Key result
Gastric bypass linked to ~60% greater CVD risk reduction in diabetes versus pre-diabetes.
Why the study?
The impact of bariatric surgery on cardiovascular risk over time in morbidly obese patients with type 2 diabetes or pre-diabetes was not well characterized.
Does Roux-en-Y gastric bypass reduce cardiovascular risk in morbidly obese patients with type 2 diabetes or pre-diabetes?
Observational (n=105)
No
Does Roux-en-Y gastric bypass reduce cardiovascular risk in morbidly obese patients with type 2 diabetes or pre-diabetes?
Odds Ratio: 0.4 (95% CI 0.3–0.63)
p-value: p=<0.001
Roux-en-Y gastric bypass significantly reduces calculated cardiovascular risk and improves metabolic parameters over 5 years in morbidly obese patients with diabetes or pre-diabetes.
RYGB may lower calculated 10-year CVD risk more in T2D than pre-diabetes; extends metabolic observations but remains hypothesis-generating pending RCTs.
BACKGROUND: Bariatric surgery is effective in remission of obesity comorbidities. This study was aimed at comparing CVD risk between morbidly obese patients with type 2 diabetes and pre-diabetes before and after bariatric surgery as well as assessing comorbidities. METHODS: This is a retrospective observational study with 105 patients with type 2 diabetes (DMbaseline) and prediabetes (preDMbaseline) who underwent Roux-en-Y gastric bypass. Data were collected preoperative and then at 3,6,12,18,24,36,48, and 60 months after surgery. Anthropometric, cardiovascular and glycemic parameters were assessed. CVD risk was calculated using the Framingham Risk Score. RESULTS: Prior to surgery, 48 patients had type 2 diabetes, while 57 had pre-diabetes. Mean age was 48 (9.2) and mean BMI was 52 (7.4). 26.1% of patients had a high CVD risk. CVD risk decreased in patients with type 2 diabetes and prediabetes at month 12 after surgery compared to the baseline risk (p < 0.001). BMI, body fat percentage, fasting plasma glucose, HbA1c, c-peptide, HOMA-IR, LDL-c, systolic blood pressure, and diastolic blood pressure decreased during the first year after surgery. From the 12th month until the 60th, they showed a flat trend, or a very mild increase in some cases. 3.2% of patients maintained high CVD risk at 60 months. Type 2 diabetes remission was 92%. No patient of the preDMbaseline group developed type 2 diabetes. CONCLUSION: .
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Rubio-Almanza et al. (2018) conducted an observational in Morbid obesity with type 2 diabetes or pre-diabetes (n=105). Roux-en-Y Gastric Bypass (RYGB) vs. Pre-diabetes group (for the primary comparison of risk reduction) was evaluated on Reduction in 10-year predicted cardiovascular disease risk (Framingham Risk Score) at 12 months (Type 2 diabetes vs Pre-diabetes) (OR 0.40, 95% CI 0.30-0.63, p=<0.001). Roux-en-Y gastric bypass significantly reduced 10-year cardiovascular disease risk at 12 months, with patients having type 2 diabetes experiencing a greater risk reduction than those with pre-diabetes (OR 0.40).
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