Bariatric surgery lowers death risk in diabetics: JAMA
Canada: Bariatric surgery may lower the risk of death and diabetes-specific cardiac and renal outcomes in patients with type 2 diabetes and severe obesity, according to a recent study in JAMA Network Open.
Findings from some high-quality randomized clinical trials have demonstrated the effect of bariatric surgery on the remission of type 2 diabetes but these studies are not powered for studying mortality in this patient group. Therefore, there is a need for large observational studies to study the association between bariatric surgery and mortality in type 2 diabetes patients.
Against the above background, Aristithes G. Doumouras, Division of General Surgery, McMaster University, Hamilton, Canada, and colleagues aimed to determine the association between bariatric surgery and all-cause mortality among patients with type 2 diabetes and severe obesity.
The study included a total of 6,910 patients from Ontario who underwent gastric bypass or sleeve gastrectomy. The majority of patients were women (72%) and the average age at the time of surgery was 52. They were matched with 3,455 control patients based on age, sex, BMI, and date of diabetes diagnosis.
All patients had pre-existing type 2 diabetes and a BMI over 35. Those with a BMI of 35 of less, over the age of 70, or had a history of several different predefined clinical conditions were excluded.
The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality and nonfatal morbidities.
Key findings of the study include:
- In the surgery group, 83 patients (2.4%) died, compared with 178 individuals (5.2%) in the control group (hazard ratio [HR] 0.53).
- Bariatric surgery was associated with a 68% lower cardiovascular mortality (HR, 0.32) and a 34% lower rate of composite cardiac events (HR, 0.68).
- Risk of nonfatal renal events was also 42% lower in the surgical group compared with the control group (HR, 0.58).
- Of the groups that had the highest absolute benefit associated with bariatric surgery, men had an absolute risk reduction (ARR) of 3.7%, individuals with more than 15 years of diabetes had an ARR of 4.3%, and individuals aged 55 years or older had an ARR of 4.7%.
"These findings suggest that bariatric surgery was associated with substantially lower all-cause mortality as well as nonfatal diabetic events in patients with type 2 diabetes," wrote the authors.
"Overall, this study reinforces that the glycemic benefit of bariatric surgery found in randomized clinical trials likely translates to a mortality benefit over time, and it supports the use of surgery as a first-line treatment for individuals with obesity and diabetes," they concluded.
Reference:
The study titled, "Association Between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients With Diabetes and Obesity," is published in JAMA Network Open.
DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778938
