical care pathway for type 2 diabetes in Ireland.”

HIQA has established an expert advisory group comprising representatives from key stakeholder groups who will advise the HTA evaluation team during the course of this assessment. 

The HTA is scheduled to be finalised in early 2022. 

The protocol for the assessment will be published on our website.  


Further information:
Marty Whelan, Head of Communications & Stakeholder Engagement
01 814 7480/085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

  • Health technology assessment (HTA) is a multidisciplinary research process that collects and summarises information about a health technology. The information can cover a range of fields, including clinical effectiveness and safety, cost effectiveness and budget impact, organisational and social aspects, and ethical and legal issues.
  • The term ‘health technology’ encompasses a wide range of health interventions. ‘Technology’ includes any intervention that may be used to promote health to prevent, diagnose or treat a disease; or in rehabilitation or long-term care.
  • HIQA agreed to undertake the HTA following a formal request from the Clinical Lead of the National Clinical Programme for Diabetes in the Health Service Executive (HSE), with support from the National Clinical Programme for Obesity.
  • In Ireland, T2D is currently treated with anti-hyperglycaemic mediations and insulin therapy, as appropriate, in addition to lifestyle changes including diet and exercise. For some patients, two or more medications may be necessary to achieve treatment targets.
  • At present, access to bariatric surgery for patients with obesity and obesity-related diseases is provided through the National Clinical Programme for Obesity or accessed through private healthcare systems in Ireland or abroad. 
  • American Diabetes Association (ADA) guidelines report that metabolic surgery should be recommended as a treatment option for T2D in screened surgical candidates with a BMI ≥40 kg/m2, and in adults with a BMI 35.0 to 39.9 kg/m2 with T2D control above treatment targets despite best medical care. Metabolic surgery may be considered as an option to treat T2D in adults with BMI 30.0 to 34.9 kg/m2 with T2D control above treatment targets despite best medical care. There are many different types of bariatric/metabolic surgery procedures. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed procedures in Ireland at present.
  • It is estimated that 160,000 people in Ireland have T2D. Obesity is the most important modifiable risk factor for T2D. The majority of people with T2D have comorbid overweight or obesity.
  • Between 2009 and 2019, cases with a diagnosis of T2D represented, on average, 25% of all cases who underwent a primary bariatric surgery procedure in Irish public hospitals.