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Preventive effect of bariatric surgery on type 2 diabetes onset in morbidly obese inpatients: a national French survey between 2008 and 2016 on 328,509 morbidly obese patients

  • Laurent Bailly
    Affiliations
    Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France

    Université Côte d’Azur, LAMHESS, Nice, France

    Département de Santé Publique, CHU Nice, Hôpital Archet 1. Niveau1 151 Route Saint Antoine de Ginestière CS 23079, 06202, Nice Cedex 3, France
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  • Luigi Schiavo
    Affiliations
    Bariatric Surgery Excellence Center of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Mercato San Severino, Salerno, Italy
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  • Lionel Sebastianelli
    Affiliations
    Université Côte d’Azur, Nice, France

    Centre Hospitalier Universitaire de Nice, Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
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  • Roxane Fabre
    Affiliations
    Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France

    EA Cobtek, University of Nice Sophia-Antipolis, Nice, France
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  • Adeline Morisot
    Affiliations
    Department of Public Health, University Hospital of Nice, Nice, France
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  • Christian Pradier
    Affiliations
    Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France

    Université Côte d’Azur, LAMHESS, Nice, France
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  • Antonio Iannelli
    Correspondence
    Correspondence: Antonio Iannelli, University of Nice Sophia, 151 Route St. Antoine de Ginestière, Antipolis, Nice, France 06107.
    Affiliations
    Université Côte d’Azur, Nice, France

    Centre Hospitalier Universitaire de Nice, Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France

    U1065, Team 8 “Hepatic complications of obesity”, Inserm, Nice, France
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Published:January 07, 2019DOI:https://doi.org/10.1016/j.soard.2018.12.028

      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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