Bariatric Surgery Leads to Remission of Type 2

BOSTON — Bariatric surgery can lead to sustained remission of type 2 diabetes and improvements in cardiovascular health that lower the risk for diabetes-specific mortality, according to Dr. Ted D. Adams, a cardiovascular researcher at the University of Utah, Salt Lake City.

In published studies, 64%-100% of patients experienced remission of type 2 diabetes, 62%-69% had resolution of hypertension at 1 or 2 years after surgery, and up to 85% had resolution of sleep apnea, Dr. Adams noted at a symposium sponsored by the International Atherosclerosis Society.

“Observational studies reporting mortality of obese subjects who have lost weight without bariatric surgery are inconclusive, with studies reporting no change, increased, or reduced mortality,” Dr. Adams said. To date, 11 published studies have examined mortality following bariatric surgery. The studies varied considerably by type of surgery, length of follow-up, selection of control groups, and body mass index; however, the eight studies with severely obese control groups reported increases in longevity among bariatric surgery patients. The reductions ranged from a mean of 29% in one study to 89% in a different study, Dr. Adams said.

A study of 232 morbidly obese patients with type 2 diabetes showed mortality rates of 9% for the 154 Roux-en-Y gastric bypass patients compared with 28% for 78 patients who did not undergo surgery. For each year of follow-up, surgical patients had a 1% chance of dying, compared with a 4.5% per year chance for controls. The investigators found that the improved mortality rate among the gastric bypass recipients was attributable primarily to a decrease in the number of cardiovascular deaths (J. Gastrointest. Surg. 1997;1:213-20).

In a case-control study, Dr. Adams and his colleagues compared 7,925 patients who underwent gastric bypass with age- weight-, and gender-matched controls from Utah driver license data. The patients' median age was 39.5 years, and their median body mass index was 45.3. The investigators found that over an 18-year follow-up period (mean 7.1 years), 2.7% of patients had died, compared with 4.1% of controls. The adjusted reduction in death associated with gastric bypass surgery was 40% (N. Engl. J. Med. 2007;357:753-61).

There were 55 cardiovascular disease deaths among cases, compared with 104 among controls, and there were fewer deaths from coronary artery disease among cases compared with controls (15 vs. 33, respectively).

There were only two deaths attributed to diabetes among cases, compared with 19 among controls, Dr. Adams noted.

In an analysis of cause-specific mortality, the authors saw a decrease of 56% in coronary artery disease for cases vs. controls (2.6 vs. 5.9 per 10,000 person-years, P = .006), a 92% reduction for cases in diabetes deaths (0.4 vs. 3.4 per 10,000 p-y, P = .005), and a 60% decrease in cancer deaths (5.5 vs. 13.3 per 10,000 p-y, respectively, P less than .001). Nondisease causes of death, such as accidents and suicide, were higher among cases compared with controls (11.1 vs. 6.4 per 10,000).

In another study, Dr. Adams and colleagues compared severely obese patients who underwent Roux-en-Y gastric bypass with patients who qualified for such surgery but were denied insurance coverage, and with matched controls not seeking surgery (Obesity 2009 June 4 [doi: 10.1038/oby.2009.178

In studies, 64%-100% of patients experienced remission of type 2 diabetes at 1 or 2 years after surgery.

Source DR. ADAMS

BOSTON — Bariatric surgery can lead to sustained remission of type 2 diabetes and improvements in cardiovascular health that lower the risk for diabetes-specific mortality, according to Dr. Ted D. Adams, a cardiovascular researcher at the University of Utah, Salt Lake City.

In published studies, 64%-100% of patients experienced remission of type 2 diabetes, 62%-69% had resolution of hypertension at 1 or 2 years after surgery, and up to 85% had resolution of sleep apnea, Dr. Adams noted at a symposium sponsored by the International Atherosclerosis Society.

“Observational studies reporting mortality of obese subjects who have lost weight without bariatric surgery are inconclusive, with studies reporting no change, increased, or reduced mortality,” Dr. Adams said. To date, 11 published studies have examined mortality following bariatric surgery. The studies varied considerably by type of surgery, length of follow-up, selection of control groups, and body mass index; however, the eight studies with severely obese control groups reported increases in longevity among bariatric surgery patients. The reductions ranged from a mean of 29% in one study to 89% in a different study, Dr. Adams said.

A study of 232 morbidly obese patients with type 2 diabetes showed mortality rates of 9% for the 154 Roux-en-Y gastric bypass patients compared with 28% for 78 patients who did not undergo surgery. For each year of follow-up, surgical patients had a 1% chance of dying, compared with a 4.5% per year chance for controls. The investigators found that the improved mortality rate among the gastric bypass recipients was attributable primarily to a decrease in the number of cardiovascular deaths (J. Gastrointest. Surg. 1997;1:213-20).

In a case-control study, Dr. Adams and his colleagues compared 7,925 patients who underwent gastric bypass with age- weight-, and gender-matched controls from Utah driver license data. The patients' median age was 39.5 years, and their median body mass index was 45.3. The investigators found that over an 18-year follow-up period (mean 7.1 years), 2.7% of patients had died, compared with 4.1% of controls. The adjusted reduction in death associated with gastric bypass surgery was 40% (N. Engl. J. Med. 2007;357:753-61).

There were 55 cardiovascular disease deaths among cases, compared with 104 among controls, and there were fewer deaths from coronary artery disease among cases compared with controls (15 vs. 33, respectively).

There were only two deaths attributed to diabetes among cases, compared with 19 among controls, Dr. Adams noted.

In an analysis of cause-specific mortality, the authors saw a decrease of 56% in coronary artery disease for cases vs. controls (2.6 vs. 5.9 per 10,000 person-years, P = .006), a 92% reduction for cases in diabetes deaths (0.4 vs. 3.4 per 10,000 p-y, P = .005), and a 60% decrease in cancer deaths (5.5 vs. 13.3 per 10,000 p-y, respectively, P less than .001). Nondisease causes of death, such as accidents and suicide, were higher among cases compared with controls (11.1 vs. 6.4 per 10,000).

In another study, Dr. Adams and colleagues compared severely obese patients who underwent Roux-en-Y gastric bypass with patients who qualified for such surgery but were denied insurance coverage, and with matched controls not seeking surgery (Obesity 2009 June 4 [doi: 10.1038/oby.2009.178

In studies, 64%-100% of patients experienced remission of type 2 diabetes at 1 or 2 years after surgery.

Source DR. ADAMS

BOSTON — Bariatric surgery can lead to sustained remission of type 2 diabetes and improvements in cardiovascular health that lower the risk for diabetes-specific mortality, according to Dr. Ted D. Adams, a cardiovascular researcher at the University of Utah, Salt Lake City.

In published studies, 64%-100% of patients experienced remission of type 2 diabetes, 62%-69% had resolution of hypertension at 1 or 2 years after surgery, and up to 85% had resolution of sleep apnea, Dr. Adams noted at a symposium sponsored by the International Atherosclerosis Society.

“Observational studies reporting mortality of obese subjects who have lost weight without bariatric surgery are inconclusive, with studies reporting no change, increased, or reduced mortality,” Dr. Adams said. To date, 11 published studies have examined mortality following bariatric surgery. The studies varied considerably by type of surgery, length of follow-up, selection of control groups, and body mass index; however, the eight studies with severely obese control groups reported increases in longevity among bariatric surgery patients. The reductions ranged from a mean of 29% in one study to 89% in a different study, Dr. Adams said.

A study of 232 morbidly obese patients with type 2 diabetes showed mortality rates of 9% for the 154 Roux-en-Y gastric bypass patients compared with 28% for 78 patients who did not undergo surgery. For each year of follow-up, surgical patients had a 1% chance of dying, compared with a 4.5% per year chance for controls. The investigators found that the improved mortality rate among the gastric bypass recipients was attributable primarily to a decrease in the number of cardiovascular deaths (J. Gastrointest. Surg. 1997;1:213-20).

In a case-control study, Dr. Adams and his colleagues compared 7,925 patients who underwent gastric bypass with age- weight-, and gender-matched controls from Utah driver license data. The patients' median age was 39.5 years, and their median body mass index was 45.3. The investigators found that over an 18-year follow-up period (mean 7.1 years), 2.7% of patients had died, compared with 4.1% of controls. The adjusted reduction in death associated with gastric bypass surgery was 40% (N. Engl. J. Med. 2007;357:753-61).

There were 55 cardiovascular disease deaths among cases, compared with 104 among controls, and there were fewer deaths from coronary artery disease among cases compared with controls (15 vs. 33, respectively).

There were only two deaths attributed to diabetes among cases, compared with 19 among controls, Dr. Adams noted.

In an analysis of cause-specific mortality, the authors saw a decrease of 56% in coronary artery disease for cases vs. controls (2.6 vs. 5.9 per 10,000 person-years, P = .006), a 92% reduction for cases in diabetes deaths (0.4 vs. 3.4 per 10,000 p-y, P = .005), and a 60% decrease in cancer deaths (5.5 vs. 13.3 per 10,000 p-y, respectively, P less than .001). Nondisease causes of death, such as accidents and suicide, were higher among cases compared with controls (11.1 vs. 6.4 per 10,000).

In another study, Dr. Adams and colleagues compared severely obese patients who underwent Roux-en-Y gastric bypass with patients who qualified for such surgery but were denied insurance coverage, and with matched controls not seeking surgery (Obesity 2009 June 4 [doi: 10.1038/oby.2009.178

In studies, 64%-100% of patients experienced remission of type 2 diabetes at 1 or 2 years after surgery.

Source DR. ADAMS