Bariatric surgery comes out ahead with greater weight loss, diabetes remission and less CVD complications than standard medical care…. 

Fifteen years after undergoing bariatric surgery, 30% of patients no longer had diabetes, but only 7% of patients who received usual care were in diabetes remission.

These long-term findings from the Swedish Obese Subjects (SOS) prospective, matched-cohort study by Lars Sjöström, MD, from Sahlgrenska University Hospital, in Gothenburg, Sweden, and colleagues was published to coincide with the American Diabetes Association Conference in San Francisco.

The study also shows that "obese diabetics whose diabetes was of shorter

duration or who had the greatest weight loss between the time of surgery and two years later were the most likely to have a sustained remission at 15 years. These patients likely had bariatric surgery before the failure of the insulin-producing cells of the pancreas was irreversible."

The SOS study enrolled 4047 obese patients in Sweden between 1987 and 2001. The current analysis looked at those who had diabetes at baseline: 260 patients who then received usual medical care and 343 patients who underwent bariatric surgery — vertical banded gastroplasty (227 patients), nonadjustable or adjustable banding (61 patients), or Roux-en-Y gastric bypass (55 patients).

The patients had a mean age of about 50, a mean body mass index (BMI) of about 41, and about 60% were women. They had had diabetes for about 3 years.

The researchers tracked microvascular complications of the kidney, eyes, and peripheral nerves and macrovascular complications — coronary heart disease, heart failure, stroke, and peripheral arterial disease — after a median of about 17 years.

Diabetes remission was defined as having a blood glucose level below 110 mg/dL and not taking antidiabetic medication.

Bariatric surgery was associated with higher diabetes-remission rates and weight loss compared with usual care, although these rates declined over time in both groups.

Bariatric surgery was also associated with a significantly decreased risk for microvascular and macrovascular complications (hazard ratios, 0.43 and 0.74, respectively).

Additional follow-up of newer studies is required to answer the question of which bariatric procedure is best for inducing long-term remission of diabetes, but those data will not be available for another 5 to 10 years.

• Fifteen years after undergoing bariatric surgery, 30% of patients no longer had diabetes
• Bariatric surgery was also associated with a significantly decreased risk for microvascular and macrovascular complications

JAMA. 2014;311: 2297-2304, 2277-2278. Abstract, Editorial