Bariatric surgery and cardiometabolic outcomes in insulin-treated T2D patients

Takeaway

• In obese patients with insulin-treated type 2 diabetes (T2D), bariatric surgery was associated with significant reductions in non-fatal coronary heart disease (CHD) and peripheral artery disease (PAD), body weight, glycated heamoglobin (HbA1c), blood pressure (BP), and insulin independency during the 10-year follow-up period.
• No significant reductions were observed with the risk of acute myocardial infarction (AMI), stroke, and heart failure (HF)

Why this matters

• Findings suggest that bariatric surgery should be considered as a genuine therapeutic option to reduce the risk for cardiovascular (CV) events, HbA1c levels and the long-term microvascular complications of diabetes as well as inducing insulin independence in obese patients with insulin-treated T2D.

Study design

• Retrospective study included 11,125 patients with T2D using data from The Health Improvement Network (THIN) database.
• Patients who underwent bariatric surgery (n=131) were compared with propensity-score matched non-bariatric group (n=579).
• Metabolic outcomes and cardiovascular risk events (AMI, stroke, CHD, HF, and PAD) were compared during a follow -up period of 10-years (9686 person-years).
• Funding: None disclosed.

Key results

• After adjustment for confounders, bariatric vs non-bariatric group had significant reductions in the risk for non-fatal CHD (HR, 0.29; 95% CI, 0.16-0.52; P<.001) and PAD (HR, 0.31; 95% CI, 0.11-0.89; P=.03).
• At 10-year, bariatric vs non-bariatric group had significant reduction in body weight and body mass index (94.1 ± 20.1 vs 107.6 ± 17.3 kg and 32.9 ± 7.7 vs 38.0 ± 7.1 kg/m² respectively).
• Bariatric vs non-bariatric group did not differ in the risk for:
  • AMI (HR, 0.98; P=.94),
  • stroke (HR, 0.87; P=.75) and
  • HF (HR, 0.89; P=.73).
• Bariatric vs non-bariatric group had favourable effects on:
  • HbA1c: At 6-year point (68.1 ± 16.9 vs 72.8 ± 18.8 mmoL/moL),
  • Systolic BP: 1-year (133 ± 17 vs 137 ± 15 mmHg; P=.07); diastolic BP: 2-year (76 ± 10 vs 79 ± 10 mmHg; P<.05), and
  • Insulin independence: 10-year (77.5% vs 33.7% of patients; P<.0001).

Limitations

• Retrospective design.
• Risk of residual confounding.