Laurent Bailly1, Luigi Schiavo2, Lionel Sebastianelli3, Roxane Fabre4, Adeline Morisot5, Christian Pradier6, Antonio Iannelli7. 1. Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France; Université Côte d'Azur, LAMHESS, Nice, France; Département de Santé Publique, CHU Nice, Hôpital Archet 1. Niveau1 151 Route Saint Antoine de Ginestière CS 23079, 06202, Nice Cedex 3, France. 2. Bariatric Surgery Excellence Center of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy. 3. Université Côte d'Azur, Nice, France; Centre Hospitalier Universitaire de Nice, Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France. 4. Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France; EA Cobtek, University of Nice Sophia-Antipolis, Nice, France. 5. Department of Public Health, University Hospital of Nice, Nice, France. 6. Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France; Université Côte d'Azur, LAMHESS, Nice, France. 7. Université Côte d'Azur, Nice, France; Centre Hospitalier Universitaire de Nice, Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; U1065, Team 8 "Hepatic complications of obesity", Inserm, Nice, France. Electronic address: iannelli.a@chu-nice.fr.
Abstract
BACKGROUND: The association between bariatric surgery (BS) and the prevention of type 2 diabetes (T2D) and its complications in patients with obesity has been rarely addressed in large, nationwide database studies. OBJECTIVE: To estimate the preventive effect of BS against T2D and its vascular complications in patients with obesity without co-morbidity at baseline. SETTING: All French public and private hospitals. METHODS: Data were extracted from the French National Health Service database between 2008 and 2016. All patients with obesity aged 18- to 60-years old, free of T2D and major co-morbidities, and with at least 1 year of follow-up were analyzed. Patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) were included in the BS group, and patients with obesity with no history of BS were considered as controls. RESULTS: Of 328,509 patients with obesity, 102,627 had BS. Between 2009 and 2016, 9.7% (31,946/328,509) of patients had a diagnosis of T2D associated with morbid obesity, 13.2% of the control group versus 2.0% of the BS group (P < .001). BS was associated with favorable 8-year T2D event-free survival estimates of 92.3% in the BS group against 58.2% in the control group. The hazard ratio for the diagnosis of T2D was .18 (95% confidence interval, .17-.19) for the BS group versus controls, after adjustment on age, sex, body mass index, and baseline differences. A significant difference was found between the type of bariatric procedure (P < .001) with more T2D after AGB (4.5%) than after GB (1.2%) or SG (0.9%). T2D complications were more common in controls (P < .001) with multiple T2D complications occurring in 1% of patients in the control group and .1% in the BS group (P < 0.001). GB and SG were more effective than AGB. CONCLUSIONS: This nationwide study shows that BS reduces the new onset of T2D in patients with obesity by 82%. SG and GB give comparable results and both are more effective than AGB.
BACKGROUND: The association between bariatric surgery (BS) and the prevention of type 2 diabetes (T2D) and its complications in patients with obesity has been rarely addressed in large, nationwide database studies. OBJECTIVE: To estimate the preventive effect of BS against T2D and its vascular complications in patients with obesity without co-morbidity at baseline. SETTING: All French public and private hospitals. METHODS: Data were extracted from the French National Health Service database between 2008 and 2016. All patients with obesity aged 18- to 60-years old, free of T2D and major co-morbidities, and with at least 1 year of follow-up were analyzed. Patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) were included in the BS group, and patients with obesity with no history of BS were considered as controls. RESULTS: Of 328,509 patients with obesity, 102,627 had BS. Between 2009 and 2016, 9.7% (31,946/328,509) of patients had a diagnosis of T2D associated with morbid obesity, 13.2% of the control group versus 2.0% of the BS group (P < .001). BS was associated with favorable 8-year T2D event-free survival estimates of 92.3% in the BS group against 58.2% in the control group. The hazard ratio for the diagnosis of T2D was .18 (95% confidence interval, .17-.19) for the BS group versus controls, after adjustment on age, sex, body mass index, and baseline differences. A significant difference was found between the type of bariatric procedure (P < .001) with more T2D after AGB (4.5%) than after GB (1.2%) or SG (0.9%). T2D complications were more common in controls (P < .001) with multiple T2D complications occurring in 1% of patients in the control group and .1% in the BS group (P < 0.001). GB and SG were more effective than AGB. CONCLUSIONS: This nationwide study shows that BS reduces the new onset of T2D in patients with obesity by 82%. SG and GB give comparable results and both are more effective than AGB.