Bariatric Surgery Halves Microvascular Risk in Type 2 Diabetes
August 07, 2018
Bariatric surgery is associated with a lower risk for microvascular disease in people with type 2 diabetes, new research suggests.
The findings, from a retrospective analysis of data from four US integrated healthcare systems, were published online August 7 in Annals of Internal Medicine by Rebecca O'Brien, MD, of Kaiser Permanente Medical Group, Oakland, California, and colleagues.
Among more than 4000 patients who underwent bariatric surgery, the 5-year incidence of microvascular disease — including neuropathy, nephropathy, and retinopathy — was nearly 60% lower than that of 11,000 matched nonsurgical control patients receiving usual diabetes care.
"What's new here is that, with a very large sample size, we found a difference in hard endpoints. Very few studies have done this," senior investigator David Arterburn, MD, MPH, and internist at Kaiser Permanente Washington Health Research Institute, Seattle, told Medscape Medical News.
The study is also notable for including a greater proportion of patients who underwent the more contemporary bariatric procedures, Roux-en-Y gastric bypass and sleeve gastrectomy. Prior studies tended to include a number of patients who underwent older procedures that are now falling out of favor.
Arterburn said that at the very least, the option of bariatric surgery should be discussed with patients who have type 2 diabetes and a body mass index (BMI) of 35 kg/m2 or greater.
"It deserves consideration even though the uptake is still very small relative to medical therapy and will remain small, but it should be part of the conversation."
In an accompanying editorial, Carel W. le Roux, MBChB, PhD, professor of experimental pathology at the Diabetes Complications Research Centre, University College Dublin, Ireland, and Philip R. Schauer, MD, professor of surgery at Cleveland Clinic Lerner College of Medicine, Ohio, write, "The healthcare policy implication of these findings is that bariatric surgery should now be considered as an effective [type 2 diabetes] treatment not only to improve hyperglycemia but also to prevent the complications which account for the morbidity and mortality of the disease."
Schauer and le Roux note that although bariatric surgery is traditionally limited to patients with type 2 diabetes who have severe obesity with the aim of reducing the obesity, "with these new data...we can now consider surgery as a treatment for diabetes beyond glycemia."
"Bariatric surgery can now be intended to prevent complications...Surgery should not be a last resort, but instead should be used earlier, as prevention is definitely better than cure."
Asked to comment, endocrinologist Janet B. McGill, MD, professor of medicine at Washington University School of Medicine, St. Louis, Missouri, said, "While the major study limitation is the retrospective design, the findings are important nonetheless."
Author: Miriam E. Tucker