For people with diabetes, the risk of dying may be higher following sleeve gastrectomy — a common form of bariatric (weight-loss) surgery — compared with gastric bypass, another common procedure, according to a new study published in the journal Diabetes Care.
For people with diabetes who also have obesity, bariatric surgery can have major health benefits. Studies have shown that bariatric surgery promotes remission of type 2 diabetes and prediabetes — meaning that many people experience normal blood glucose levels without taking any glucose-lowering medications. It may also reduce the risk for certain diabetes complications such as retinopathy (eye disease), and could even help reduce the need for knee replacement surgery. Bariatric surgery is also linked to healthier lifestyle behaviors and a lower overall death risk.
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For the latest study, researchers looked at bariatric surgery outcomes in Sweden and Finland between 2007 and 2020. They calculated the risk of dying following sleeve gastrectomy or gastric bypass, adjusting for factors like age, sex, blood pressure, diabetes status, and other health conditions. A total of 61,503 people who underwent gastric bypass (51,891, or 84.4%) or sleeve gastrectomy (9,612, or 15.6%) were included in the study, with a median age of 42, and about 75% of participants were women. During an average per-person follow-up period lasting 6.8 years, 1,571 participants (2.6%) died after undergoing bariatric surgery.
Sleeve gastrectomy linked to increased death risk in those with diabetes
The researchers found that overall, participants who underwent each type of bariatric surgery had an almost identical risk of dying during the follow-up period — with those who underwent sleeve gastrectomy 2% less likely to die over the entire study period, but 28% less likely to die between 2014 and 2020. But the results were very different when the researchers looked just at people with diabetes — over the course of the study period, people with diabetes who underwent sleeve gastrectomy were 54% more likely to die than those who underwent gastric bypass.
The most common causes of death during the follow-up period were cardiovascular disease and cancer, as noted in an article on the study at Healio — with no difference in rates of these specific causes of death between participants who underwent gastric bypass and those who underwent sleeve gastrectomy. There was no indication that either type of bariatric surgery carried a higher risk of immediate surgical complications that could lead to death, and the study did not compare the risk of dying between people who had bariatric surgery and those who didn’t undergo the procedure.
The researchers concluded that even though sleeve gastrectomy was linked to a lower overall death risk in recent years compared with gastric bypass, the different results in people with diabetes demonstrate that “a tailored surgical approach in relation to patients’ diabetes status may optimize survival in patients selected for bariatric surgery.”
Want to learn more about bariatric surgery and diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”