Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects
Open accessAbstract
BACKGROUND: Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone. In an analysis of data from a nonrandomized, prospective, controlled study, we examined the effects of bariatric surgery on the prevention of type 2 diabetes. METHODS: In this analysis, we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls (with matching performed on a group, rather than individual, level). None of the participants had diabetes at baseline. Patients in the bariatric-surgery cohort underwent banding (19%), vertical banded gastroplasty (69%), or gastric bypass (12%); nonrandomized, matched, prospective controls received usual care. Participants were 37 to 60 years of age, and the body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) was 34 or more in men and 38 or more in women. This analysis focused on the rate of incident type 2 diabetes, which was a prespecified secondary end point in the main study. At the time of this analysis (January 1, 2012), participants had been followed for up to 15 years. Despite matching, some baseline characteristics differed significantly between the groups; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group. At 15 years, 36.2% of the original participants had dropped out of the study, and 30.9% had not yet reached the time for their 15-year follow-up examination. RESULTS: During the follow-up period, type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group, corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years, respectively (adjusted hazard ratio with bariatric surgery, 0.17; 95% confidence interval, 0.13 to 0.21; P<0.001). The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose (P=0.002 for the interaction) but not by BMI (P=0.54). Sensitivity analyses, including end-point imputations, did not change the overall conclusions. The postoperative mortality was 0.2%, and 2.8% of patients who underwent bariatric surgery required reoperation within 90 days owing to complications. CONCLUSIONS: Bariatric surgery appears to be markedly more efficient than usual care in the prevention of type 2 diabetes in obese persons. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01479452.).
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A meta-analysis of 63 real-world diabetes prevention efforts found weight loss of 2.2 kg in participants and 0.8 kg in controls, but still a 25% reduction in incident diabetes.
“Another meta-analysis of 63 real-world DM prevention efforts demonstrated a weight loss of 2.2 kg in participants and 0.8 kg in controls, but still led to a reduction in incident DM by 25%.866”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [866]
The Abstract identifies this paper as an analysis of a nonrandomized, prospective, controlled bariatric-surgery study, not a meta-analysis of 63 real-world prevention efforts. The Results report weight loss of approximately 20 kg in the surgery group after 10 and 15 years, rather than the claimed 2.2 kg. The paper does not report the cited meta-analysis’s weight-loss figures or 25% reduction. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredTranslation of the Diabetes Prevention Program structured lifestyle intervention to community-based, commercial, and remote-technology programs achieved less weight loss than in the original trial.
“The translation of the structured lifestyle intervention used in the Diabetes Prevention Program to community-based programs, commercial programs, and programs using remote technologies have achieved less weight loss than observed in the Diabetes Prevention Program trial itself.861–869”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [866]
The Introduction discusses lifestyle interventions for diabetes prevention, and the Results report weight changes after bariatric surgery and among matched controls. Neither section compares community-based, commercial, or remote-technology adaptations of the Diabetes Prevention Program with the original trial. Searches for those program types and the claimed weight-loss comparison found no passage addressing it; page numbers were not supplied. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn the Swedish Obese Subjects study, among patients without diabetes at baseline, incident diabetes was reduced by 76%.
“In the Swedish Obese Subjects (SOS), a prospective, non-randomized study of bariatric surgery (gastric banding, vertical-banded gastroplasty, and Roux-en-Y gastric bypass) patients and obese controls, among patients without diabetes at baseline, incident diabetes was reduced by 76%.”
From The Vasculature in Prediabetes (2018) · cites this paper as [194]
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- Authors
- Carlsson, L. M. S., Peltonen, M., Ahlin, S., Anveden, Å., Bouchard, C., Carlsson, B., Jacobson, P., Lönroth, H., Maglio, C., Näslund, I., Pirazzi, C., Romeo, S., Sjöholm, K., Sjöström, E., Wedel, H., Svensson, P.-A., & Sjöström, L.
- Affiliations
- University of Gothenburg (SE)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-08-23
- Volume
- 367
- Issue
- 8
- Pages
- 695-704
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2108519858
- Cited by
- 794
- References
- 39
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 28 · 2023: 44 · 2022: 39 · 2021: 45 · 2020: 60 · 2019: 50 · 2018: 46 · 2017: 70 · 2016: 67 · 2015: 99 · 2014: 94 · 2013: 94 · 2012: 17
- FWCI
- 99.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- WOS
- Funders
- Pfizer
- AstraZeneca
- Sanofi
- Wenner-Gren Stiftelserna
- Australian Government
- Stiftelsen för Strategisk Forskning
- VINNOVA
- Vetenskapsrådet (K2012-55X-22082-01-3, K2012-55X-22082-01, 11285, K2010-55X-11285-13)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- bariatric surgery, type 2 diabetes prevention, obesity, gastric bypass, vertical banded gastroplasty, gastric banding, impaired fasting glucose, weight loss, diabetes incidence, postoperative mortality, long-term follow-up, matched controls, Swedish Obese Subjects study, body mass index, diabetes risk factors, diabetes remission
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Postoperative Complications, Prospective Studies, Reoperation, Risk Factors, Weight Loss, Body Mass Index, Incidence, Bariatric Surgery
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