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SOS outcomes

15-year SOS outcomes show surgical superiority

Bariatric surgery patients show greater rate of diabetes remission
Bariatric surgery patients had fewer complications than patients who received usual care

Bariatric surgery was associated with greater remission from diabetes and fewer complications than patients who received usual care, according the 15-year outcomes from the Swedish Obese Subjects (SOS) study. Published in JAMA, the reported diabetes remission rate two years after surgery was 16.4% (11.7%-22.2%; 34/207) for control patients and 72.3% (66.9%-77.2%; 219/303) for bariatric surgery patients (p<0.001). However, at 15 years, the diabetes remission rates decreased to 6.5% (4/62) for control patients and to 30.4% (35/115) for bariatric surgery patients (p<0.001).

Furthermore, the cumulative incidence of microvascular complications was 41.8 per 1,000 person-years for control patients and 20.6 per 1,000 person-years in the surgery group (p<0.001). Macrovascular complications were observed in 44.2 per 1,000 person-years in control patients and 31.7 per 1,000 person-years for the surgical group (p=0.001).

Dr Lars Sjostrom of the University of Gothenburg, Sweden, who is the lead author of the paper

The Swedish Obese Subjects (SOS) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary health care centres in Sweden. From the patients recruited between September 1987 and January 2001, 260 of 2,037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline.

Adjustable or nonadjustable banding (n = 61), vertical banded gastroplasty (n = 227), or gastric bypass (n = 55) procedures were performed in the surgery group, and usual obesity and diabetes care was provided to the control group. All types of bariatric surgery were associated with higher remission rates compared with usual care.

Diabetes status was determined at SOS health examinations until May 2013 and information on diabetes complications was obtained from national health registers until December 2012. Remission was defined as blood glucose <110mg/dL and no diabetes medication.

Participation rates at the two-, ten-, and 15-year examinations were 81%, 58%, and 41% in the control group and 90%, 76%, and 47% in the surgery group. For diabetes assessment, the median follow-up time was ten years in the control and surgery groups. For diabetes complications, the median follow-up time was 17.6 years and 18.1 years in the control and surgery groups, respectively.

"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. These findings require confirmation in randomized trials," the authors conclude.

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