A retrospective cohort study performed by David P. Fisher and his colleagues was published in JAMA, showing that bariatric surgery in obese patients with diabetes was associated with a lower incidence of macrovascular events.
The investigators followed up 5301 adults with type 2 diabetes mellitus who had severe obesity described as a body mass index (BMI) of more than 35 who had bariatric surgery as cases and matched 3 non-surgical controls for each bariatric surgery patient based on sex, age, BMI, HbA1c level, and insulin use with a total number of 14934 control patients. The data were analyzed retrospectively for 6 years. Multiple data systems were used to extract information. The primary endpoint was defined as time to either first cardiovascular or cerebrovascular event and also all-cause mortality. Investigators used adjusted Cox regression models for endpoint analysis and E-value methodology of VanderWeele and Ding for sensitivity analysis.
“These findings have strong biological plausibility and are consistent with other research. Randomized trials have demonstrated that bariatric procedures are more effective than the best-available intensive medical and lifestyle interventions in promoting weight loss, improving glycemic control and serum lipid levels, and reducing the need for medications used to control diabetes, hypertension, and dyslipidemia. “- Dr. David P. Fisher, M.D.
David P. Fisher et al. followed up patients in the surgical and non-surgical group for a mean duration of 4.7 and 4.6 years respectively. The follow up results in 1, 3, 5, and 7 years for macrovascular disease incident were 0.5%, 1.1%, 2.1%, and 3.2%, respectively for patients undergoing bariatric surgery, and 1.1%, 2.6%, 4.3%, and 6.2% for patients in the matched controls group. They calculated a hazard ratio of 0.60 for macrovascular disease incident when comparing patients undergoing surgery to patients in the non-surgical group. It was reported that during the follow up at 1, 3, 5, and 7 years, the mortality rates were 0.4%, 0.9%, 1.3%,and 2.0%,respectively, for patients undergoing bariatric surgery and 0.9%,2.7%, 4.5%, 6.4% for patients in the matched controls group. They reported that the risk of all-cause mortality for 5 years was significantly lower in patients who underwent bariatric surgery as compared to non-surgical patients.
Investigators discussed that the effect of bariatric surgery on the improvement in glycemic control was more significant in patients undergoing Roux-en-Y surgery as compared to other bariatric surgery techniques. The authors mentioned that although their study was deterministic for evaluation of bariatric surgery and macrovascular events, there is still room for further randomized clinical trials to focus on this matter.
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