Bariatric Surgery Reduces Macrovascular Risks in Obese Diabetes Patients

Obese patients with type 2 diabetes who underwent bariatric surgery significantly decreased their odds of macrovascular outcomes compared with patients who did not have surgery, in a new retrospective, cohort matched study. 

Severely obese patients (body mass index [BMI] ≥ 35) with type 2 diabetes aged 19 to 79 years who underwent bariatric surgery from 2005 to 2011 (n = 5,301) were matched to 14,934 controls, for a total of 20,235 patients (mean age, 50 years). In the surgical and nonsurgical cohorts, patients were 76% and 75% female, respectively, and baseline mean BMI was 44.7 and 43.8, respectively. 

Over the study period, the surgical cohort experienced 106 macrovascular events (including 37 cerebrovascular and 78 coronary artery events), while the nonsurgical group had 596 macrovascular events (including 227 cerebrovascular and 398 coronary artery events). At five years, bariatric surgery was associated with a lower incidence of macrovascular events (2.1% in the surgical group vs 4.3% in the nonsurgical group; hazard ratio (HR), 0.60 [95% CI, 0.42-0.86]), and coronary artery disease (1.6% in the surgical group vs 2.8% in the nonsurgical group; HR, 0.64 [95% CI, 0.42-0.99]). Cerebrovascular disease incidence did not differ greatly between the groups at five years (0.7% in the surgical group vs 1.7% in the nonsurgical group; HR, 0.69 [95% CI, 0.38-1.25]). 

The researchers added that the findings have not yet been confirmed in a clinical trial. In an accompanying editorial, Dr. Paulina Salimnen said that a clinical trial “would be extremely challenging and expensive, not to mention the evident ethical concern as the mounting evidence clearly shows superior glycemic control and greater macrovascular risk factor reduction after bariatric surgery compared with both intensive lifestyle and medical treatment combined.” 

Still, Salminen said the findings “further add to the current debate and discussion of the use of bariatric and metabolic surgery in the treatment for type 2 diabetes–bariatric surgery should also be intended to prevent type 2 diabetes complications as prevention is better than cure.” 

“Surgical options have not yet been included in the existing diabetes treatment algorithms despite the existing sufficient clinical and mechanistic evidence supporting the inclusion of metabolic surgery among antidiabetes interventions for patients with type 2 diabetes and obesity according to the recent Diabetes Surgery Summit guidelines,” Salminen wrote. 

The study authors recommended, “Health care professionals should engage patients with severe obesity and type 2 diabetes in a shared decision making conversation about the potential role of bariatric surgery in the prevention of macrovascular events.” 

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Source: JAMA: Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity; Standardized Uniform Reporting and Indications for Bariatric and Metabolic Surgery