Insurance Covers Surgery For Diabetes Control For A Man With A Low BMI

May 30, 2013

Groundbreaking: Insurance Pays For Man With A BMI of 33 To Have Bariatric Surgery For Diabetes Control

Gary Breno, 62, had worked at the Cleveland Clinic for 43 years and was battling Type 2 diabetes which was not being well-controlled with injections and medications.  Breno had to inject himself with insulin eight times a day and his blood sugar levels still remained high.  He was experiencing numbness in his toes and had other comorbidities and was facing an uncertain future health wise. As with many who have Type 2 diabetes, he was at risk for having a stroke, blindness, kidney damage or failure, or possible limb amputation.

Knowing that weight loss surgery can control or eliminate Type 2 diabetes, Breno had tried to get approval for the surgery but was turned down because his BMI, which was closer to 33, was too low.  As with most insurance policies worldwide, Cleveland Clinic's insurance required a BMI of 35 or higher.

But in January of this year, a groundbreaking change to the Clinic’s insurance policy was revealed.  The plan was changed to include coverage for weight loss surgery for patients whose Type 2 diabetes was not being well-controlled.  Breno sought approval for the surgery once again and this time he received a green light making him the first person at Cleveland Clinic (and perhaps nationally) with a BMI of 35 or less for whom insurance covered the surgery.

After attending support meetings for bariatric patients and going through all the requirements for surgery, Breno had laparoscopic weight loss surgery on May 20thDr. Philip Schauer performed the 90-minute procedure.

Schauer, who is the Director Bariatric and Metabolic Institute for Cleveland Clinic, is a nationally renowned surgeon and had led research for a study that showed that weight loss surgery can eliminate Type 2 diabetes.

According to Dr. Schauer, many patients can stop taking insulin before they even leave the hospital.  He and his team of researchers think that the hormonal changes in the body after surgery causes the pancreas to start creating more insulin and therefore helps to get the patients diabetes under control.

Since Breno’s weight loss surgery, he has not needed insulin injections but for now is still taking oral medication for his diabetes.  Just one day after his surgery, his blood sugar had dropped from an average of 180-190 to 130 which is still higher than the normal range of 100 but Breno is on track to having his diabetes under control and that’s something he is very much looking forward to.

Last year, a panel of over 100 Cleveland Clinic physicians and researchers voted weight loss surgery for diabetes as the top medical innovation for 2013.