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. 2021 Apr 1;4(4):e216820.
doi: 10.1001/jamanetworkopen.2021.6820.

Association Between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients With Diabetes and Obesity

Aristithes G Doumouras  1   2 , Yung Lee  1 , J Michael Paterson  2   3 , Hertzel C Gerstein  4   5 , Baiju R Shah  2   6   7 , Branavan Sivapathasundaram  2 , Jean-Eric Tarride  8   9 , Mehran Anvari  1   2 , Dennis Hong  1   2
Affiliations

Association Between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients With Diabetes and Obesity

Aristithes G Doumouras et al. JAMA Netw Open. .

Erratum in

  • Error in Table 1.
    [No authors listed] [No authors listed] JAMA Netw Open. 2021 May 3;4(5):e2115446. doi: 10.1001/jamanetworkopen.2021.15446. JAMA Netw Open. 2021. PMID: 34032857 Free PMC article. No abstract available.

Abstract

Importance: There are high-quality randomized clinical trial data demonstrating the effect of bariatric surgery on type 2 diabetes remission, but these studies are not powered to study mortality in this patient group. Large observational studies are warranted to study the association of bariatric surgery with mortality in patients with type 2 diabetes.

Objective: To determine the association between bariatric surgery and all-cause mortality among patients with type 2 diabetes and severe obesity.

Design, setting, and participants: This retrospective, population-based matched cohort study included patients with type 2 diabetes and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) 35 or greater who underwent bariatric surgery from January 2010 to December 2016 in Ontario, Canada. Multiple linked administrative databases were used to define confounders, including age, baseline BMI, sex, comorbidities, duration of diabetes diagnosis, health care utilization, socioeconomic status, smoking status, substance abuse, cancer screening, and psychiatric history. Potential controls were identified from a primary care electronic medical record database. Data were analyzed in 2020.

Exposure: Bariatric surgery (gastric bypass and sleeve gastrectomy) and nonsurgical management of obesity provided by the primary care physician.

Main outcomes and measures: The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality and nonfatal morbidities. Groups were compared through a multivariable Cox proportional Hazards model.

Results: A total of 6910 patients (mean [SD] age at baseline, 52.04 [9.45] years; 4950 [71.6%] women) were included, with 3455 patients who underwent bariatric surgery and 3455 match controls and a median (interquartile range) follow-up time of 4.6 (3.22-6.35) years. In the surgery group, 83 patients (2.4%) died, compared with 178 individuals (5.2%) in the control group (hazard ratio [HR] 0.53 [95% CI, 0.41-0.69]; P < .001). Bariatric surgery was associated with a 68% lower cardiovascular mortality (HR, 0.32 [95% CI, 0.15-0.66]; P = .002) and a 34% lower rate of composite cardiac events (HR, 0.68 [95% CI, 0.55-0.85]; P < .001). Risk of nonfatal renal events was also 42% lower in the surgical group compared with the control group (HR, 0.58 [95% CI, 0.35-0.95], P = .03). Of the groups that had the highest absolute benefit associated with bariatric surgery, men had an absolute risk reduction (ARR) of 3.7% (95% CI, 1.7%-5.7%), individuals with more than 15 years of diabetes had an ARR of 4.3% (95% CI, 0.8%-7.8%), and individuals aged 55 years or older had an ARR of 4.7% (95% CI, 3.0%-6.4%).

Conclusions and relevance: These findings suggest that bariatric surgery was associated with reduced all-cause mortality and diabetes-specific cardiac and renal outcomes in patients with type 2 diabetes and severe obesity.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gerstein reported holding the McMaster-Sanofi Population Health Institute Chair in Diabetes Research and Care. Dr Anvari reported serving as a consultant for Johnson & Johnson outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Cohort Creation and Identification of Eligible Patients for Inclusion
BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); COE, Centers of Excellence; and EMR, electronic medical record.
Figure 2.
Figure 2.. Kaplan-Meier Curves of All-Cause Mortality for Patients Who Underwent Bariatric Surgery and Matched Nonsurgical Controls
See this image and copyright information in PMC

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