Bariatric Surgery: There Is a Room for Improvement to Reduce Mortality in Patients with Type 2 Diabetes
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BRIEF COMMUNICATION
Bariatric Surgery: There Is a Room for Improvement to Reduce Mortality in Patients with Type 2 Diabetes Carel W. le Roux 1 & Johan Ottosson 2,3 & Erik Näslund 2,4 & Ricardo V. Cohen 5 Ingmar Näslund 2,3
& Erik Stenberg
2,3
& Magnus Sundbom
2,6
&
Received: 6 July 2020 / Revised: 13 August 2020 / Accepted: 14 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The new Scandinavian Obesity Surgery Registry (SOReg) report may influence current guidelines. Patients without type 2 diabetes (T2DM) prior to bariatric surgery had lower mortality over 6.3 years compared to those with T2DM. Moreover, patients with T2DM who achieved remission within 1 year after surgery had lower mortality than those who did not remit. Finally, there was no threshold at 10 years, but rather a linear relationship between duration of T2DM and glycemic remission. The SOReg report challenges existing recommendations and clinical practice. A case may also be made for patients with T2DM who did not achieve glycemic remission after 1 year to have a combination approach of surgery with medicines rather than surgery alone. Ultimately, the impact of T2DM duration on glycemic remission again suggest that patients with T2DM should have bariatric surgery earlier. Keywords Bariatric surgery . Metabolic surgery . Type 2 diabetes
The Scandinavian Obesity Surgery Registry (SOReg) described 65,345 patients with up to 10-year follow-up after primary bariatric surgery. Of these, 11,990 (18.1%) patients had type 2 diabetes (T2DM) prior to gastric bypass or sleeve gastrectomy. A further 19,281 (29.5%) had prediabetes. A significant advantage is that the Swedish registries have complete mortality data because of the linkage to their national population register. On 12 May 2020, SOReg published its
* Ricardo V. Cohen [email protected] 1
Diabetes Complications Research Center, University College Dublin, Dublin, Ireland
2
Scandinavian Obesity Surgery Registry, Lund, Sweden
3
Faculty of Medicine and Health, Örebro University, Örebro, Sweden
4
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
5
The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Rua Cincinato Braga, 37. 5th floor, Sao Paulo, SP 01333-010, Brazil
6
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
latest in-depth report on the effects of bariatric surgery on T2DM [1]. Randomized controlled trials and cohort studies consistently showed that bariatric surgery is an effective treatment for T2DM with superior metabolic control compared with best medical care [2]. The new SOReg report provides long-term follow-up in a large cohort, thus addressing the knowledge gap identified by the National Institute of Health in the USA and the National Institute for Health and Care Excellence guidelines in the UK on bariatric surgery for diabetes [3]. Clinical management of patients with diabetes after bariatric surgery evolved, but often in the absence of an es
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