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Bariatric surgery reduced onset of type 2 diabetes in patients with obesity
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Bariatric surgery decreased the likelihood patients with obesity would develop type 2 diabetes for as long as 7 years after the procedure, according to research published in The Lancet Diabetes & Endocrinology.
“Our study shows that in people with severe obesity, weight-loss surgery is associated with a substantial reduction in the risk of new-onset diabetes,” Martin C. Gulliford, FFPH, of King’s College London, United Kingdom, told Endocrine Today.
Gulliford and colleagues from other institutions identified adults aged 20 to 100 years with obesity (BMI ≥30 kg/m2) but not diabetes through a national database of family practices in order to conduct a population-based cohort study.
The investigators matched 2,167 patients who underwent bariatric surgery between January 1, 2002, and April 30, 2014, with 2,167 controls who had not had surgery according to BMI, age, sex, index year and HbA1c. Surgeries included laparoscopic gastric banding (n=1,053), gastric bypass (n=795) and sleeve gastrectomy (n=317); two surgeries were undefined.
Confirming previous studies
Through a systematic review, the researchers found four studies that assessed diabetes incidence after surgery. None were population-based, and the largest was the Swedish Obese Subjects study involving 1,658 participants; however, all had also suggested a reduced occurrence of diabetes after bariatric surgery.
“These results show that currently used weight-loss procedures may be effective in preventing or delaying the onset of diabetes, confirming the results of the earlier Swedish Obese Subjects study,” Gulliford said.
The researchers extracted data on the development of clinical diabetes from electronic health records and conducted analyses with adjustments for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs.
During a maximum of 7 years of follow-up (median, 2.8 years; IQR 1.3-4.5), 38 new diabetes diagnoses were made in surgery patients vs. 177 in controls. By the end of 7 years of follow-up, 4.3% (95% CI, 2.9-6.5) of bariatric surgery patients had developed diabetes vs. 16.2% (95% CI, 13.3-19.6) of controls.
Per 1,000 person-years, the incidence of diabetes diagnosis was 5.7 (95% CI, 4.2-7.8) in bariatric surgery patients and 28.2 (95% CI, 24.4-32.7) in controls, with an adjusted HR of 0.20 (95% CI, 0.13-0.30).
After varying the comparison group in sensitivity analyses, excluding gestational diabetes or allowing for competing mortality risk, the evaluations remained strong.
“While obesity prevention must be a key public health objective to control the epidemic of diabetes, weight-loss surgery may have a role in those who have already developed severe obesity,” Gulliford said.
In a related commentary, Jacques Himpens, MD, of Saint Pierre University Hospital, Brussels, Belgium, called the findings “important” but highlighted variables that presented limitations.
“Although the results … bring us a step closer to confirming the effect of bariatric surgery on the incidence of de-novo type 2 diabetes,” he wrote, “many questions still remain unanswered, and more evidence is needed to convince endocrinologists about the nature of this effect.” — by Allegra Tiver
For More Information: Gulliford can be reached at the Department of Primary Care and Public Health, King’s College London, London SE1 3QD, UK; email: martin.gulliford@kcl.ac.uk.
Disclosures: This research was funded by the UK National Institutes for Health Research (NIHR) Health Services and Delivery Research program; three researchers report support from the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London
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