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

Alkharaiji, Mohammed; Anyanwagu, Uchenna; Donnelly, Richard; Idris, Iskandar

Abstract

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. 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 10years (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 10years 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 10years of follow-up.

Citation

Alkharaiji, M., Anyanwagu, U., Donnelly, R., & Idris, I. (2019). Effect of Bariatric Surgery on Cardiovascular Events and Metabolic Outcomes in Obese Patients with Insulin-Treated Type 2 Diabetes: a Retrospective Cohort Study. Obesity Surgery, 29(10), 3154-3164. https://doi.org/10.1007/s11695-019-03809-4

• Journal Article Type: Article
• Acceptance Date: Feb 16, 2019
• Online Publication Date: Aug 7, 2019
• Publication Date: Oct 1, 2019
• Deposit Date: Jul 2, 2019
• Publicly Available Date: Aug 8, 2020
• Journal: Obesity Surgery
• Print ISSN: 0960-8923
• Electronic ISSN: 1708-0428
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 10
• Pages: 3154-3164
• DOI: https://doi.org/10.1007/s11695-019-03809-4
• Keywords: Obesity, Insulin, Type 2 diabetes, Cardiometabolic, Cardiovascular, Peripheral vascular disease, Bariatric, Weight loss
• Public URL: https://nottingham-repository.worktribe.com/output/2257489
• Publisher URL: https://link.springer.com/article/10.1007/s11695-019-03809-4
• Additional Information: This is a post-peer-review, pre-copyedit version of an article published in Obesity Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11695-019-03809-4