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Surgery reduces T2DM risk

Surgery substantially reduces risk of developing T2DM

The results showed that there were 38 new diagnoses of diabetes in bariatric surgery patients and 177 in controls during the seven years after the procedure

Bariatric could reduce the risk of developing type 2 diabetes by around 80% in obese people, compared with standard care, according to a paper 'Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study', published in The Lancet Diabetes & Endocrinology}} journal.

"Our results suggest that bariatric surgery may be a highly effective method of preventing the onset of new diabetes in men and women with severe obesity,” said lead author of the study, Professor Gulliford, Professor of Public Health at King's College London, UK. “We need to understand how weight loss surgery can be used, together with interventions to increase physical activity and promote healthy eating, as part of an overall diabetes prevention strategy."

Using electronic health records from the UK Clinical Practice Research Datalink, Gulliford and colleagues assessed the effect of contemporary surgical weight loss procedures on the development of diabetes.

They identified 2,167 obese adults without diabetes who underwent one of three surgical procedures (1,053 (49%) patients received laparoscopic gastric banding, 795 (37%) had gastric bypass procedures and 317 (15%) underwent sleeve gastrectomy; two people had codes for more than one type of procedure on the index date) for weight loss from 2002 onwards. These participants were compared with 2,167 controls matched for age, sex, BMI, and blood glucose control (measured as HbA1c) who did not have surgery or other obesity treatments. Participants were followed up for a maximum of seven years (median 2.8 years).

Bariatric surgery patients and controls were generally well matched for age, sex, and BMI; index BMI40 or higher for about 60% of all participants. However, surgery patients were more likely to have elevated blood pressure or raised total cholesterol values and were taking anti-hypertensive or lipid-lowering drugs.

Outcomes

The results showed that there were 38 new diagnoses of diabetes in bariatric surgery patients and 177 in controls during the seven years after the procedure. Figure 1 shows the incidence of diabetes in in both groups seven years after the procedure.

By the end of seven-year follow-up, 4.3% (95% CI 2·9—6·5) of bariatric surgery patients and 16.2% (13·3—19·6) of matched controls had developed diabetes and the incidence of diabetes was 28.2 (95% CI 24·4—32·7) diagnoses per 1,000 person-years in controls and 5.7 (4·2—7·8) per 1,000 person-years in bariatric surgery patients.

Figure 1: Incidence of type 2 diabetes in patients undergoing bariatric surgery and in matched controls during 7 years of follow-up

“In a large population-based cohort of obese patients undergoing bariatric surgery by contemporary methods, the risk of developing type 2 diabetes was reduced by 80% over a maximum of seven years of follow-up compared with controls who did not undergo surgery,” the authors note. “Our study is perhaps the first large-scale pragmatic study to assess the effect of current bariatric surgical procedures on diabetes incidence in the context of usual care settings (panel). Even in patients seen in routine clinical practice, our results show that modern bariatric surgical procedures have particular effectiveness for diabetes prevention in obese patients.”

Compared with controls, the unadjusted hazard ratio for development of diabetes in bariatric surgery patients was 0·20 (95% CI 0·14—0·30; p<0·0001). Multivariable adjustment for baseline characteristics had a “negligible effect on the size of the estimated hazard ratio”. The fully adjusted hazard ratio for bariatric surgery was 0·20 (0·13—0·30; p<0·0001).

“Our findings, together with those of previous studies suggest that bariatric surgery could be a highly effective method for prevention of diabetes in patients with severe obesity,” the authors conclude. “How should surgery for obesity be integrated into strategies for control of obesity and prevention of diabetes in the population at risk? Further research is needed to understand the outcomes of different levels of uptake of obesity surgery, and the long-term effects for patients who receive current surgical procedures for obesity.”

This research was funded by the UK National Institutes for Health Research (NIHR) Health Services and Delivery Research programme.

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