P1039BARIATRIC SURGERY AND RISKS OF RENAL DISEASES, CARDIOVASCULAR DISEASES AND MORTALITY AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract Background and Aims To measure and compare the risks of end-stage renal diseases (ESRD), cardiovascular diseases (CVD), all-cause mortality between obese type 2 diabetes mellitus (T2DM) patients with and without bariatric surgery. Method A retrospective population-based cohort of 1,690 obese T2DM patients who were free of ESRD and CVD were assembled based on 2006-2017 Hospital Authority database. One-to-five propensity-score matching was used to balance baseline covariates between patients in bariatric surgery and control groups. Incidence rates (IR) of stage 4/5 chronic renal diseases, ESRD, CVD and all-cause mortality events for two groups were calculated. Hazard ratios (HR) for stage 4/5 chronic renal diseases, ESRD, CVD events were assessed using Cox proportional hazard models. Changes in estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) were measured up to 60 months. Results Over a mean follow-up period of 34 months with 863 person-years, cumulative incidences of mortality, stage 4/5 chronic kidney diseases, ESRD and CVD for surgical patients were 0, 0.050, 0.017, and 0.036, respectively. Surgical patients had reduced IR of all-cause mortality, stage 4/5 chronic kidney diseases, ESRD and CVD (IR=0, 1.784, 0.587 and 1.321 per 100 person-years, respectively) than control patients (IR=1.954, 2.028, 0.914 and 2.814 per 100 person-years, respectively). Surgery group had a significant reduction in risk of CVD events (HR=0.464, P=0.015), and no occurrence of mortality events. However, the IR of stage 4/5 chronic kidney diseases and ESRD of the two groups were not significantly different. Surgical patients had significantly higher eGFR within 12 months, and had significantly lower until 48 months. Conclusion Among obese T2DM patients, bariatric surgery lowered the risk of CVD and mortality, and was beneficial towards the kidney outcomes of eGFR up to 36 months.

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Effects of bariatric surgery on kidney diseases, cardiovascular diseases, mortality and severe hypoglycaemia among patients with Type 2 diabetes mellitus

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa075 ◽

2020 ◽

Author(s):

Carlos K H Wong ◽

Tingting Wu ◽

Simon K H Wong ◽

Betty T T Law ◽

Eleanor Grieve ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Type 2 Diabetes Mellitus ◽

Cardiovascular Diseases ◽

Severe Hypoglycaemia ◽

Kidney Diseases ◽

Stage 4 ◽

All Cause Mortality

Abstract Background Bariatric surgery has been widely indicated for the management of obesity and related comorbidities. However, there are uncertainties pertaining to the risks of post-bariatric severe hypoglycaemia (SH), cardiovascular diseases (CVDs), end-stage kidney diseases (ESKDs) and all-cause mortality in obese patients with Type 2 diabetes mellitus (T2DM), especially among Asian populations. Methods A retrospective population-based cohort of 1702 obese T2DM patients who were free of CVD and ESKD were assembled based on the 2006–17 Hospital Authority database. One-to-five propensity-score matching was used to balance baseline covariates between patients in bariatric surgery and control groups. Incidence rates (IRs) of SH, CVD, Stage 4/5 chronic kidney diseases (CKD), ESKD and all-cause mortality events for two groups were calculated. Hazard ratios (HR) for SH, CVD and Stage 4/5 CKD events were assessed using Cox-proportional hazard models. Changes in estimated glomerular filtration rate (eGFR) and urine albumin–creatinine ratio (UACR) were measured up to 60 months. Results Over a mean follow-up period of 32 months with 5725 person-years, cumulative incidences of mortality, CVD, Stage 4/5 CKD, ESKD and SH were 0, 0.036, 0.050, 0.017 and 0.020, respectively. The surgery group had a significant reduction in risk of CVD events (HR = 0.464, P = 0.015) and no occurrence of mortality events. However, there were no significant differences in risks of SH [HR = 0.469, 95% confidence interval (CI): 0.204–1.081], Stage 4/5 CKD (HR =0.896, 95% CI: 0.519–1.545) and ESKD (HR = 0.666, 95% CI: 0.264–1.683) between two groups, although IRs were lower in the surgery group. Surgical patients had significantly higher eGFR within 12 months and had significantly lower UACR until 48 months. Conclusions Among obese T2DM patients, bariatric surgery lowered the risk of CVD and mortality, and was beneficial towards the kidney outcomes.

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SGLT2 Inhibitors, GLP-1 Receptor Agonists, or Bariatric Surgery and Risks of All-Cause Mortality, Cardiovascular Diseases, End-Stage Renal Diseases, and Severe Hypoglycemia in Obese Patients with Type 2 Diabetes Mellitus

SSRN Electronic Journal ◽

10.2139/ssrn.3551370 ◽

2020 ◽

Author(s):

Carlos Wong ◽

Tingting Wu ◽

Eric Tang ◽

Kenneth Man ◽

Simon Wong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Severe Hypoglycemia ◽

Sglt2 Inhibitors ◽

Renal Diseases ◽

Obese Patients ◽

All Cause Mortality ◽

End Stage

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Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020464 ◽

2021 ◽

Vol 50 (2) ◽

pp. 159-170

Author(s):

Felicia Clara JH Tan ◽

Seng Bin Ang ◽

Yong Mong Bee

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Lactic Acidosis ◽

Cohort Studies ◽

Case Series ◽

Stage 4 ◽

Ckd Stage ◽

All Cause Mortality

Introduction: Practice guidelines advise caution on the use of metformin in patients with type 2 diabetes mellitus with chronic kidney disease (CKD). This review aims to examine the evidence for the benefits and risks of metformin use in patients with T2DM and CKD. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and PubMed were searched; the references of selected papers were hand searched. Systematic reviews, randomised controlled trials, cohort studies, case series and case-control studies were included. The full text of selected articles was reviewed. The outcomes studied were all-cause mortality, cardiovascular complications, lactic acidosis and worsening of renal function. Recommendations were graded according to the Scottish Intercollegiate Guidelines Network system. Results: A total of 139 unique articles were identified, 14 of which met the inclusion criteria and were selected for full-text review. Four cohort studies reported an association between metformin use and improved all-cause mortality in CKD stage 4 and better. Two cohort studies reported improved cardiovascular outcomes with metformin use. Four cohort studies, 1 case series and 1 case-control study reported no significant association between metformin use and an increased risk of lactic acidosis in CKD. There is a moderate level of evidence to support reduced mortality, improved cardiovascular outcomes and a low risk of lactic acidosis with metformin use in patients with T2DM and with CKD stage 4 and above. Conclusion: Existing recommendations to restrict metformin use in diabetes patients with CKD need to be reviewed in light of emerging evidence supporting its overall benefits in these patients. Keywords: Chronic renal insufficiency, metformin, type 2 diabetes mellitus

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Five-year direct medical costs and comorbidities after bariatric surgery of obese patients with type 2 diabetes mellitus: A population-based propensity score-matched study

10.21203/rs.3.rs-16320/v1 ◽

2020 ◽

Author(s):

Tingting Wu ◽

Simon Kin Hung Wong ◽

Betty Tsz Ting Law ◽

Eleanor Grieve ◽

Olivia Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Type 2 Diabetes Mellitus ◽

Medical Costs ◽

Population Based ◽

Surgical Patients ◽

Obese Patients ◽

Direct Medical Costs

Abstract Background: Bariatric surgery is effective in weight reduction and diabetes remission. This study aimed to estimate direct medical costs and changes of comorbidities after bariatric surgery up to five years among obese patients with type 2 diabetes mellitus. Methods: A population-based retrospective cohort of obese type 2 diabetes patients from Hong Kong Hospital Authority between 2006 and 2017 was assembled. One-to-five propensity score matching method was applied to match 401 eligible surgical patients with 1,894 non-surgical patients. Frequency of healthcare service utilization and dispense of diabetes medication were collected for both groups to estimate the direct medical costs from baseline to up to 60 months; Charlson Comorbidity Index (CCI) and number of comorbidities were measured to compare the changes of comorbidities between two groups over the 5 years. Results: Direct medical costs were US$40,889 for surgical patients and US$6,163 for controls in the index year (p<0.001), with incremental costs of US$34,726. Bariatric surgery and hospitalization were the main cost drivers for surgical patients in the year of surgery. Although surgical patients had significantly lower annual costs than control patients in the subsequent four years, five-year cumulative costs incurred by surgical patients were significantly greater than controls (US$60,174 vs US$33,374, p<0.001), regardless of subgroups. Surgical patients had better profile of comorbidities than controls, as they had significantly lower CCI after baseline and fewer percentages of them proceeded to higher CCI categories. Conclusions: Over 5 years, bariatric surgery was associated with increased medical costs in the year of surgery and cumulative costs. Although bariatric surgery is not cost-saving for type 2 diabetes patients at 5 years, it is associated with improved comorbidity profile.

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How to Classify Type 2 Diabetes Mellitus and Approach its Treatment in View of Associated Diabetes and Complications-A Short Communication

Series of Endocrinology, Diabetes and Metabolism ◽

10.54178/jsedmv1i2002 ◽

2019 ◽

Vol 1 (2) ◽

pp. 29-34

Author(s):

Kulvinder Kochar Kaur ◽

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Type 2 Diabetes Mellitus ◽

Short Communication ◽

Morbidly Obese ◽

Stage 4 ◽

Obese Subjects ◽

Obesity Drugs

With the increase in epidemic of obesity, the incidence of type 2 diabetes mellitus (T2DM) is increasing globally so much that the need has arisen for treating the two diseases together with the term diabesity getting coined. Here, we have tried to sub-classify T2DM stage-wise and how the treatment should be aimed keeping in view the use of weight-neutral anti-diabetic drugs. Preferably, insulin needs to be avoided due to its weight gaining effects and use of liraglutide should be preferred in the heavily obese diabetics due to its weight lowering effects. If the patient is in stage 4 group where insulin is practically non-existent, one can try using anti-obesity drugs along with insulin or see which works better with the influence of bariatric surgery seen on controlling diabetes in morbidly obese subjects.

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