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SA JOURNAL OF DIABETES & VASCULAR DISEASE
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VOLUME 11 NUMBER 2 • JUNE 2014
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B
ariatric surgery comes out ahead, with greater weight loss, dia-
betes remission and fewer cardiovascular disease (CVD) compli-
cations than standard medical care. Fifteen years after undergoing
bariatric surgery, 30% of patients no longer had diabetes, but only
7% of patients who received usual care were in diabetes remission.
These long-term findings from the Swedish Obese Subjects
(SOS) prospective, matched-cohort study by Dr Lars Sjöström,
from Sahlgrenska University Hospital, in Gothenburg, Sweden,
and colleagues (J Am Med Assoc 2014; 311: 2297–2304, 2277–
2278) were published to coincide with the American Diabetes
Association Conference in San Francisco.
The study also shows that ‘obese diabetics whose diabetes was
of shorter duration or who had the greatest weight loss between
the time of surgery and two years later were the most likely to
have a sustained remission at 15 years. These patients likely had
bariatric surgery before the failure of the insulin-producing cells
of the pancreas was irreversible.’
The SOS study enrolled 4 047 obese patients in Sweden
between 1987 and 2001. The current analysis looked at those who
had diabetes at baseline: 260 patients who then received usual
medical care and 343 patients who underwent bariatric surgery:
vertical banded gastroplasty (227 patients), non-adjustable or
adjustable banding (61), or Roux-en-Y gastric bypass (55).
The patients had a mean age of around 50 years, a mean body
mass index (BMI) of close to 41 kg/m2 and almost 60% were
women. They had had diabetes for approximately three years.
The researchers tracked microvascular complications of
the kidney, eyes and peripheral nerves and macrovascular
complications (coronary heart disease, heart failure, stroke and
peripheral arterial disease) after a median of 17 years. Diabetes
remission was defined as having a blood glucose level below
110 mg/dl and not taking antidiabetic medication.
Bariatric surgery was associated with higher diabetes remission
rates and weight loss compared with usual care, although these
rates declined over time in both groups. This surgery was also
associated with a significantly decreased risk for microvascular
and macrovascular complications (hazard ratios: 0.43 and 0.74,
respectively).
Additional follow up of newer studies is required to answer the
question of which bariatric procedure is best for inducing long-
term remission of diabetes, but those data will not be available
for another five to 10 years.
Source:
has-better-outcomes-after-15-years
Bariatric surgery has better outcomes after 15 years
