Mortality in relation to diabetes remission in Swedish Obese Subjects – a prospective cohort study

• Published in: International journal of surgery (London, England) Vol. 110; no. 10; pp. 6581 - 6590
• Main Authors: Carlsson, Lena M.S., Carlsson, Björn, Jacobson, Peter, Karlsson, Cecilia, Andersson-Assarsson, Johanna C., Kristensson, Felipe M., Ahlin, Sofie, Svensson, Per-Arne, Taube, Magdalena, Näslund, Ingmar, Karason, Kristjan, Peltonen, Markku, Sjöholm, Kajsa
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.10.2024
• Subjects: Adult; Bariatric Surgery - mortality; cause-specific mortality; Cohort Studies; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - therapy; diabetes remission; Female; Humans; Kirurgi; life expectancy; Male; Middle Aged; obesity; Obesity - complications; Obesity - mortality; Original Research; Prospective Studies; Remission Induction; Surgery; Sweden - epidemiology; type 2 diabetes; Sweden
• ISSN: 1743-9159; 1743-9191; 1743-9159
• DOI: 10.1097/JS9.0000000000001807

People with obesity and type 2 diabetes (T2D) have reduced life expectancy, partly explained by increased risk of cardiovascular diseases and cancer. Here, we examined whether 2-year diabetes remission after bariatric surgery or usual care is associated with long-term mortality. This report includes 586 participants with obesity and concomitant T2D from the prospective Swedish Obese Subjects (SOS) cohort study; 338 underwent bariatric surgery and 248 received usual obesity care. At inclusion, age was 37-60 years and BMI ≥34 kg/m 2 in men and ≥38 kg/m 2 in women. Median follow-up was 26.2 years (interquartile range 22.7-28.7). Diabetes status was determined using self-reported data on diabetes medication and in-study measures of blood glucose and HbA1c. The study was cross-linked to Swedish national registers for data on morbidity, death, and emigration. Overall, 284 participants, 71.9% of surgery and 16.5% of usual care patients were in remission at the 2-year examination. During follow-up, mortality rates were 16.6 deaths per 1000 person-years (95% CI: 13.7-20.1) in the remission subgroup and 26.0 deaths per 1000 person-years (95% CI:22.2-30.4) in the non-remission subgroup (adjusted hazard ratio (HR adj )=0.71, 95% CI:0.54-0.95, P =0.019). The adjusted median life expectancy in the remission subgroup was 2.5 years (95% CI:0.3-4.7) longer than in the non-remission subgroup. Specifically, remission was associated with decreased cardiovascular mortality (sub-HR adj =0.54, 95% CI: 0.35-0.85, P =0.008), but no detectable association with cancer mortality was found (sub-HR adj =1.06, 95% CI:0.60-1.86), P =0.841). In this post-hoc analysis of data from the SOS study, patients who achieved short-term diabetes remission had increased life expectancy and decreased cardiovascular death over up to 32 years of follow-up. Future studies should confirm these findings.