Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and nondiabetic obese patients undergoing gastric banding: a controlled study

Abstract

Background and aimAim of this retrospective study was to compare long-term mortality and incidence of new diseases [diabetes and cardiovascular (CV) disease] in morbidly obese diabetic and nondiabetic patients, undergoing gastric banding (LAGB) in comparison to medical treatment.Patients and methodsMedical records of obese patients [body mass index (BMI) > 35 kg/m2 undergoing LAGB (n = 385; 52 with diabetes) or medical treatment (controls, n = 681; 127 with diabetes), during the period 1995–2001 (visit 1)] were collected. Patients were matched for age, sex, BMI, and blood pressure. Identification codes of patients were entered in the Italian National Health System Lumbardy database, that contains life status, causes of death, as well as exemptions, drug prescriptions, and hospital admissions (proxies of diseases) from visit 1 to September 2012. Survival was compared across LAGB patients and matched controls using Kaplan–Meier plots adjusted Cox regression analyses.ResultsObservation period was 13.9 ± 1.87 (mean ± SD). Mortality rate was 2.6, 6.6, and 10.1 % in controls at 5, 10, and 15 years, respectively; mortality rate was 0.8, 2.5, and 3.1 % in LAGB patients at 5, 10, and 15 years, respectively. Compared to controls, surgery was associated with reduced mortality [HR 0.35, 95 % CI 0.19–0.65, p < 0.001 at univariate analysis, HR 0.41, 95 % CI 0.21–0.76, p < 0.005 at adjusted analysis], similar in diabetic [HR 0.34, 95 % CI 0.13–0.87, p = 0.025] and nondiabetic [HR 0.42, 95 % CI 0.19–0.97, p = 0.041] patients. Surgery was also associated with lower incidence of diabetes (15 vs 48 cases, p = 0.035) and CV diseases (52 vs 124 cases, p = 0.048), and of hospital admissions (88 vs 197, p = 0.04). ConclusionUp to 17 years, gastric banding is associated with reduced mortality in diabetic and nondiabetic patients, and with reduced incidence of diabetes and cardiovascular diseases.

Short‐ and long‐term mortality after bariatric surgery: A systematic review and meta‐analysis

“…13,28,59,62,63 Furthermore, the study by Eliasson et al involved mostly patients with diabetes (81% in the BS group and 90% in controls). 13,28,62,63 Again, when any one study was removed from the analysis, the OR remained consistent (0.40-0.52, P < .05). Cancer data were reported in 4 studies, and the unadjusted pooled estimates showed that mortality was also lower in the BS group than in the non-operated obese control group (OR, 0.47; 95% CI, 0.36-0.63, P < .001; I 2 = 0%, P Q = .461) ( Figure 4B).…”

“…63 Thus, the evidence suggests that BS may improve the long-term survival of obese patients and possibly decrease cardiovascular and cancer-related mortality, but these effect estimates were pooled from lower quality studies (ie, observational studies).…”

“…60,61 Most studies (10 out of 12) reported adjusted estimates. 13,26,28,39,40,[59][60][61][62][63] Of these, 10 reported adjusted estimates for age, 9 for age and gender, and 5 for age, gender and BMI (Table S3). Furthermore, the study 26,40 Most studies (8 out of 12) did not provide data on follow-up rates or reported unclear or low rates, and a high risk of attrition was therefore possible (Table S1).…”

“…However, there was no statistical evidence that the impact of BS varied by surgical technique, although the number of studies was low (Q = 3.908, P = .142). Despite one study 61 included in the meta-analysis that assessed only AGB procedures not reporting patient characteristics (for the BS or control groups), another study 63 (Table S3). When this analysis was extended to the entire dataset, the results were similar, but the absence of patient characteristics in some studies limited interpretation of the data.…”

“…13,59 Patients included in these studies, which were by than patients in the other studies analysed (Table S3). 13,28,59,62,63 Furthermore, the study by Eliasson et al involved mostly patients with diabetes (81% in the BS group and 90% in controls). However, when any one study was removed, the effect size ranged from 0.37 to 0.57 (P < .05) and, therefore, the exclusion did not change the tendency of the summary effect.…”