SEATTLE, September 2, 2019—Weight-loss surgery performed in patients with type 2 diabetes and obesity is associated with a lower risk of death and fewer major adverse cardiovascular events than usual medical care, according to a large Cleveland Clinic study with a Kaiser Permanente Washington Health Research Institute (KPWHRI) coauthor. These patients also lost more weight, had better diabetes control, and used fewer medications for treatment of their diabetes and cardiovascular disease than those undergoing usual medical care.
The results were presented as a late-breaking study at the European Society of Cardiology Congress and simultaneously published in the Journal of the American Medical Association (JAMA) as “Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity.”
The observational study looked at nearly 2,300 Cleveland Clinic patients who had metabolic surgery and 11,500 matched patients with similar characteristics who received usual medical care. Patients underwent one of four types of weight-loss surgery (also known as metabolic or bariatric surgery): gastric bypass, sleeve gastrectomy, adjustable gastric banding, or duodenal switch.
These results matter because more than one in three (nearly 40 percent of) Americans has obesity, which is linked to type 2 diabetes heart disease, and stroke. And adults with diabetes are two to four times more likely to die from heart disease than those without diabetes: Heart disease is the leading cause of death for people with obesity and diabetes.
“This is an important paper, validating and extending our prior work in the Health Care Systems Research Network, or HCSRN,” says coauthor David Arterburn, MD, MPH, a KPWHRI senior investigator and internal medicine physician with Washington Permanente Medical Group. “It helps to reinforce the message that patients with type 2 diabetes and severe obesity should be discussing bariatric surgery as a reasonable treatment option for preventing long-term consequences of their diabetes.”
A 2018 HCSRN study, including Kaiser Permanente Washington, showed that bariatric surgery was linked to a significant reduction of heart problems in patients with obesity and diabetes. What distinguishes this new study is that it measured more outcomes, including atrial fibrillation and kidney disease.
The primary endpoint of the new study was the occurrence of death or one of five major complications associated with obesity and diabetes—coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and kidney disease:
“The striking results that we saw after metabolic surgery may be related to the patients’ substantial and sustained weight loss,” says Ali Aminian, MD, a bariatric surgeon at Cleveland Clinic and lead author of the new study. “However, there is a growing body of evidence to suggest that there are beneficial metabolic and hormonal changes after these surgical procedures that are independent of weight loss.”
Compared with the non-surgery group, patients who had metabolic surgery had an average of 15 percent more weight loss and lower blood sugar levels. They also needed less diabetes medications, including insulin, and less heart medications such as blood pressure and cholesterol therapies.
“Cardiovascular complications from obesity and diabetes can be devastating. Now that we’ve seen these remarkable results, a well-designed randomized controlled trial is needed to definitively determine whether metabolic surgery can reduce the incidence of major heart problems in patients with type 2 diabetes and obesity,” says the study’s senior author Steven Nissen, MD, chief academic officer of Cleveland Clinic’s Heart & Vascular Institute.
Coauthors of Dr. Aminian, Nissen, and Arterburn are Philip R. Schauer, MD, Michael W. Kattan, PhD, Alexander Zajichek, MS, and Kathy E. Wolski, MPH, of Cleveland Clinic; and Stacy A. Brethauer, MD, of Cleveland Clinic and The Ohio State University Wexner Medical Center, in Columbus.
The National Institute of Diabetes and Digestive and Kidney Diseases grant R01-DK105960 supported Dr. Arterburn. This study was partially funded by an unrestricted grant from Medtronic. Medtronic had no role in the design, conduct of the study, and reporting of the results.
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Obese people with diabetes had fewer deaths in 5 years after bariatric surgery vs. usual care, in large, long-term study.