1484-P: Association between Bariatric Surgery and Cardiovascular Events, Mortality, and Glycemic Control among Diabetes Patients: Evidence from a Large EMR Network

Abstract

Introduction: Studies show that cardiovascular (CV) risk among patients with type 2 diabetes (T2D) and obesity is not always well managed by lifestyle changes. The following study used RWD to examine the effect of bariatric surgery (BS) on CV outcomes and glycemic control (GC) among high risk T2D patients. Methods: In a 1:1 matched propensity score (PS) analysis using the TriNetX database, a federated EMR network representing over 40M patients, T2D patients undergoing BS were compared to T2D patients who were not. Definitions were based on ICD9/10, CPT, RxNorm, and LOINC codes. Patients aged 18-90 were required to have two T2D diagnosis codes 6 months apart, no type 1 diabetes, and a BMI ≥ 30 kg/m2 in the year prior to the index event (IE). The IE was defined by the first BS code in the treated group and the first RxNorm or CPT code in the comparison group. Outcomes of interest were a combined CV event (stroke, MI, or angina) and overall survival (OS). GC (HbA1c < 6.5%) was examined among patients with a HbA1c greater than 9% at baseline. Risk ratios (RR; 95% CIs) and KM curves were calculated for each outcome. Results: In two matched cohorts of 2,972 patients each, a standardized mean difference of <10% was observed for all variables used to calculate the PS. At the time of the IE, patients were 51 (11) and 50 (13) years old, 69% and 68% female, and 62% and 64% white in the BS and comparison groups, respectively. Patients undergoing BS were 60% (70-50%) less likely to experience a CV event (n = 65 events and 173 events, respectively). The 5-year OS was 97% compared to 94% (p<0.01). In a matched subsample of 904 patients with a HbA1c of > 9% in the year prior to the IE, patients undergoing BS were 3.6 (2.4-5.5) times more likely to achieve a HbA1c of < 6.5 in the 12-18 months after the IE. Conclusion: This analysis provides RWE to support a growing body of literature that BS reduces the risk of CV events and mortality, and increase glycemic control, among high risk T2D patients. Disclosure S. Kuranz: Employee; Self; TriNetX, Inc.