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Bariatric surgery bested usual care in prevention of type 2 diabetes
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As millions are set to develop type 2 diabetes during the next 20 years, researchers are seeking new ways to prevent the progressive disease. Now, data from a study conducted by researchers in Sweden suggest that the prevention of type 2 diabetes through bariatric surgery is markedly more efficient compared with lifestyle modifications.
Using the ongoing Swedish Obese Subjects (SOS) study, researchers conducted a prospective, controlled intervention trial examining the long-term effects of bariatric surgery compared with the effects of usual care. Of the 1,658 patients who had bariatric surgery, 311 underwent banding, 1,140 vertical banded gastroplasty and 207 had gastric bypass. Obese-matched control patients (n=1,771) received usual care. Patients from each group were aged 37 to 60 years and had no diagnosis of diabetes at baseline.
Based on questionnaires administered to patients at 6 months, 1 year and 2 years, 54% of control patients attempted to lose weight via professional guidance and 46% did not. According to researchers, physical examinations took place at matching and baseline examinations and after 6 months and 1, 2, 3, 4, 6, 8, 10 and 15 years. Additionally, biochemical assays were done at the matching visit, at baseline and after 2, 10 and 15 years.
Incidence rates (IR) were based on a 15-year follow-up, during which time 392 patients developed type 2 diabetes in the control group (IR=28.4; 95% CI, 25.7-31.3) and 110 patients developed type 2 diabetes in the bariatric surgery group (IR=6.8; 95% CI, 5.7-8.3), per 1,000 person-years.
In the control group, researchers found no significant differences between those who attempted to lose weight with professional guidance, and those who did not (P=.20). However, all forms of bariatric surgery (ie, gastric bypass, banding and vertical banded gastroplasty) were associated with a decreased incidence of type 2 diabetes (P<.001).
“The results of this analysis show that bariatric surgery, as compared with usual care, reduces the long-term incidence of type 2 diabetes by 78% in obese patients,” researchers wrote. “Among patients with impaired fasting glucose, bariatric surgery reduced the risk by 87%, and type 2 diabetes did not develop in approximately 10 of 13 obese patients who underwent bariatric surgery.”
These data suggest that glucose metabolism disturbances could be treated early. However, researchers wrote that post hoc findings should be confirmed by prospective, controlled trials designed to study treatment effects on particular endpoints within subgroups.
Disclosure: Dr. Carlsson reports receiving consulting fees from AstraZeneca and owning stock in Sahltech. See the study for a full list of relevant financial disclosures.
Perspective
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George A. Bray, MD
The Swedish Obese Subjects (SOS) study has been an important source of prospective information about the effects of bariatric surgery. In this very nice study following patients out to 15 years, there was a highly significant (83%) reduction in the risk for conversion to diabetes. These data extend the data from a number of other studies with bariatric surgery showing that this form of treatment can profoundly affect both the risk for developing diabetes and for reversing diabetes in many patients with diabetes at the time of surgery. The effect appears to be, at least in part, related to the degree of weight loss and the functional capacity of the pancreatic beta cell. As shown in this paper, the benefits were greatest in those individuals with impaired glucose tolerance and higher insulin than in individuals with more normal values. For many people at high risk for diabetes, bariatric surgery may be a treatment worth considering.
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