scholarly journals Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

2021 ◽  
Author(s):  
Kajsa Sjöholm ◽  
Lena MS Carlsson ◽  
Per-Arne Svensson ◽  
Johanna C. Andersson-Assarsson ◽  
Felipe Kristensson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Cancer Risk ◽  
Cancer Incidence ◽  
Diabetes Remission ◽  
Obesity And Diabetes ◽  
Obese Subjects

<b>OBJECTIVE</b> <p>Obesity and type 2 diabetes are associated with serious, adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of which underwent bariatric surgery, and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). </p> <p><b>RESULTS</b></p> <p>During follow-up, the incidence rate for first-time cancer was 9.1 per 1000-person-years (95% CI, 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1000-person-years (95% CI, 11.2-17.7) in patients treated with usual obesity care (HRadj=0.63; 95% CI 0.44-0.89, p=0.008). Moreover, surgery was associated with reduced cancer incidence in women (HRadj=0.58; 0.38-0.90, p=0.016), although the sex-treatment interaction was non-significant (p=0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (HRadj=0.40; 95% CI 0.22-0.74, p=0.003).</p> <p><b>CONCLUSIONS</b></p> <p>These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes, and that durable diabetes remission is associated with reduced cancer risk. </p>

scholarly journals Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

2021 ◽  
Author(s):  
Kajsa Sjöholm ◽  
Lena MS Carlsson ◽  
Per-Arne Svensson ◽  
Johanna C. Andersson-Assarsson ◽  
Felipe Kristensson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Cancer Risk ◽  
Cancer Incidence ◽  
Diabetes Remission ◽  
Obesity And Diabetes ◽  
Obese Subjects

<b>OBJECTIVE</b> <p>Obesity and type 2 diabetes are associated with serious, adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of which underwent bariatric surgery, and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). </p> <p><b>RESULTS</b></p> <p>During follow-up, the incidence rate for first-time cancer was 9.1 per 1000-person-years (95% CI, 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1000-person-years (95% CI, 11.2-17.7) in patients treated with usual obesity care (HRadj=0.63; 95% CI 0.44-0.89, p=0.008). Moreover, surgery was associated with reduced cancer incidence in women (HRadj=0.58; 0.38-0.90, p=0.016), although the sex-treatment interaction was non-significant (p=0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (HRadj=0.40; 95% CI 0.22-0.74, p=0.003).</p> <p><b>CONCLUSIONS</b></p> <p>These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes, and that durable diabetes remission is associated with reduced cancer risk. </p>

scholarly journals New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

2020 ◽  
Vol 9 (4) ◽  
pp. 1070
Author(s):  
Ana de Hollanda ◽  
Albert Lecube ◽  
Miguel Angel Rubio ◽  
Enric Sánchez ◽  
Núria Vilarrasa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Diabetes Remission ◽  
Dynamic Responses ◽  
Type 2 Diabetes Remission

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the “time-within-remission range” as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, “time-within-remission range” and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m2) underwent primary bariatric procedures. “Time-within-remission range” were 83.3% (33.3–91.6) after gastric bypass, 68.7% (7.1–87.5) after sleeve gastrectomy and 90% (83.3–92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the “time-within-remission range”. The association of bariatric techniques with “time-within-remission range”, using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34–5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40–0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The “time-within-remission range” unveils a superiority of gastric bypass compared to sleeve gastrectomy.

scholarly journals MON-657 The Long-Term Effects of Sleeve Gastrectomy in Veterans with Type 2 Diabetes Mellitus (8-Year Follow-Up Analysis)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Johane Simelane ◽  
Amelia Tisi ◽  
Irma Husain ◽  
Pietra Dale Greenberg
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Friedman Test ◽  
The Mean ◽  
Mental Health Diagnoses

Abstract We previously reported a nonrandomized case control study that showed significant improvements in BMI, HbA1c and HDL levels in 30 diabetic veterans who underwent sleeve gastrectomy (SG) through 2 yrs, compared to 23 controls receiving medical management. BMI decreased from 46 to 34 over two yrs and HbA1c from 7.3 to 5.9% in the SG group. We now report the 8 yr follow up. Since then, bariatric surgery has increasingly become an option for the management of not only obesity but also type 2 diabetes. More data is needed on long term outcomes of bariatric surgery compared to medical care. Our cohort is mainly men with more comorbidities and higher average age than typically included in other cohorts that usually include more women. Objectives: The main objective was to compare long term changes in weight, HbA1C, lipids and creatinine in SG group vs. controls. Secondary objectives analyzed were cardiovascular (CV) and mental health outcomes in SG cases and controls. Methods: Charts for diabetic veterans 18 to 80 yrs were reviewed over an 8 yr period. Data was analyzed using Friedman Test, Wilcoxon Signed Rank test with 2-tailed significance level set at p&lt;05. Results: 23 cases and 22 controls were included in the 8-year data analysis. Mean age was 56 and 96% were male. The mean BMI and HbA1C at baseline were 45 and 7.3 in SG group with 41% on insulin and 42 and 8.4 for controls with 59% on insulin. A Friedman test found significant differences in mean changes in weight for BMI, HbA1C and HDL between SG cases and controls over the 8 yrs. (chi-square = 327.48; df = 4; p&lt;0.000001). Follow up pairwise comparisons used a Wilcoxon test. HDL was higher in the SG group (p&lt;.05) in each yr. Mean change in weight and BMI was significantly better for the SG group in the first 6 yrs after SG (p&lt; .01). Nonetheless, the mean weight and BMI of SG group remained below their mean baseline weight and BMI for the full 8 year-period. The mean change in HbA1C was significantly better for the SG group in only the first 2 yrs (p&lt;0.05). LDL change was significantly worse in SG group but not in all years. There were no significant differences in creatinine. Patients who had SG had fewer CV events 8 yrs after SG (baseline OR: 4.17, yr 8 OR:0.77). However, they also had more mental health diagnoses (yr 8 OR: 1.61). Conclusion:The weight loss in the SG group, as compared to controls, lessened over time remaining statistically significant until yr 6. However, the SG group mean BMI and weight remained below baseline at 8 years. HbA1C change remained significantly better in the SG group compared to controls only during the first 2 yrs. Follow up diabetes management in SG group was less consistent than controls. HDL remained significantly higher among the SG group which may be explain the lower CV events in this group. Awareness of more mental health diagnoses among bariatric surgery patients may lead to improved management and better adherence to a healthy lifestyle.

scholarly journals Can Bariatric Surgery be Considered Standard Therapy to Treat Type 2 Diabetes?

2013 ◽  
Vol 09 (02) ◽  
pp. 108
Author(s):  
Karen Meyvis ◽  
Christophe De Block ◽  
Luc F Van Gaal ◽  
◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Randomized Trials ◽  
Diabetes Remission ◽  
Independent Effect ◽  
Pharmacologic Therapy ◽  
Diabetes Treatment ◽  
Pronounced Increase

With the rapid increase in obesity there has been a pronounced increase in obesity-related metabolic disorders including type 2 diabetes, cardiovascular disease, dyslipidemia, and hypertension. Bariatric surgery is a highly effective treatment for achieving long-term weight loss and is increasingly recognized to have benefits in diabetes treatment and cause improvement in other metabolic factors. Recent small randomized trials reported better glycemic control after surgical intervention compared with pharmacologic therapy. Physiologic studies suggest a surgeryspecific, weight-independent effect on glucose homeostasis. Long-term efficacy is to be proven. Consensus on definition of diabetes and diabetes remission must be achieved. Larger multicentre, randomized trials need to be performed to clarify the place of metabolic surgery in diabetes treatment algorithms.

scholarly journals Comparison of preoperative remission scores and diabetes duration alone as predictors of durable type 2 diabetes remission and risk of diabetes complications after bariatric surgery: a post-hoc analysis of participants from the Swedish Obese Subjects study

2020 ◽  
Author(s):  
Kajsa Sjöholm ◽  
Lena MS Carlsson ◽  
Magdalena Taube ◽  
Carel W le Roux ◽  
Per-Arne Svensson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Diabetes Complications ◽  
Predictive Ability ◽  
Diabetes Remission ◽  
Diabetes Duration ◽  
Diabetes Medication ◽  
Obese Subjects ◽  
Durable Remission

<b>Objective </b>Bariatric surgery is associated with diabetes remission and prevention of diabetes-related complications. The scores ABCD, DiaRem, Ad-DiaRem, DiaBetter and IMS were developed to predict short to medium-term diabetes remission after bariatric surgery. However, they have not been tested for predicting durable remission nor the risk of diabetes complications, nor compared with diabetes duration alone. <p><b>Research Design and Methods </b>We identified 363<b> </b>individuals from the surgically treated group in the prospective Swedish Obese Subjects (SOS) study with preoperative type 2 diabetes and for whom data (preoperative age, BMI, C-peptide, HbA1c, oral diabetes medication(s), insulin use, and diabetes duration) were available for calculation of remission scores. Partial remission (after 2 and 10 years) was defined as blood glucose <6.1 mmol/L or HbA1c <6.5% (48 mmol/mol) and no diabetes medication. Information on diabetes complications (at baseline and over 15 years of follow-up) was obtained from national health registers. Discrimination was evaluated by area under receiving operator characteristic curves (AUROCs).</p> <p><b>Results </b>For 2-year diabetes remission, AUROCs were between 0.79 and 0.88 for remission scores and 0.84 for diabetes duration alone. After 10 years, the predictive ability of scores decreased markedly (AUROCs between 0.70-0.76) and no score had higher predictive capacity than diabetes duration alone (AUROC=0.73). For development of microvascular and macrovascular diabetes complications over 15 years, AUROCs for remission scores were 0.70-0.80 and 0.62-0.71, respectively, and AUROCs for diabetes duration alone were 0.77 and 0.66, respectively. </p> <b>Conclusions </b>Remission scores and diabetes duration are good predictors of short-term diabetes remission. However, for durable remission and risk of complications, remission scores and diabetes duration alone have limited predictive ability.

scholarly journals Long-term incidence of colorectal cancer after bariatric surgery or usual care in the Swedish Obese Subjects study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248550
Author(s):  
Magdalena Taube ◽  
Markku Peltonen ◽  
Kajsa Sjöholm ◽  
Richard Palmqvist ◽  
Johanna C. Andersson-Assarsson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Bariatric Surgery ◽  
Rectal Cancer ◽  
Cancer Risk ◽  
Colorectal Cancer Risk ◽  
Control Group ◽  
Surgery Group ◽  
Obese Subjects

Bariatric surgery in patients with obesity is generally considered to reduce cancer risk in patients with obesity. However, for colorectal cancer some studies report an increased risk with bariatric surgery, whereas others report a decreased risk. These conflicting results demonstrate the need of more long-term studies analyzing the effect of bariatric surgery on colorectal cancer risk. Therefore, data from the Swedish Obese Subjects (SOS) study, ClinicalTrials.gov identifier: NCT01479452, was used to examine the impact of bariatric surgery on long-term incidence of colorectal cancer. The SOS study includes 2007 patients who underwent bariatric surgery and 2040 contemporaneously matched controls who received conventional obesity treatment. Patients in the surgery group underwent gastric bypass (n = 266), banding (n = 376) or vertical banded gastroplasty (n = 1365). Information on colorectal cancer events was obtained from the Swedish National Cancer Registry. Median follow-up was 22.2 years (inter-quartile range 18.3–25.2). During follow up there were 58 colorectal cancer events in the surgery group and 67 colorectal cancer events in the matched control group with a hazard ratio (HR) of 0.79 (95% CI:0.55–1.12; p = 0.183). After adjusting for age, body mass index, alcohol intake, smoking status, and diabetes, the adjusted HR was 0.89 (95% CI:0.62–1.29; p = 0.551). When analyzing rectal cancer events separately- 19 events in the surgery group and 31 events in the control group-a decreased risk of rectal cancer with surgery was observed (HR = 0.56; 95% CI:0.32–0.99; p = 0.045, adjusted HR = 0.61 (95% CI:0.34–1.10; p = 0.099), while the risk of colon cancer was unchanged. To conclude- in this long-term, prospective study, bariatric surgery was not associated with altered colorectal cancer risk.

scholarly journals Can Bariatric Surgery be Considered Standard Therapy to Treat Type 2 Diabetes?

2010 ◽  
Vol 9 (2) ◽  
pp. 86 ◽  
Author(s):  
Karen Meyvis ◽  
Christophe De Block ◽  
Luc F Van Gaal ◽  
◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Diabetes Remission ◽  
Pharmacological Therapy ◽  
Independent Effect ◽  
Diabetes Treatment ◽  
Randomised Trials ◽  
Pronounced Increase

With the rapid increase in obesity there has been a pronounced increase in obesity-related metabolic disorders including type 2 diabetes, cardiovascular disease, dyslipidaemia and hypertension. Bariatric surgery is a highly effective treatment for achieving long-term weight loss and is increasingly recognised to have benefits in diabetes treatment and cause improvement in other metabolic factors. Recent small randomised trials reported better glycaemic control after surgical intervention compared to pharmacological therapy. Physiological studies suggest a surgery-specific, weight-independent effect on glucose homeostasis. Long-term efficacy is to be proven. Consensus on definition of diabetes and diabetes remission must be achieved. Larger multicentre, randomised trials need to be done to clarify the place of metabolic surgery in diabetes treatment algorithms.

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