Gastric Bypass Surgery Leads to Long-term Remission or Improvement of Type 2 Diabetes and Significant Decrease of Microvascular and Macrovascular Complications

Chen, Yijun; Corsino, Leonor; Shantavasinkul, Prapimporn Chattranukulchai; Grant, John P.; Portenier, Dana; Ding, Laura; Torquati, Alfonso

doi:10.1097/sla.0000000000001509

Cited by 54 publications

(35 citation statements)

References 32 publications

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“…Patients with diabetes who were treated by bariatric surgery and experienced long-lasting remission, had markedly reduced risk of microvascular diabetes complications compared with those who were not in remission at the 15-year follow-up, however, it is unknown if patients cycled between remission and relapse before this time point. There have been similar findings in the literature; fewer microvascular complications in patients with diabetes who experienced remission after gastric bypass 28 and an additional reduction of the risk for microvascular disease for every year spent in remission after bariatric surgery, even if the patients eventually experienced a relapse. 29 Importantly, we also show that bariatric surgery reduces the risk of future microvascular events in those with prediabetes at baseline regardless of whether they had progressed to diabetes or remained diabetes free at the 15-year follow-up.…”

Section: Discussionsupporting

confidence: 76%

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

Carlsson

Sjöholm

Karlsson

et al. 2017

The Lancet Diabetes & Endocrinology

112

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Summary Background Bariatric surgery in patients with obesity and type 2 diabetes is associated with diabetes remission and prevention of complications. The long-term effects of bariatric surgery on microvascular complications in patients with prediabetes are unknown. Methods The prospective, matched Swedish Obese Subjects study examines outcomes after bariatric surgery. Patients were recruited between September 1, 1987, and January 31, 2001. Age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women. The surgery group (n=2010) underwent gastric bypass (13·2%), banding (18·7%), or vertical banded gastroplasty (68·1%), and controls (n=2037) received usual care. After exclusion of 4 patients with suspected type 1 diabetes, and 11 patients with unknown glucose status at baseline, 4032 of the 4047 participants in the SOS study were included in the current analysis. The main outcome of this report was incidence of microvascular events (retinopathy, diabetic kidney disease, and neuropathy, whichever came first), obtained from nationwide registers, in subgroups stratified by baseline glucose status (euglycemia n=2838; prediabetes n=591; screen-detected diabetes n=246; established diabetes n=357). Data were analyzed both by intention to treat and per protocol. Median follow-up was 19 years. This study is registered with ClinicalTrials.gov, NCT01479452. Findings There were 374 first-time microvascular events in the control group and 224 in the surgery group (hazard ratio, 0·56; 95% CI 0·48–0·66; p<0·0001). There was a significant interaction between baseline glucose status and treatment effect (p=0.0003), and unadjusted hazard ratios for comparing the surgery group to the control group were lowest in the subgroup with prediabetes (0·18; 95% CI 0·11–0·30), followed by subgroups with screen-detected diabetes (0·39; 95% CI 0·24–0·65), established diabetes (0·54; 95% CI 0·40–0·72), and euglycemia (0·63; 95% CI 0·48–0·81). In patients with baseline prediabetes, treatment was associated with reduced incidence of microvascular events both in those who developed diabetes and in those who remained diabetes free during follow-up. Interpretation Bariatric surgery was associated with reduced risk of microvascular complications in all subgroups, but the greatest relative risk reduction was observed in patients with baseline prediabetes. Our results indicate that prediabetes should be treated aggressively to prevent future microvascular events.

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Section: Discussionsupporting

confidence: 76%

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

Carlsson

Sjöholm

Karlsson

et al. 2017

The Lancet Diabetes & Endocrinology

112

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“…A recent study evidenced a 29% decrease in the risk of developing microvascular complications among patients surgically treated whose disease went into remission. In those that experienced a relapse after remission, the time they remained in remission was related inversely to the risk of microvascular complications [55]. These results would support a legacy effect for MS.…”

Section: What Are the Results Of Medical Vs Surgical Treatment In Thesupporting

confidence: 69%

“…In 10 years, a significant decrease in the development of microvascular complications in patients surgically treated (11.5% vs 46.3%) was observed as well as in macrovascular complications (5% vs 20.3%). 74.5% of patients operated had DM2 partial or complete remission, while none under medical treatment experienced remission of the disease [55].…”

Section: What Are the Results Of Medical Vs Surgical Treatment In Thementioning

confidence: 99%

Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico

et al. 2018

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Introduction Metabolic surgery (MS) can be a useful therapeutic strategy in patients with type 2 diabetes (DM2) and obesity. Objective To define the place of MS within DM2 treatment in Mexico. Methods A committee of experts consisting of internists and surgeons representing the leading Mexican associations involved in the field was created. Each one responded to a specific question regarding mechanisms involved in controlling DM2, surgical procedures, and the indications and contraindications for MS. This document was prepared based on the presentation and discussion of such answers.Results Obesity through insulin resistance, incretins, bile salts, and intestinal microbiota plays a determining role in the appearance of DM2. MS improves glucose homeostasis by reducing weight and intake, increasing incretins, and modifying bile salts and microbiota. MS leads to remission of DM2 and reduces cardiovascular risk factors in well-selected cases. We recommend MS as a therapeutic option in DM2 and grade III obesity regardless of metabolic control and grade II and grade I obesity with poor glycemic control. MS could be considered an option in grade II obesity with good metabolic control in the presence of associated comorbidities. Gastric bypass presents the most favorable risk-benefit profile.Conclusions Current evidence endorses the inclusion of MS in the algorithm for treatment of DM2 and obesity. The therapeutic approach must be multidisciplinary at experienced centers.

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“…Abstracted data related to patient population, inclusion of control participants, and microvascular and macrovascular outcomes are identified in this table. With the exception of the STAMPEDE trial (25), a 3-year RCT that reports on renal outcomes, the remainder of the referenced studies are prospective cohort trials (5,6,67,68), observational prospective trials (69–71), prospective pilot studies (72), retrospective cohort studies (4,73–88), case-control trials (89), or case reports (90–92). …”

Section: Microvascular and Macrovascular Complications: Reviewmentioning

confidence: 99%

Clinical Outcomes of Metabolic Surgery: Microvascular and Macrovascular Complications

et al. 2016

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Understanding of the long-term clinical outcomes associated with bariatric surgery has recently been advanced. Research related to the sequelae of diabetes—in particular, long-term microvascular and macrovascular complications—in patients who undergo weight-loss surgery is imperative to this pursuit. While numerous randomized control trials have assessed glucose control with bariatric surgery compared with intensive medical therapy, bariatric surgery outcome data relating to microvascular and macrovascular complications have been limited to observational studies and nonrandomized clinical trials. As a result, whether bariatric surgery is associated with a long-term reduction in microvascular and macrovascular complications when compared with current intensive glycemic control therapy cannot be determined because the evidence is insufficient. However, the consistent salutary effects of bariatric surgery on diabetes remission and glycemic improvement support the opportunity (and need) to conduct high-quality studies of bariatric surgery versus intensive glucose control. This review provides relevant background information related to the treatment of diabetes, hyperglycemia, and long-term complications; reports clinical findings (to date) with bariatric surgery; and identifies ongoing research focusing on long-term vascular outcomes associated with bariatric surgery.

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Gastric Bypass Surgery Leads to Long-term Remission or Improvement of Type 2 Diabetes and Significant Decrease of Microvascular and Macrovascular Complications

Cited by 54 publications

References 32 publications

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

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

Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico

Clinical Outcomes of Metabolic Surgery: Microvascular and Macrovascular Complications

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