Patients with diabetes and a history of metabolic surgery had significantly fewer heart attacks, strokes, hospitalisations and death, compared to matched patients who did not have the surgery, according to a new study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2023 Annual Scientific Meeting.
“This is an important study in that it demonstrates that the effectiveness of metabolic surgery on diabetes should not be measured solely in whether diabetes disappears or not,” said Dr Teresa LaMasters, ASMBS President and a bariatric surgeon and board-certified obesity medicine physician, who was not involved in the study. “While some diabetes may remain, the protective effects against the complications of disease are enduring.”
The US spends billions annually on diabetic care, but there are significant hidden costs such as the increased burden of cardiovascular disease. Metabolic surgery is known to provide remission in 50-80% of T2DM. This study aimed to assess the impact of metabolic surgery on the cardiovascular outcomes of patients with T2DM, the authors stated.
Using the National Inpatient Samples (2016-19), they performed a 1:5 case-match analysis on patients with T2DM and then compared patients with or without history of bariatric surgery, matched for age, gender, race, socioeconomic status, and Charlson comorbidity index. Logistic regression analysis was performed to examine occurrence, estimated cost, length of stay and mortality controlling for matched variable and BMI. Additionally, estimates of annual reduction in occurrence and cost savings were calculated if obese patients were T2DM undergo metabolic surgery.
They reported that patients who received metabolic surgery were associated with a significantly reduced risk of developing myocardial infarction, congestive heart failure, cerebrovascular accident and requiring coronary bypass, coronary angioplasty and lower limb amputation. Patients reduced their chances of winding up in a hospital with a heart attack by more than 35%, a stroke by more than 25% and congestive heart failure by nearly 15%. And if they did experience any of these and other complications, they were much less likely to die. Patients who had a myocardial infection reduced their risk of death by a little over 27%, while congestive heart failure and stroke patients cut the risk by more than 40% and nearly 27%, respectively.
In addition, metabolic surgery was associated with reduced mortality, length of stay, and cost of admission of these diseases and procedures, lowering costs from over US$1,000 to nearly US$4,000, depending on complication and required treatment. The researchers estimate that if all patients with type 2 diabetes and obesity in the US were to achieve such results, it could lead to cost savings of over US$2 billion a year.
“This study shows that a patient does not have to go into full diabetes remission to get significant cardiovascular benefits from metabolic surgery,” said study co-author, Dr Jonathan Jenkins, who conducted the research at University of Oklahoma in Tulsa. “We anticipated there would be small differences, but we were surprised to see the significant microvascular and macrovascular protective effects. We hypothesise the increased glycaemic control in metabolic surgery resistant type 2 diabetes drives decreased cardiovascular risk.”