Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications

• Published in: JAMA : the journal of the American Medical Association 2014-06, Vol.311 (22), p.2297-2304
• Main Authors: Sjöström, Lars, Peltonen, Markku, Jacobson, Peter, Ahlin, Sofie, Andersson-Assarsson, Johanna, Anveden, Åsa, Bouchard, Claude, Carlsson, Björn, Karason, Kristjan, Lönroth, Hans, Näslund, Ingmar, Sjöström, Elisabeth, Taube, Magdalena, Wedel, Hans, Svensson, Per-Arne, Sjöholm, Kajsa, Carlsson, Lena M. S
• Format: Article
• Language: English
• Subjects: Adult; Bariatric Surgery; Biological and medical sciences; Blood Glucose; Case-Control Studies; Clinical Medicine; Diabetes; Diabetes Complications - prevention & control; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - surgery; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Gastrointestinal surgery; General aspects; Humans; Klinisk medicin; Male; Medical research; Medical sciences; Middle Aged; Obesity; Obesity - complications; Obesity - surgery; Prospective Studies; Recurrence; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Sweden; Treatment Outcome; Weight Loss
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.2014.5988

IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known. OBJECTIVES To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS The Swedish Obese Subjects (SOS) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden. Of patients recruited between September 1, 1987, and January 31, 2001, 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline. For the current analysis, diabetes status was determined at SOS health examinations until May 22, 2013. Information on diabetes complications was obtained from national health registers until December 31, 2012. Participation rates at the 2-, 10-, and 15-year examinations were 81%, 58%, and 41% in the control group and 90%, 76%, and 47% in the surgery group. For diabetes assessment, the median follow-up time was 10 years (interquartile range [IQR], 2-15) and 10 years (IQR, 10-15) in the control and surgery groups, respectively. For diabetes complications, the median follow-up time was 17.6 years (IQR, 14.2-19.8) and 18.1 years (IQR, 15.2-21.1) in the control and surgery groups, respectively. INTERVENTIONS Adjustable or nonadjustable banding (n = 61), vertical banded gastroplasty (n = 227), or gastric bypass (n = 55) procedures were performed in the surgery group, and usual obesity and diabetes care was provided to the control group. MAIN OUTCOMES AND MEASURES Diabetes remission, relapse, and diabetes complications. Remission was defined as blood glucose