Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications

Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297-2304.

This analysis examined long-term type 2 diabetes remission and macro- and microvascular complications among subjects in the Swedish Obese Subjects (SOS) study who underwent bariatric surgery or were part of the control (usual care) group and had type 2 diabetes at baseline.

SOS included subjects aged 37-60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women). The bariatric surgery group received adjustable or nonadjustable banding, vertical banded gastroplasty, or gastric bypass. The control group received customary lifestyle and pharmacologic treatment for obesity and type 2 diabetes.

Current analysis:

  • Bariatric surgery (n=343)
  • Control (n=260)
  • All subjects: type 2 diabetes at baseline

The primary outcomes were as follows: type 2 diabetes remission*, relapse, incidence of diabetes complications. Median follow-up for diabetes assessment in both groups was 10 years; 18.1-year median follow-up in bariatric surgery group and 17.6-year median follow-up in control group for complications.

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Bariatric Surgery Association With Long-Term Type 2 Diabetes Remission and Complications in the SOS Study Design  
Bariatric Surgery Association With Long-Term Type 2 Diabetes Remission and Complications in the SOS Study: Design  

Type 2 diabetes remission
For the primary outcome: type 2 diabetes remission* (proportion in type 2 diabetes remission, %) decreased at Year 15 vs Year 2:

  • At 2 years:
    • Bariatric surgery: 72.3 (219/303)
    • Control: 16.4 (34/207)
    • Unadjusted OR, 13.3; 95% CI, 8.5-20.7; P<0.001
     
  • At 15 years:
    • Bariatric surgery: 30.4 (35/115)
    • Control: 6.5 (4/62)
    • Unadjusted OR, 6.3; 95% CI, 2.1-18.9; P<0.001
     

Greater remission rates were seen with all types of bariatric surgery received in the study (adjustable or nonadjustable banding, vertical banded gastroplasty, gastric bypass) vs usual care (control). Shorter type 2 diabetes duration at baseline was associated with higher diabetes remission rates among subjects who received bariatric surgery at Years 2, 10, and 15. Among subjects who underwent bariatric surgery and had a shorter type 2 diabetes duration at baseline, an association was seen with high remission rate at 2 years (P<0.001), as well as low rate of type 2 diabetes relapse between 2 and 10 years of follow-up (P=0.03). 

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Type 2 Diabetes Remission With Bariatric Surgery Vs Control at 15 Years in SOS  
Type 2 Diabetes Remission With Bariatric Surgery Vs Control at 15 Years in SOS 

Type 2 diabetes complications
For the primary outcome of incidence of type 2 diabetes complications (incidence rate per 1,000 person-years):

  • Microvascular
    • Bariatric surgery: 20.6 (95% CI, 17.0-24.9); 106 events
    • Control: 41.8 (95% CI, 35.3-49.5); 134 events
    • HR, 0.44; 95% CI, 0.34-0.56; P<0.001
     
  • Macrovascular
    • Bariatric surgery: 31.7 (95% CI, 27.0-37.2); 151 events
    • Control: 44.2 (95% CI, 37.5-52.1); 142 events
    • HR, 0.68; 95% CI, 0.54-0.85; P=0.001
     

Longer type 2 diabetes duration at baseline was significantly associated with increased risk of macro- and microvascular complications. 

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Decreased Incidence of Type 2 Diabetes Complications With Bariatric Surgery Vs Control Over Long-Term Follow-up in SOS  
Decreased Incidence of Type 2 Diabetes Complications With Bariatric Surgery Vs Control Over Long-Term Follow-up in SOS 

Weight loss
Mean weight loss was 26.3 kg (21.2%) in the bariatric surgery group (n=304) and 3.0 kg (2.4%) in the control group at 2 years (n=207; P<0.001), and 22.5 kg (18.0%) in the bariatric surgery group (n=239) and 4.4 kg (3.6%) in the control group at 10 years (n=134; P<0.001).  

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Long-Term Weight Loss With Bariatric Surgery Vs Control in SOS   
Long-Term Weight Loss With Bariatric Surgery Vs Control in SOS 

*Blood glucose <110 mg/dL and no antihyperglycemic medication
Microvascular complications: eyes, kidneys, and peripheral nerves, whichever came first; macrovascular complications: legs, heart, and brain, whichever came first 

 
   

June 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 8/4/2014