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Bariatric Surgery and Prevention of Type 2 Diabetes in Swedish Obese Subjects
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Institute of Medicine, Sahlgrenska Academy, University; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland of Gothenburg, Gothenburg, Sweden.ORCID iD: 0000-0002-3767-4223
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID iD: 0000-0003-0619-2683
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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2012 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 367, no 8, 695-704 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone. In an analysis of data from a nonrandomized, prospective, controlled study, we examined the effects of bariatric surgery on the prevention of type 2 diabetes.

METHODS: In this analysis, we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls (with matching performed on a group, rather than individual, level). None of the participants had diabetes at baseline. Patients in the bariatric-surgery cohort underwent banding (19%), vertical banded gastroplasty (69%), or gastric bypass (12%); nonrandomized, matched, prospective controls received usual care. Participants were 37 to 60 years of age, and the body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) was 34 or more in men and 38 or more in women. This analysis focused on the rate of incident type 2 diabetes, which was a prespecified secondary end point in the main study. At the time of this analysis (January 1, 2012), participants had been followed for up to 15 years. Despite matching, some baseline characteristics differed significantly between the groups; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group. At 15 years, 36.2% of the original participants had dropped out of the study, and 30.9% had not yet reached the time for their 15-year follow-up examination.

RESULTS: During the follow-up period, type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group, corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years, respectively (adjusted hazard ratio with bariatric surgery, 0.17; 95% confidence interval, 0.13 to 0.21; P< 0.001). The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose (P = 0.002 for the interaction) but not by BMI (P = 0.54). Sensitivity analyses, including end-point imputations, did not change the overall conclusions. The postoperative mortality was 0.2%, and 2.8% of patients who underwent bariatric surgery required reoperation within 90 days owing to complications.

CONCLUSIONS: Bariatric surgery appears to be markedly more efficient than usual care in the prevention of type 2 diabetes in obese persons. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01479452.)

Place, publisher, year, edition, pages
Massachusetts Medical Society , 2012. Vol. 367, no 8, 695-704 p.
National Category
Surgery Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-58386DOI: 10.1056/NEJMoa1112082ISI: 000307754200004PubMedID: 22913680Scopus ID: 2-s2.0-84865293878OAI: oai:DiVA.org:oru-58386DiVA: diva2:1117838
Funder
Swedish Research Council, K2012-55X-22082-01-3 K2010-55X-11285-13 K2008-65x-20753-01-4Swedish Foundation for Strategic Research
Note

Funding Agencies:

AstraZeneca  

New York Obesity Nutrition Research Center  

Pathway Genomics  

Weight Watchers  

Nike  

Human Kinetics and Informa Healthcare  

Pfizer  

Roche  

Novartis  

Johnson Johnson  

Swedish federal government under the LUA/ALF  

VINNOVA-VINNMER program  

Wenner-Gren Foundations  

Hoffmann-La Roche  

Cederroth  

Sanofi-Aventis 

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2017-10-18Bibliographically approved

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Näslund, Ingmar

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Peltonen, MarkkuAhlin, SofieNäslund, IngmarRomeo, StefanoSjöholm, KajsaSvensson, Per-Arne
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New England Journal of Medicine
SurgeryEndocrinology and Diabetes

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