Diabetes News/Recent Literature Review/ First Quarter 2018

Abstract

Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity   In this observational retrospective study, 2287 patients with obesity (BMI≥30 ) and type 2 diabetes who underwent metabolic surgery within the Cleveland Clinic Health System, were matched 1:5 to nonsurgical patients with diabetes and obesity. The primary end point was the incident of extended major adverse cardiovascular events (MACE, composite of 6 outcomes), defined a first all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy and atrial fibrillation. Secondary outcome included 3-component MACE (myocardial infarction, ischemic stroke and mortality). The median follow-up duration was 3.9 years. At the end of the study period, 385 (30.8%) patients in the surgical group and 3243 (44.7%) patients in the nonsurgical group experienced a primary end point (hazard ratio, HR 0.61, 95% CI, 0.55 – 0.69). All secondary putcomes showed significantly differences in favor of metabolic surgery. All-cause mortality occurred in 112 patients in the metabolic surgery group and 1111 patients in the nonsurgical group (HR = 0.59, 95%CI, 0.48- 0.72). Metabolic surgery was also associated with a significant reduction of HbA1c (mean difference between groups1.1%), and use of noninsulin diabetes medication, insulin antihypertensive medications and lipid0lower therapies. In the 90 days after metabolic surgery, complications included bleeding requiring transfusion (n=68, 3.0 %), pulmonary adverse events (n=58, 2.5%), venous thromboembolism (n=4, 0.2%), cardiac events (n=17, 0.7%), and renal failure requiring dialysis (n=4, 0.2%) (Aminlan A et al, JAMA 2019;322:1271-1282).