Potential benefits and harms of gastric bypass surgery in obese individuals with type 1 diabetes: a nationwide, matched, observational cohort study

Abstract

<b>Objective:</b> To study the potential long‑term benefits and possible complications of bariatric surgery in patients with type 1 diabetes. <p> </p> <p><b>Research Design and Methods:</b> In this register‑based nationwide cohort study we compared individuals with T1D and obesity that underwent Roux‑en‑Y gastric bypass surgery (RYGB) with patients with T1D and obesity matched for age, gender, BMI and calendar time that did not undergo surgery. By linking the Swedish National Diabetes Register and Scandinavian Obesity Surgery Registry study individuals were included between 2007 and 2013. Outcomes examined included all-cause mortality, cardiovascular disease, stroke, heart failure and hospitalization for serious hypo‑ or hyperglycemic events, amputation, psychiatric disorders, changes in kidney function and substance abuse.</p> <p> </p> <p><b>Results:</b> We identified 387 individuals that had undergone RYGB and 387 controls. Follow‑up for hospitalization was up to 9 years. Analysis showed lower risk for cardiovascular disease (HR 0.43, 95% CI 0.20‑0.9), cardiovascular death (HR 0.15, 95% CI 0.03-0.68), hospitalization for heart failure (HR 0.32, 95% CI 0.15‑0.67) and stroke (HR 0.18, 95% CI 0.04-0.82) for the RYGB group. There was a higher risk for serious hyperglycemic events (HR 1.99, 95% CI 1.07‑3.72) and substance abuse (HR 3.71, 95% CI 1.03-3.29) after surgery. </p> <p> </p> <p><b>Conclusion:</b> This observational study suggests bariatric surgery may yield similar benefits on risk for cardiovascular outcomes and mortality in patients with T1D and obesity as for patients with type 2 diabetes. However, some potential serious adverse effects suggest need for careful monitoring of such patients after surgery. </p>

Obesity in people living with type 1 diabetes

“…87 A Swedish observational study in people with type 1 diabetes compared 387 people who had RouxenY Gastric Bypass versus a control group of 387 people with obesity, matched for age, sex, BMI, and calendar year of surgery. 88 The authors saw a lower risk of cardiovascular disease (hazard ratio [HR] 0•43 [0•20-0•9]), cardiovascular death (0•15 [0•03-0•68]), and stroke (0•18 [0•04-0•82]) for the bypass group, but no improvement in glycaemic control and a higher risk for hyperglycaemic events (1•99 [1•07-3•72]) and substance misuse (3•71 [1•03-3•29]), compared with the control group. 88 Other studies 87,89 yielded similar results, but all studies em phasised that although shortterm results of bariatric surgery in people with type 1 diabetes are encouraging, larger and longerterm studies are needed.…”

“…88 The authors saw a lower risk of cardiovascular disease (hazard ratio [HR] 0•43 [0•20-0•9]), cardiovascular death (0•15 [0•03-0•68]), and stroke (0•18 [0•04-0•82]) for the bypass group, but no improvement in glycaemic control and a higher risk for hyperglycaemic events (1•99 [1•07-3•72]) and substance misuse (3•71 [1•03-3•29]), compared with the control group. 88 Other studies 87,89 yielded similar results, but all studies em phasised that although shortterm results of bariatric surgery in people with type 1 diabetes are encouraging, larger and longerterm studies are needed. 89 However, largescale prospective trials are difficult to do in this patient group, because bariatric surgery is not often done in people with type 1 diabetes so, for studies to include sufficient numbers, international collaboration is needed.…”

The Effects of Bariatric Surgery on Cardiovascular Outcomes and Cardiovascular Mortality: A Systematic Review and Meta-Analysis

“…The studies showed high heterogeneity with an I 2 = 79%. Sources: [13,17,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35]40] Like previously mentioned, Bouchard et al [13] reported a combined incidence and hence was excluded. Johnson et al [26], Sjöström et al [23,25], Michaels et al [31], and Ardissino et al [20] provided only the incidence data and were not included in the analysis.…”

Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation

“…111,[176][177][178][179][180][181][182][183][184][185][186][187][188] Observational data regarding surgical interventions show that bariatric procedures improve weight loss as well as incidence of T2DM (lowered by 78%), CV death, MI and stroke (reduced by 33%) over a 15-year follow-up. [156][157][158][159][189][190][191][192][193][194][195] There is also evidence for bariatric surgery being associated with larger potential reductions of cardiorenal complications (eg, HF) than ASCVD outcomes in patients living with T2DM and obesity. 196 Although bariatric surgery is very effective for weight loss and the observational data summarised above provide 'proof of principle' that weight loss is likely to be beneficial for CVD prevention in those with severe obesity, the proportion of people currently able to access surgery is extremely low compared to the numbers of people living with obesity.…”

“…Bariatric surgery has been shown to promote weight loss, reduce CV risk factors, and lower overall CVD risk. 105,110,122,[155][156][157][189][190][191][192][193][194][195][196] Health professionals should discuss referral to appropriate bariatric surgery services with people who have severe obesity (in general, people with BMI >35 kg/m 2 with established CVD or BMI >40 kg/m 2 ).…”