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. 2024 Oct 1;110(10):6581-6590.
doi: 10.1097/JS9.0000000000001807.

Mortality in relation to diabetes remission in Swedish Obese Subjects - a prospective cohort study

Lena M S Carlsson  1 , Björn Carlsson  1   2 , Peter Jacobson  1 , Cecilia Karlsson  1   3 , Johanna C Andersson-Assarsson  1 , Felipe M Kristensson  1   4 , Sofie Ahlin  1   5 , Per-Arne Svensson  1   6 , Magdalena Taube  1 , Ingmar Näslund  5 , Kristjan Karason  1 , Markku Peltonen  7 , Kajsa Sjöholm  1
Affiliations

Mortality in relation to diabetes remission in Swedish Obese Subjects - a prospective cohort study

Lena M S Carlsson et al. Int J Surg. .

Abstract

Background: People with obesity and type 2 diabetes (T2D) have reduced life expectancy, partly explained by increased risk of cardiovascular diseases and cancer. Here, we examined whether 2-year diabetes remission after bariatric surgery or usual care is associated with long-term mortality.

Materials and methods: This report includes 586 participants with obesity and concomitant T2D from the prospective Swedish Obese Subjects (SOS) cohort study; 338 underwent bariatric surgery and 248 received usual obesity care. At inclusion, age was 37-60 years and BMI ≥34 kg/m 2 in men and ≥38 kg/m 2 in women. Median follow-up was 26.2 years (interquartile range 22.7-28.7). Diabetes status was determined using self-reported data on diabetes medication and in-study measures of blood glucose and HbA1c. The study was cross-linked to Swedish national registers for data on morbidity, death, and emigration.

Results: Overall, 284 participants, 71.9% of surgery and 16.5% of usual care patients were in remission at the 2-year examination. During follow-up, mortality rates were 16.6 deaths per 1000 person-years (95% CI: 13.7-20.1) in the remission subgroup and 26.0 deaths per 1000 person-years (95% CI:22.2-30.4) in the non-remission subgroup (adjusted hazard ratio (HR adj )=0.71, 95% CI:0.54-0.95, P =0.019). The adjusted median life expectancy in the remission subgroup was 2.5 years (95% CI:0.3-4.7) longer than in the non-remission subgroup. Specifically, remission was associated with decreased cardiovascular mortality (sub-HR adj =0.54, 95% CI: 0.35-0.85, P =0.008), but no detectable association with cancer mortality was found (sub-HR adj =1.06, 95% CI:0.60-1.86), P =0.841).

Conclusion: In this post-hoc analysis of data from the SOS study, patients who achieved short-term diabetes remission had increased life expectancy and decreased cardiovascular death over up to 32 years of follow-up. Future studies should confirm these findings.

Trial registration: ClinicalTrials.gov NCT01479452.

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Conflict of interest statement

B.C. and C.K. are employed by AstraZeneca and hold stocks in the same company. No other conflicts of interest relevant to this study were reported.

Figures

Figure 1
Figure 1
Flowchart for the Swedish Obese Subjects (SOS) study describing stratification into remission and non-remission subgroups for mortality analyses.
Figure 2
Figure 2
Cumulative mortality in the full cohort (left panel), surgery (middle panel), and usual care (right panel) groups of the SOS study by diabetes remission at 2 years. Per-protocol analysis adjusted for BMI, age, sex, smoking, inclusion year, diabetes duration, previous cardiovascular disease (CVD), hypertension, and total cholesterol. IR/1000, the incidence rate per 1000 person-years.
Figure 3
Figure 3
Cumulative incidence of cardiovascular disease (CVD), malignancy, and microvascular events in the full cohort by diabetes remission at 2 years. Per-protocol analysis adjusted for BMI, age, sex, smoking, inclusion year, diabetes duration, previous CVD, hypertension, and total cholesterol. IR/1000, the incidence rate per 1000 person-years.
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References

    1. Bhaskaran K, Dos-Santos-Silva I, Leon DA, et al. . Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol 2018;6:944–953. - PMC - PubMed
    1. Carlsson LMS, Sjöholm K, Jacobson P, et al. . Life expectancy after bariatric surgery in the Swedish Obese Subjects study. N Engl J Med 2020;383:1535–1543. - PMC - PubMed
    1. Ma C, Avenell A, Bolland M, et al. . Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ 2017;359:j4849. - PMC - PubMed
    1. Sjöholm K, Carlsson LMS, Svensson PA, et al. . Association of bariatric surgery with cancer incidence in patients with obesity and diabetes: long-term results from the Swedish Obese Subjects study. Diabetes Care 2022;45:444–450. - PMC - PubMed
    1. Sjöström L, Peltonen M, Jacobson P, et al. . Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014;311:2297–2304. - PubMed

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