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NASHVILLE – Metabolic surgery outperformed medical therapy in patients with diabetes.
In a systematic review and meta-analysis of 19 trials, people who underwent a metabolic rate of 50% reduced mortality for all-cause mortality (OR 0.34, 95% CI 0.25-0.46, P<0.00001) when compared with medical therapy, found Adrian Billeter, MD, PhD, of the University of Heidelberg in Germany, and colleagues.
Macrovascular complications of type 2 diabetes were also significantly reduced in people who underwent metabolic surgery compared with medical therapy (OR 0.38, 95% CI 0.22-0.67, P= 0.0008), according to the study reported at Obesity Week, a joint meeting of the Obesity Society and the American Society for Metabolic and Bariatric Surgery (ASMBS).
"What we know so far is that we are more likely to be more successful in the treatment of glycemic control compared to medical therapy," Billeter said during his oral presentation of the findings. "However, what do we know if we have an effect on the heart endpoints, such as mortality or cardiovascular events." Previous trials have been under powered to determine this, he noted.
For the analysis, he and his colleagues identified six randomized controlled trials, 10 retrospective cohorts, and two prospective cohorts, and one prospective case-control study. All analyzes included, with an average follow-up of 7 years, were required to have a group of participants with diabetes who underwent metabolic surgery compared to those who received "conservative" treatment.
The total number of participants who underwent metabolic surgery included in the meta-analysis was over 13,000, and this group was compared with data for 88,000 individuals who received medical therapy only.
Across all the data included in the analysis, every trial and study favored metabolic surgery compared to medical therapy in view to overall mortality. This is the result of the analysis (OR 0.18, 95% CI 0.03-1.17), the researchers reported.
Similar outcomes were found for cardiovascular mortality, which significantly favored metabolic surgery over medical therapy (OR 0.22, 95% CI 0.11-0.44, P<0.0001). "This is probably the most important outcome of this is what patients with type 2 diabetes die from," noted Billeter. These findings also included the chances of myocardial infarction, which dropped after metabolic surgery (OR 0.35, 95% CI 0.19-0.63, P= 0.0005).
While metabolic surgery was slightly impaired, it did not reach statistical significance (OR 0.57, 95% CI 0.18-1.80, P= 0.34), he said.
'Profound Effect of Metabolic Surgery'
"This study adds to the huge amount of data demonstrating the profound and definitive effect of the metabolic surgery on obesity, diabetes, and its complications that can not be achieved, yet surgery remains vastly underutilized as a treatment," commented ASMBS president Samer Mattar, MD, in a statement. "While metabolic surgery is certainly not for everyone – there are many factors to consider – many are missing out on a transformational procedure."
At the session where the study was presented, the moderator, Cori McBride, MD, of the University of Nebraska Medical Center in Omaha, asked Billeter what the next steps are. "We know that metabolic surgery is better for glycemic control," Billeter replied. "All studies with drugs – especially liraglutide and empagliflozin – focus on cardiovascular mortality." "This is what we need to show, that is, that metabolic surgery is actually superior to those drugs."
"First of all it's cheaper in the long run, but it's probably more effective," he continued. "This is the most important step to establish that metabolic surgery is the key treatment for type 2 diabetes."
Billeter and co-authors reported no disclosures.
1969-12-31T19: 00: 00-0500
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