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Effect of Bariatric Surgery on Cardiovascular Events and Metabolic Outcomes in Obese Patients with Insulin-Treated Type 2 Diabetes: a Retrospective Cohort Study

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Abstract

Aims

To compare non-fatal cardiovascular (CV) events and metabolic outcomes, among obese patients with insulin-treated type 2 diabetes who underwent bariatric surgery compared with a propensity-matched non-bariatric cohort.

Methods

A retrospective cohort study was conducted among 11,125 active patients with type 2 diabetes from The Health Improvement Network (THIN) database. Propensity score matching (up to 1:6 ratio) was used to identify patients who underwent bariatric surgery (N = 131) with a non-bariatric cohort (N = 579). Follow-up was undertaken for 10 years (9686 person-years) to compare differences in metabolic outcomes and CV risk events that included the following: acute myocardial infarction (AMI), stroke, coronary heart disease (CHD), heart failure (HF) and peripheral artery disease (PAD). Cox proportional regression was used to compute the outcomes between groups.

Results

The mean age was 52 (SD 13) years (60% female); the baseline weight and BMI were 116 (SD 25) kg and 41 (SD 9) kg/m2, respectively. Significant reductions in weight and BMI were observed in bariatric group during 10 years of follow-up. Bariatric surgery had a significant cardioprotective effect by reducing the risk of non-fatal CHD (adjusted hazard ratio [aHR] 0.29, 95% CI 0.16–0.52, p < 0.001) and PAD events (aHR 0.31, 95% CI 0.11–0.89, p = 0.03). However, the surgery had no significant effect on AMI (aHR 0.98, p = 0.95), stroke (HR 0.87, p = 0.76) and HF (HR 0.89, p = 0.73) risks. Bariatric surgery had favourable effects on insulin independence, HbA1c and BP.

Conclusion

Among obese insulin-treated patients with type 2 diabetes, bariatric surgery is associated with significant reductions in non-fatal CHD and PAD events, lower body weight, HbA1c, BP and a greater likelihood of insulin independency during 10 years of follow-up.

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Authors and Affiliations

  1. Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK

    Mohammed Alkharaiji, Uchenna Anyanwagu, Richard Donnelly & Iskandar Idris

  2. Faculty of Public Health, College of Health, The Saudi Electronic University, Riyadh, Saudi Arabia

    Mohammed Alkharaiji

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  1. Mohammed Alkharaiji
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  2. Uchenna Anyanwagu
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  4. Iskandar Idris
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Corresponding author

Correspondence to Iskandar Idris.

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Ethics approval was provided by the NHS South East Multi-centre Research Ethics Committee (MREC).

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The authors declare that they have no conflict of interest.

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What is already known about this subject?

- Obesity and type 2 diabetes are associated with a high risk of cardiovascular events.

- Obesity is causally associated with peripheral artery disease.

- Insulin-treated type 2 diabetes is associated with additional excess risk of cardiovascular events.

- Bariatric surgery in people with or without diabetes reduces cardiovascular events.

What does this study add?

- This study focuses on insulin-treated type 2 diabetes—recently recognised to be associated with higher risks of cardiovascular events.

- Among insulin-treated type 2 diabetes, bariatric surgery is associated with a significant reduction in non-fatal coronary heart disease and peripheral artery disease.

- Among insulin-treated type 2 diabetes, bariatric surgery is associated with significant reduction and maintenance of weight loss, a significant reduction in HbA1c, with relapse of HbA1c levels after 6 years of follow-up and with increased likelyhood of insulin independency.

How might this impact on clinical practice?

- Bariatric surgery should be considered as a genuine therapeutic option for the management of obese insulin-treated type 2 diabetes to reduce risk of coronary heart disease, and peripheral artery disease, reduce HbA1c levels and potentially reduce the long-term risk of microvascular complications of diabetes as well as inducing insulin independence.

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Appendix

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Table 3 STROBE Statement—checklist of items that should be included in reports of observational studies
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Alkharaiji, M., Anyanwagu, U., Donnelly, R. et al. Effect of Bariatric Surgery on Cardiovascular Events and Metabolic Outcomes in Obese Patients with Insulin-Treated Type 2 Diabetes: a Retrospective Cohort Study. OBES SURG 29, 3154–3164 (2019). https://doi.org/10.1007/s11695-019-03809-4

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  • DOI: https://doi.org/10.1007/s11695-019-03809-4

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