While bariatric surgery has clear benefits for obese people with type 2 diabetes, it is also responsible for long-term, significant adverse events that require patient selection and prolonged surveillance.
In obese patients with type 2 diabetes, bariatric surgery reduces the risk of all-cause death by 49%, according to a new study from the University of Gothenburg. For cardiovascular diseases, particularly myocardial infarction and heart failure, the risk is reduced by 34% in the bariatric surgery group.
There is also a significant decrease in the risk of hyperglycemia, limb amputations, kidney disease and cancer. However, this benefit is not generalizable to all patients. In addition, because of its late side effects, bariatric surgery requires adequate and prolonged monitoring. So far, bariatric surgery studies have not provided much evidence of long-term beneficial and negative impact.
This study was presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Berlin.
A national study
The researchers followed for 9 years a Swedish national cohort of obese patients treated by bariatric surgery. The cohort was formed by merging data from the Scandinavian Register of Obesity Surgery, the National Diabetes Registry and national databases.
With this cohort, they were able to compare over an average of 9 years of follow-up obese patients suffering from type 2 diabetes and having had a bariatric surgery (5321 patients), with those who were not surgically treated for obesity. (5321 patients).
Short and long term complications
A number of short-term complications are more common after bariatric surgery: gallstones and gallbladder disease (2.5-fold risk), ulcer and gastrointestinal reflux (5.4-fold), intestinal obstruction ( 9.5 times). Abdominal pain and gastrointestinal disorders are also more common in the bariatric surgery group and have often required additional surgery (risk 3.3 times higher).
In the long term, it appears that bariatric surgery increases the risk of anemia by 92% and makes patients 3 times more likely to suffer from malnutrition. In addition, people who are operated on are 33% more likely to have a psychiatric problem or addiction to alcohol (three times more often than in the control group).
Better risk and benefit assessment
This national study confirms the benefits of bariatric surgery, but allows us to better understand the frequency of adverse effects that can occur in the aftermath of surgery in obese people with type 2 diabetes. Having this information should allow doctors to make more informed decisions when selecting candidates for surgery and enable them to better organize follow-up and support to make available to patients.