Bariatric surgery would appear to offer better outcomes and may be good value for money given the costs of treating Diabetes

Bariatric surgery would appear to offer better outcomes and may be good value for money given the costs of treating Diabetes (Diabetes: the cost of diabetes Fact sheet N°236 WHO ). Gastric bypass operations reportedly costing the NHS £85 million a year but this is small change compared to the cost of managing Diabetes and its associated co-morbidity (an estimated £14 billion pounds is spent a year on treating diabetes and its complications). However up to 2 million Brits may be eligible for Bariatric surgery ( at a cost of £6k x 2,000,000=£12 billion ) but it still works out a better deal than treating Diabetes through the traditional therapies .

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Implications of bariatric surgery on cardiovascular disease and mortality in obese type 2 diabetic patients

Bariatric surgery appears to be beneficial for patients with obesity and type 2 diabetes

Background

In patients with diabetes and obesity specifically, no studies have examined mortality after bariatric surgery. We did a nationwide study in Sweden to examine risks of cardiovascular disease and mortality in patients with obesity and diabetes who had undergone bariatric surgery (Roux-en-Y gastric bypass [RYGB]).

Methods

In this nationwide, matched, observational cohort study, we merged data for patients who had undergone RYGB registered in the Scandinavian Obesity Surgery Registry with other national databases, and identified matched controls (on the basis of sex, age, BMI, and calendar time [year]) who had not undergone bariatric surgery from the National Diabetes Registry. We assessed risks of cardiovascular disease and death using a Cox proportional-hazards regression model and other methods to examine the treatment effect while accounting for residual confounding. Primary outcomes were total mortality, cardiovascular death, and fatal or non-fatal myocardial infarction.

Findings

Between Jan 1, 2007, and Dec 31, 2014, we obtained data for 6132 patients who had undergone RYGB and 6132 control patients who had not. Median follow-up was 3·5 years (IQR 2·1–4·7). We noted a 58% relative risk reduction (hazard ratio [HR] 0·42, 95% CI 0·30–0·57; p<0·0001) in overall mortality in the RYGB group compared with the controls. The risk of fatal or non-fatal myocardial infarction was 49% lower (HR 0·51, 0·29–0·91; p=0·021) and that of cardiovascular death was 59% lower (0·41, 0·19–0·90; p=0·026) in the RYGB group than in the control group. 5 year absolute risks of death were 1·8% (95% CI 1·5–2·2) in the RYGB group and 5·8% (5·0–6·8) in the control group.

Interpretation

Our findings provide support for the benefits of RYGB surgery for patients with obesity and type 2 diabetes. The causes of these beneficial effects may be the weight reduction per se, changes in physiology and metabolism, improved care and treatment, improvements in lifestyle and risk factors, or combinations of these factors.

Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study

Björn Eliasson, MDcorrespondence,Vasileios Liakopoulos, MD,Stefan Franzén, PhD,Ingmar Näslund, MD,Ann-Marie Svensson, PhD,Johan Ottosson, MDSoffia Gudbjörnsdottir, MD

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