Highlights
- •The association between bariatric surgery (BS) and the prevention of type 2 diabetes (T2D) and its complications in patients with obesity has been rarely addressed in large nationwide database studies.
- •This nationwide study (French National Health Service database) shows that BS reduces the new onset of T2D in patients with obesity by 82%.
- •Sleeve gastrectomy and Gastric bypass give comparable results and both are more effective than adjustable gastric banding.
Abstract
Background
The association between bariatric surgery (BS) and the prevention of type 2 diabetes
(T2D) and its complications in patients with obesity has been rarely addressed in
large, nationwide database studies.
Objective
To estimate the preventive effect of BS against T2D and its vascular complications
in patients with obesity without co-morbidity at baseline.
Setting
All French public and private hospitals.
Methods
Data were extracted from the French National Health Service database between 2008
and 2016. All patients with obesity aged 18- to 60-years old, free of T2D and major
co-morbidities, and with at least 1 year of follow-up were analyzed. Patients who
had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric
banding (AGB) were included in the BS group, and patients with obesity with no history
of BS were considered as controls.
Results
Of 328,509 patients with obesity, 102,627 had BS. Between 2009 and 2016, 9.7% (31,946/328,509)
of patients had a diagnosis of T2D associated with morbid obesity, 13.2% of the control
group versus 2.0% of the BS group (P < .001). BS was associated with favorable 8-year T2D event-free survival estimates
of 92.3% in the BS group against 58.2% in the control group. The hazard ratio for
the diagnosis of T2D was .18 (95% confidence interval, .17–.19) for the BS group versus
controls, after adjustment on age, sex, body mass index, and baseline differences.
A significant difference was found between the type of bariatric procedure (P < .001) with more T2D after AGB (4.5%) than after GB (1.2%) or SG (0.9%). T2D complications
were more common in controls (P < .001) with multiple T2D complications occurring in 1% of patients in the control
group and .1% in the BS group (P < 0.001). GB and SG were more effective than AGB.
Conclusions
This nationwide study shows that BS reduces the new onset of T2D in patients with
obesity by 82%. SG and GB give comparable results and both are more effective than
AGB.
Key words
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Article info
Publication history
Published online: January 07, 2019
Accepted:
December 28,
2018
Received in revised form:
December 23,
2018
Received:
November 5,
2018
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
