Bariatric Surgery Associated With Decreased Mortality in Severely Obese Patients With Type 2 Diabetes

Bariatric surgery was found to be associated with reduced all-cause mortality among patients who were severely obese and had type 2 diabetes (T2D). These findings from a retrospective, population-based match cohort analysis were published in JAMA Network Open.

Patients (n=3455) with T2D and a BMI ³35 kg/m² undergoing bariatric surgery in Ontario, Canada, between 2010 and 2016 were assessed for clinical outcomes and compared with a matched control cohort (n=3455).

The majority of the participants were women (71.6%), with a mean age of 52.04 years and an average BMI of 44.67 kg/m². Nearly half of the participants (44.2%) had been diagnosed with T2D within the past 5 years. Among the surgery cohort, 86.7% underwent gastric bypass and 13.3% underwent sleeve gastrectomy.

At a median follow-up of 4.6 years, 83 deaths occurred among the surgery group and 178 deaths occurred among the controls, indicating surgery to be associated with a decreased risk for all-cause mortality (absolute risk reduction 2.7% [95% CI, 1.9-3.6).

Decreased risk for all-cause mortality associated with bariatric surgery was observed among patients with a BMI >50 kg/m² (aHR, 0.44; 95% CI, 0.26-0.74), those with shorter (£5 years) duration of T2D (aHR, 0.48; 95% CI, 0.29-0.78), among women (aHR, 0.52; 95% CI, 0.37-0.73), with gastric bypass procedures (aHR, 0.54; 95% CI, 0.40-0.71) and with age (45-54 years; aHR, 0.56; 95% CI, 0.34-0.93).

Bariatric surgery also associated with reduced diabetes-related cardiovascular (HR, 0.66; 95% CI, 0.53-0.82; P <.001) and renal (HR, 0.55; 95% CI, 0.33-0.90; P =.02) events, cardiac-related mortality (HR, 0.23; 95% CI, 0.11-0.48; P <.001), and cancer-related mortality (HR, 0.42; 95% CI, 0.23-0.80; P =.006).

This study may have been biased due to overfitting, as the investigators chose to include all clinical parameters in their model.

These data indicate that patients who are severely obese and who have T2D may benefit from bariatric surgery, with subsequent decreased risk for all-cause mortality and diabetes-related cardiovascular and renal outcomes.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Doumouras AG, Lee Y, Paterson JM, et al. Association between bariatric surgery and major adverse diabetes outcomes in patients with diabetes and obesity. JAMA Netw Open. 2021;4(4):e216820. doi:10.1001/jamanetworkopen.2021.6820