Life Expectancy After Bariatric Surgery or Usual Care in Patients with or Without Baseline Type 2 Diabetes in Swedish Obese Subjects

Overview

Journal Int J Obes (Lond)

Specialty Endocrinology

Date 2023 Jul 12

PMID 37438611

Authors

Lena M S Carlsson

Bjorn Carlsson

Peter Jacobson

Cecilia Karlsson

Johanna C Andersson-Assarsson

Felipe M Kristensson

Sofie Ahlin

Per-Arne Svensson

Magdalena Taube

Ingmar Naslund

Kristjan Karason

Markku Peltonen

Kajsa Sjoholm

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine life expectancy and causes of death after bariatric surgery in relation to baseline type 2 diabetes (T2D) in the prospective, Swedish Obese Subjects study.

Methods: The study included 2010 patients with obesity who underwent bariatric surgery and 2037 matched controls, eligible for surgery. The surgery group underwent gastric bypass (n = 265), banding (n = 376), or vertical banded gastroplasty (n = 1369). The control group (n = 2037) received usual obesity care. Causes of death were obtained from the Swedish Cause of Death Register, case sheets and autopsy reports, in patients with baseline T2D (n = 392 surgery patients/n = 305 controls) or non-T2D (n = 1609 surgery patients/n = 1726 controls) during a median follow-up 26 years.

Results: In T2D and non-T2D subgroups, bariatric surgery was associated with increased life expectancy (2.1, 95% confidence interval (95% CI) 0.2-4.0; and 1.6, 0.5-2.7 years, respectively) and reduced overall mortality (adjusted hazard ratio (adjHR) = 0.77, 95% CI: 0.61-0.97; and 0.82, 0.72-0.94, respectively), and the treatment benefit was similar (interaction p = 0.615). Bariatric surgery was associated with reduced cardiovascular mortality in both subgroups (adjHR = 0.65, 95% CI: 0.46-0.91; and 0.70, 0.55-0.88, respectively (interaction p = 0.516)).

Conclusions: Bariatric surgery is associated with similar reduction of overall and cardiovascular mortality and increased life expectancy regardless of baseline diabetes status.

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References

Sjostrom L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden A . Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014; 311(22):2297-304. DOI: 10.1001/jama.2014.5988. View

Carlsson L, Sjoholm K, Jacobson P, Andersson-Assarsson J, Svensson P, Taube M . Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study. N Engl J Med. 2020; 383(16):1535-1543. PMC: 7580786. DOI: 10.1056/NEJMoa2002449. View

Carstensen B, Ronn P, Jorgensen M . Lifetime risk and years lost to type 1 and type 2 diabetes in Denmark, 1996-2016. BMJ Open Diabetes Res Care. 2021; 9(1). PMC: 7929801. DOI: 10.1136/bmjdrc-2019-001065. View

Carlsson L, Sjoholm K, Karlsson C, Jacobson P, Andersson-Assarsson J, Svensson P . Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol. 2017; 5(4):271-279. PMC: 5394228. DOI: 10.1016/S2213-8587(17)30061-X. View

Sjostrom L, Narbro K, Sjostrom C, Karason K, Larsson B, Wedel H . Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007; 357(8):741-52. DOI: 10.1056/NEJMoa066254. View

Arterburn D, Bogart A, Sherwood N, Sidney S, Coleman K, Haneuse S . A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2012; 23(1):93-102. PMC: 4641311. DOI: 10.1007/s11695-012-0802-1. View

Zhang K, Luo Y, Dai H, Deng Z . Effects of Bariatric Surgery on Cancer Risk: Evidence from Meta-analysis. Obes Surg. 2019; 30(4):1265-1272. DOI: 10.1007/s11695-019-04368-4. View

Lent M, Benotti P, Mirshahi T, Gerhard G, Strodel W, Petrick A . All-Cause and Specific-Cause Mortality Risk After Roux-en-Y Gastric Bypass in Patients With and Without Diabetes. Diabetes Care. 2017; 40(10):1379-1385. PMC: 5606311. DOI: 10.2337/dc17-0519. View

Cohen R, Sforza N, Clemente R . Impact of Metabolic Surgery on Type 2 Diabetes Mellitus, Cardiovascular Risk Factors, and Mortality: A Review. Curr Hypertens Rev. 2020; 17(2):159-169. DOI: 10.2174/1573402116666200804153228. View

10.

Aminian A, Aleassa E, Bhatt D, Tu C, Khorgami Z, Schauer P . Bariatric surgery is associated with a lower rate of death after myocardial infarction and stroke: A nationwide study. Diabetes Obes Metab. 2019; 21(9):2058-2067. DOI: 10.1111/dom.13765. View

11.

Lingvay I, Sumithran P, Cohen R, le Roux C . Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet. 2021; 399(10322):394-405. DOI: 10.1016/S0140-6736(21)01919-X. View

12.

Syn N, Cummings D, Wang L, Lin D, Zhao J, Loh M . Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021; 397(10287):1830-1841. DOI: 10.1016/S0140-6736(21)00591-2. View

13.

Courcoulas A, Johnson E, Arterburn D, Haneuse S, Herrinton L, Fisher D . Reduction in Long-term Mortality After Sleeve Gastrectomy and Gastric Bypass Compared to Nonsurgical Patients With Severe Obesity. Ann Surg. 2021; 277(3):442-448. PMC: 8840990. DOI: 10.1097/SLA.0000000000005155. View

14.

Brantley P, Waldo K, Matthews-Ewald M, Brock R, Champagne C, Church T . Why patients seek bariatric surgery: does insurance coverage matter?. Obes Surg. 2014; 24(6):961-4. PMC: 4111953. DOI: 10.1007/s11695-014-1237-7. View

15.

Carlsson L, Peltonen M, Ahlin S, Anveden A, Bouchard C, Carlsson B . Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012; 367(8):695-704. DOI: 10.1056/NEJMoa1112082. View

16.

Adams T, Meeks H, Fraser A, Davidson L, Holmen J, Newman M . Long-term all-cause and cause-specific mortality for four bariatric surgery procedures. Obesity (Silver Spring). 2023; 31(2):574-585. PMC: 9881843. DOI: 10.1002/oby.23646. View

17.

Adams T, Stroup A, Gress R, Adams K, Calle E, Smith S . Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009; 17(4):796-802. PMC: 2859193. DOI: 10.1038/oby.2008.610. View

18.

Arterburn D, Olsen M, Smith V, Livingston E, Van Scoyoc L, Yancy Jr W . Association between bariatric surgery and long-term survival. JAMA. 2015; 313(1):62-70. DOI: 10.1001/jama.2014.16968. View