Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: Evidence for the legacy effect of surgery

Karen J. Coleman, Sebastien Haneuse, Eric Johnson, Andy Bogart, David Fisher, Patrick J. O'Connor, Nancy E. Sherwood, Steve Sidney, Mary Kay Theis, Jane Anau, Emily B. Schroeder, Rebecca O'Brien, David Arterburn

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Abstract

OBJECTIVE: To identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a retrospective observational cohort study (n = 4,683; 40% racial/ethnic minority) of patients with type 2 diabetes who underwent bariatric surgery from 2001 through 2011. The primary outcome measure was incident microvascular disease defined as a composite indicator of the first occurrence of retinopathy, neuropathy, and/or nephropathy. The Cox proportional hazards framework was used to investigate the associations between type 2 diabetes remission/relapse status and time to microvascular disease. RESULTS: Covariate-adjusted analyses showed that patients who experienced type 2 diabetes remission had 29% lower risk of incident microvascular disease compared with patients who never remitted (hazard ratio [HR] 0.71 [95% CI 0.60, 0.85]). Among patients who experienced a relapse after remission, the length of time spent in remission was inversely related to the risk of incident microvascular disease; for every additional year of time spent in remission prior to relapse, the risk of microvascular disease was reduced by 19% (HR 0.81 [95% CI 0.67,0.99]) compared with patients who never remitted. CONCLUSIONS: Our results indicate that remission of type 2 diabetes after bariatric surgery confers benefits for risk of incident microvascular disease even if patients eventually experience a relapse of their type 2 diabetes. This provides support for a legacy effect of bariatric surgery, where even a transient period of surgically induced type 2 diabetes remission is associated with lower long-term microvascular disease risk.

Original languageEnglish (US)
Pages (from-to)1400-1407
Number of pages8
JournalDiabetes care
Volume39
Issue number8
DOIs
StatePublished - Aug 1 2016

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Bariatric Surgery
Type 2 Diabetes Mellitus
Recurrence
Observational Studies
Cohort Studies
Research Design
Outcome Assessment (Health Care)

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Coleman, K. J., Haneuse, S., Johnson, E., Bogart, A., Fisher, D., O'Connor, P. J., ... Arterburn, D. (2016). Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: Evidence for the legacy effect of surgery. Diabetes care, 39(8), 1400-1407. https://doi.org/10.2337/dc16-0194

Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery : Evidence for the legacy effect of surgery. / Coleman, Karen J.; Haneuse, Sebastien; Johnson, Eric; Bogart, Andy; Fisher, David; O'Connor, Patrick J.; Sherwood, Nancy E.; Sidney, Steve; Theis, Mary Kay; Anau, Jane; Schroeder, Emily B.; O'Brien, Rebecca; Arterburn, David.

In: Diabetes care, Vol. 39, No. 8, 01.08.2016, p. 1400-1407.

Research output: Contribution to journalArticle

Coleman, KJ, Haneuse, S, Johnson, E, Bogart, A, Fisher, D, O'Connor, PJ, Sherwood, NE, Sidney, S, Theis, MK, Anau, J, Schroeder, EB, O'Brien, R & Arterburn, D 2016, 'Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: Evidence for the legacy effect of surgery', Diabetes care, vol. 39, no. 8, pp. 1400-1407. https://doi.org/10.2337/dc16-0194
Coleman, Karen J. ; Haneuse, Sebastien ; Johnson, Eric ; Bogart, Andy ; Fisher, David ; O'Connor, Patrick J. ; Sherwood, Nancy E. ; Sidney, Steve ; Theis, Mary Kay ; Anau, Jane ; Schroeder, Emily B. ; O'Brien, Rebecca ; Arterburn, David. / Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery : Evidence for the legacy effect of surgery. In: Diabetes care. 2016 ; Vol. 39, No. 8. pp. 1400-1407.
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abstract = "OBJECTIVE: To identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a retrospective observational cohort study (n = 4,683; 40{\%} racial/ethnic minority) of patients with type 2 diabetes who underwent bariatric surgery from 2001 through 2011. The primary outcome measure was incident microvascular disease defined as a composite indicator of the first occurrence of retinopathy, neuropathy, and/or nephropathy. The Cox proportional hazards framework was used to investigate the associations between type 2 diabetes remission/relapse status and time to microvascular disease. RESULTS: Covariate-adjusted analyses showed that patients who experienced type 2 diabetes remission had 29{\%} lower risk of incident microvascular disease compared with patients who never remitted (hazard ratio [HR] 0.71 [95{\%} CI 0.60, 0.85]). Among patients who experienced a relapse after remission, the length of time spent in remission was inversely related to the risk of incident microvascular disease; for every additional year of time spent in remission prior to relapse, the risk of microvascular disease was reduced by 19{\%} (HR 0.81 [95{\%} CI 0.67,0.99]) compared with patients who never remitted. CONCLUSIONS: Our results indicate that remission of type 2 diabetes after bariatric surgery confers benefits for risk of incident microvascular disease even if patients eventually experience a relapse of their type 2 diabetes. This provides support for a legacy effect of bariatric surgery, where even a transient period of surgically induced type 2 diabetes remission is associated with lower long-term microvascular disease risk.",
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AU - Haneuse, Sebastien

AU - Johnson, Eric

AU - Bogart, Andy

AU - Fisher, David

AU - O'Connor, Patrick J.

AU - Sherwood, Nancy E.

AU - Sidney, Steve

AU - Theis, Mary Kay

AU - Anau, Jane

AU - Schroeder, Emily B.

AU - O'Brien, Rebecca

AU - Arterburn, David

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N2 - OBJECTIVE: To identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a retrospective observational cohort study (n = 4,683; 40% racial/ethnic minority) of patients with type 2 diabetes who underwent bariatric surgery from 2001 through 2011. The primary outcome measure was incident microvascular disease defined as a composite indicator of the first occurrence of retinopathy, neuropathy, and/or nephropathy. The Cox proportional hazards framework was used to investigate the associations between type 2 diabetes remission/relapse status and time to microvascular disease. RESULTS: Covariate-adjusted analyses showed that patients who experienced type 2 diabetes remission had 29% lower risk of incident microvascular disease compared with patients who never remitted (hazard ratio [HR] 0.71 [95% CI 0.60, 0.85]). Among patients who experienced a relapse after remission, the length of time spent in remission was inversely related to the risk of incident microvascular disease; for every additional year of time spent in remission prior to relapse, the risk of microvascular disease was reduced by 19% (HR 0.81 [95% CI 0.67,0.99]) compared with patients who never remitted. CONCLUSIONS: Our results indicate that remission of type 2 diabetes after bariatric surgery confers benefits for risk of incident microvascular disease even if patients eventually experience a relapse of their type 2 diabetes. This provides support for a legacy effect of bariatric surgery, where even a transient period of surgically induced type 2 diabetes remission is associated with lower long-term microvascular disease risk.

AB - OBJECTIVE: To identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a retrospective observational cohort study (n = 4,683; 40% racial/ethnic minority) of patients with type 2 diabetes who underwent bariatric surgery from 2001 through 2011. The primary outcome measure was incident microvascular disease defined as a composite indicator of the first occurrence of retinopathy, neuropathy, and/or nephropathy. The Cox proportional hazards framework was used to investigate the associations between type 2 diabetes remission/relapse status and time to microvascular disease. RESULTS: Covariate-adjusted analyses showed that patients who experienced type 2 diabetes remission had 29% lower risk of incident microvascular disease compared with patients who never remitted (hazard ratio [HR] 0.71 [95% CI 0.60, 0.85]). Among patients who experienced a relapse after remission, the length of time spent in remission was inversely related to the risk of incident microvascular disease; for every additional year of time spent in remission prior to relapse, the risk of microvascular disease was reduced by 19% (HR 0.81 [95% CI 0.67,0.99]) compared with patients who never remitted. CONCLUSIONS: Our results indicate that remission of type 2 diabetes after bariatric surgery confers benefits for risk of incident microvascular disease even if patients eventually experience a relapse of their type 2 diabetes. This provides support for a legacy effect of bariatric surgery, where even a transient period of surgically induced type 2 diabetes remission is associated with lower long-term microvascular disease risk.

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