Many people with diabetes are overweight and know they should lose weight, but it can be so difficult. For extreme cases of obesity, however, there is always the option of weight-loss surgery, or bariatric surgery as it’s also known. But before choosing what might seem a drastic option, it would be valuable to know just how beneficial weight-loss surgery is. Now, a new study from researchers in Canada has indicated it can be helpful indeed. The report says that for patients with type 2 diabetes, weight-loss surgery is linked to a reduced risk of death from all causes.
In the province of Ontario, Canada, residents are able to access bariatric surgery through an online referral process, and for this reason the researchers had a large family medicine database of statistics to draw from — more than 500,000 patients and more than 400 physicians. After establishing specific criteria and excluding certain subjects, the researchers were able to identify a total of 3,455 patients who had undergone weight-loss surgery, as well as a control group of the same number. All the subjects had type 2 diabetes. The average age of the entire group was about 52. Nearly three out of four (71.6%) were women, and average mean body-mass index (BMI) was 44.67 (a BMI above 40 is sometimes termed “severe obesity”). Not quite half the subjects (44.1%) had diabetes for five years or less.
The great majority of the bariatric surgery patients (86.7%) had a gastric bypass, the rest had a sleeve gastrectomy, a procedure that removes about three-quarters of the stomach. Sleeve gastrectomy has become the most popular type of bariatric surgery in the United States but has been less common in Canada. The focus of the study was to compare death rates in diabetes patients who had the surgery and in those who did not. The researchers’ specific goal was to assess mortality from any and all causes, although they did classify the cause of death (cardiovascular, cancer, respiratory, gastrointestinal, infectious, and other causes, along with trauma and suicide).
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Bariatric surgery linked to lower death risk
In all, 261 deaths occurred during the follow-up period, which was just under five years. There were 83 deaths (2.4%) in the group that had bariatric surgery and 178 deaths (5.2%) in the control group, which meant that surgery patients had, as the authors wrote, a “46% lower hazard of all-cause mortality compared with their matched counterparts.” The researchers also noted that “A similar association was observed in patients who received a sleeve gastrectomy. Overall, the observed associations of gastric bypass or sleeve gastrectomy with primary and secondary outcomes were similar.” Although weight-loss surgery was beneficial across the board, some patients benefited more than others: these were the ones aged 55 and older and the ones with a BMI of 40 or more. Men also benefited more than women. Finally, surgery was associated with a reduction in death from heart disease of 68% and a reduction in cancer death of 52%.
Because, the researchers concluded, “in patients aged 55 years and older and men, bariatric surgery was associated with pronounced mortality benefit,” the results suggest “that bariatric surgery should be aggressively recommended for patients within this population.” They also said, “Healthcare practitioners should continue to encourage surgery as an option to control diabetes and obesity for all men and older individuals.” As for younger patients and those with lower BMIs, however, “longer studies may be required to examine associations with mortality.”
Want to learn more about bariatric surgery and type 2 diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”
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