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Metabolic surgery and mortality

Metabolic surgery reduces mortality from diabetes or any other cause

Bariatric patients were also 62 percent less likely to suffer a heart attack or stroke, although the duration of diabetes reduced the effect of metabolic surgery on the incidence of these macrovascular complications

People with diabetes and severe obesity who had metabolic surgery were much less likely to die from diabetes or any other cause than those who received drug therapy alone, according to a meta-analysis by German researchers who presented their findings at ObesityWeek 2018, hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS)and The Obesity Society (TOS).

In the presentation, ‘Metabolic surgery reduces mortality and macrovascular complications in patients with type 2 diabetes mellitus compared to medical therapy: a meta-analysis’ (Abstract no. 136), the researchers assessed 19 studies – six randomised controlled trials and 14 clinical trials published between 1997 and 2017 – and found that 66 percent fewer metabolic surgery patients died than patients who received standard medical therapy for their diabetes.

Patients were also 62 percent less likely to suffer a heart attack or stroke, although the duration of diabetes reduced the effect of metabolic surgery on the incidence of these macrovascular complications. The average BMI42 in the surgery group and BMI40 in the medical therapy group.

Adrian T Billeter

"This analysis shows metabolic surgery is the only therapy that beneficially affects all diabetes-related complications, at the same time resulting in fewer deaths and cardiovascular events," said Dr Adrian T Billeter, lead study author from the University of Heidelberg in Germany. "The majority of diabetes medications do not have such an effect, so the case for metabolic surgery is very compelling."

In another meta-analysis published earlier this year in the British Journal of Surgery, Billeter and colleagues reported that metabolic surgery was also superior to medical therapy, by as much as 74 percent, in preventing the development of microvascular complications including diabetic nephropathy, neuropathy, and retinopathy in patients with type 2 diabetes and severe obesity.

"This study adds to the enormous amount of data demonstrating the profound and definitive effect of metabolic surgery on obesity, diabetes and its complications that no other therapy can achieve, yet surgery remains vastly underutilized as a treatment," said Dr Samer Mattar, president, ASMBS and medical director at Swedish Weight Loss Services in Seattle, Washington, who was not involved in the study. "While metabolic surgery is certainly not for everyone, there are many factors to consider, many are missing out on a transformational procedure."

The CDC reports 93.3 million or 39.8 percent of adults in the US had obesity in 2015-2016. The ASMBS estimates about 24 million have severe obesity, which for adults means a BMI>35 with an obesity-related condition like diabetes or a BMI of 40 or more. In 2017, 228,000 bariatric procedures were performed in the US, which is about 1 percent of the population eligible for surgery based on BMI.

The co-authors of the study were Drs Adrian T Billeter, Katharina Scheurlen, Stefan Kopf, Pascal Probst, Beat P Müller-Stich and Sebastian Eichel (medical student) all from the University of Heidelberg, Germany.

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