American Diabetes Association Scientific Sessions

American Diabetes Association Scientific Sessions

June 15, 2014
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Bariatric surgery prevents long-term mortality, type 2 diabetes

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SAN FRANCISCO — Bariatric surgery can reduce deaths related to both cardiovascular disease and other causes and prevent the development of type 2 diabetes, according to research presented at the American Diabetes Association’s 74th Scientific Sessions.

Antonio E. Pontiroli, MD, of the Università degli Studi di Milano, Ospedale San Paolo, in Milano, Italy, and colleagues looked at 527 patients who received laparoscopic adjustable gastric banding (LAGB) and 963 who received solely medical treatment between 1995 and 2001.

“This was intended as a long-term study to assess diabetes prevention and diabetes remission,” Pontiroli said during his presentation, of the prospective cohort record-linked study of patients at four institutions in Milano. The first follow-up was conducted in 2004; another assessment is scheduled for 2017.

Participants originally considered for the study were aged 18 to 65 years with BMI >35. Of the whole population selected, type 2 diabetes was present in 59 patients in the LAGB and 150 in the medical treatment group.

The researchers looked at clinical data from the Italian National Health System to track life status, examinations, “exemptions” — free treatments offered to Italians upon developing chronic diseases including diabetes and cardiovascular disease — and drug prescriptions. Sanitary districts were also investigated to determine causes of death and nature of exemptions.

Better patient outcomes were observed in patients with surgery compared with medical treatment including long-term mortality (17 vs. 92, P=.0001) and coronary heart disease (5 vs. 49, P=.0001).

Recognizing the limitations of divergent patient markers, Pontiroli and colleagues matched surgical and non-surgical patients with type 2 diabetes and patients without diabetes. This second patient set comprised 385 who received LAGB and 681 who received medical treatment; type 2 diabetes was present in 52 and 127 patients, respectively.

Similar patient outcomes were observed with surgery compared with medical treatment in long-term mortality (12 vs. 65, P=.0001) and CHD (4 vs. 35, P=.0001).

Considering exemptions, incidence of new cases of diabetes was lower with surgery than with medical treatment for whole population (24 vs. 76, P=.0025) and matched patients (15 vs. 48, P=.0214). Development of cardiovascular disease was also lower with surgery for whole population (71 vs. 212, P=.0001) and matched patients (49 vs. 120, P=.0364).

“In this study, which was concerned only with gastric banding, the prevention of mortality continues for long periods, as does the prevention of development of new diseases, such as diabetes and cardiovascular disease,” Pontiroli said. “Similar studies are now going to be required to look at other surgical techniques such as gastric bypass and sleeve gastrectomy.”

For More Information: Pontiroli AF. Abstract 98-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.

Disclosures: Pontiroli reported no relevant disclosures.