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Cardiovascular and Metabolic Risk

Potential Benefits and Harms of Gastric Bypass Surgery in Obese Individuals With Type 1 Diabetes: A Nationwide, Matched, Observational Cohort Study

  1. Gudrun Höskuldsdóttir1,2⇑,
  2. Jan Ekelund3,
  3. Mervete Miftaraj3,
  4. Ville Wallenius4,5,
  5. Johan Ottosson6,
  6. Ingmar Näslund6,
  7. Soffia Gudbjörnsdottir3,
  8. Naveed Sattar7,
  9. Ann-Marie Svensson3 and
  10. Björn Eliasson1,2
  1. 1Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
  2. 2Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
  3. 3National Diabetes Register, Centre of Registers, Gothenburg, Sweden
  4. 4Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
  5. 5Institution of Clinical Sciences, Department of Surgery, University of Gothenburg, Gothenburg, Sweden
  6. 6Department of Surgery, Örebro University, Örebro, Sweden
  7. 7The Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
  1. Corresponding author: Gudrun Höskuldsdóttir, gudrun.hoskuldsdottir{at}vgregion.se
Diabetes Care 2020 Dec; 43(12): 3079-3085. https://doi.org/10.2337/dc20-0388
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Abstract

OBJECTIVE To study the potential long-term benefits and possible complications of bariatric surgery in patients with type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS In this register-based nationwide cohort study, we compared individuals with T1D and obesity who underwent Roux-en-Y gastric bypass (RYGB) surgery with patients with T1D and obesity matched for age, sex, BMI, and calendar time that did not undergo surgery. By linking the Swedish National Diabetes Register and Scandinavian Obesity Surgery Registry study individuals were included between 2007 and 2013. Outcomes examined included all-cause mortality, cardiovascular disease, stroke, heart failure, and hospitalization for serious hypo- or hyperglycemic events, amputation, psychiatric disorders, changes in kidney function, and substance abuse.

RESULTS We identified 387 individuals who had undergone RYGB and 387 control patients. Follow-up for hospitalization was up to 9 years. Analysis showed lower risk for cardiovascular disease (hazard ratio [HR] 0.43; 95% CI 0.20–0.9), cardiovascular death (HR 0.15; 95% CI 0.03–0.68), hospitalization for heart failure (HR 0.32; 95% CI 0.15–0.67), and stroke (HR 0.18; 95% CI 0.04–0.82) for the RYGB group. There was a higher risk for serious hyperglycemic events (HR 1.99; 95% CI 1.07–3.72) and substance abuse (HR 3.71; 95% CI 1.03–3.29) after surgery.

CONCLUSIONS This observational study suggests bariatric surgery may yield similar benefits on risk for cardiovascular outcomes and mortality in patients with T1D and obesity as for patients with type 2 diabetes. However, some potential serious adverse effects suggest need for careful monitoring of such patients after surgery.

Footnotes

  • This article contains supplementary material online at https://doi.org/10.2337/figshare.13087424.

  • Received February 25, 2020.
  • Accepted September 13, 2020.
  • © 2020 by the American Diabetes Association
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Diabetes Care: 43 (12)

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December 2020, 43(12)
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Potential Benefits and Harms of Gastric Bypass Surgery in Obese Individuals With Type 1 Diabetes: A Nationwide, Matched, Observational Cohort Study
Gudrun Höskuldsdóttir, Jan Ekelund, Mervete Miftaraj, Ville Wallenius, Johan Ottosson, Ingmar Näslund, Soffia Gudbjörnsdottir, Naveed Sattar, Ann-Marie Svensson, Björn Eliasson
Diabetes Care Dec 2020, 43 (12) 3079-3085; DOI: 10.2337/dc20-0388

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Potential Benefits and Harms of Gastric Bypass Surgery in Obese Individuals With Type 1 Diabetes: A Nationwide, Matched, Observational Cohort Study
Gudrun Höskuldsdóttir, Jan Ekelund, Mervete Miftaraj, Ville Wallenius, Johan Ottosson, Ingmar Näslund, Soffia Gudbjörnsdottir, Naveed Sattar, Ann-Marie Svensson, Björn Eliasson
Diabetes Care Dec 2020, 43 (12) 3079-3085; DOI: 10.2337/dc20-0388
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