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June 10, 2014
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Bariatric surgery yielded longer-term diabetes remission than usual care

Diabetes remission is more likely for patients with obesity who undergo bariatric surgery than those who continue customary lifestyle and pharmacological treatment, according to findings published in JAMA.

In the Swedish Obese Subjects (SOS) prospective matched cohort study, patients with type 2 diabetes also experienced fewer cumulative microvascular and macrovascular complications in the long term after surgery vs. usual care.

Lars Sjöström, MD, PhD, of the University of Gothenburg, Sweden, and colleagues conducted a follow-up of the SOS study, which included 25 surgical departments and 480 primary health care centers throughout the country.

Of the patients recruited during nearly 15 years, 260 of 2,037 control patients and 343 of 2,010 bariatric surgery patients had type 2 diabetes at baseline. Surgeries included adjustable or nonadjustable banding (n=61), vertical banded gastroplasty (n=227) and gastric bypass (n=55); the control group received usual obesity and diabetes care.

For the purpose of the follow-up, the researchers determined current diabetes status from SOS health examinations and updated information on diabetes complications from national health registers. Participation rates were 81% in the control group vs. 90% in the surgery group at the 2-year examination; 58% vs. 76% at the 10-year examination; and 41% vs. 47% at the 15-year examination.

Median diabetes status follow-up was 10 years for the control group (interquartile range [IQR], 2-15) and 10 years for the surgery groups (IQR, 10-15). Median diabetes complications follow-up was 17.6 years for control (IQR, 14.2-19.8) and 18.1 years for surgery (IQR, 15.2-21.1).

Diabetes remission rates were higher with surgery:

  • At 2 years: control, 16.4% (34/207) vs. surgery, 72.3% (219/303), for an OR of 13.3 (95% CI, 8.5-20.7);
  • At 15 years: control, 6.5% (4/62) vs. surgery, 30.4% (35/115), for an OR of 6.3 (95% CI, 2.1-18.9).

Cumulative incidence of complications decreased with surgery:

  • Microvascular: control, 41.8 per 1,000 person-years (95% CI, 35.3-49.5) vs. surgery, 20.6 per 1,000 person-years (95% CI, 17-24.9), for a HR of 0.44 (95% CI, 0.34-0.56).
  • Macrovascular: control, 44.2 per 1,000 person-years (95% CI, 37.5-52.1) vs. surgery, 31.7 per 1,000 person-years (95% CI, 27-37.2), for a HR of 0.68 (95% CI, 0.54-0.85).

“In this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care,” the researchers wrote. “These findings require confirmation in randomized trials.”

Disclosure: Please see the study for full list of researchers’ financial disclosures.

Sources/Disclosures

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Source: Sjöström L. JAMA. 2014;doi:311:2297-2304.