Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 3;111(4):znae105.
doi: 10.1093/bjs/znae105.

Cohort study on incidence of new-onset type 2 diabetes in patients after bariatric surgery and matched controls

Viiko Vahtera  1   2 , Jukka Pajarinen  3 , Mika Kivimäki  4   5   6 , Jenni Ervasti  4 , Jaana Pentti  6   7 , Sari Stenholm  7   8 , Jussi Vahtera  7   8 , Paulina Salminen  2   9
Affiliations

Cohort study on incidence of new-onset type 2 diabetes in patients after bariatric surgery and matched controls

Viiko Vahtera et al. Br J Surg. .

Abstract

Background: Metabolic bariatric surgery the reduces risk of new-onset type 2 diabetes in individuals with obesity, but it is unclear whether the benefit varies by sex, age, or socioeconomic status. The aim was to assess the risk of new-onset type 2 diabetes after metabolic bariatric surgery in these subgroups.

Methods: The Finnish Public Sector study, a follow-up study with matched controls nested in a large employee cohort, included patients without type 2 diabetes and with a diagnosis of obesity or self-reported BMI of at least 35 kg/m2. For each patient who had laparoscopic metabolic bariatric surgery (2008-2016), two propensity-score matched controls were selected. New-onset type 2 diabetes was ascertained from linked records from national health registries.

Results: The study included a total of 917 patients and 1811 matched controls with obesity. New-onset type 2 diabetes was diagnosed in 15 of the patients who had metabolic bariatric surgery (4.1 per 1000 person-years) and 164 controls (20.2 per 1000 person-years). The corresponding rate ratio (RR) was 0.20 (95% c.i. 0.12 to 0.35) and the rate difference (RD) was -16.1 (-19.8 to -12.3) per 1000 person-years. The risk reduction was more marked in individuals of low socioeconomic status (RR 0.10 (0.04 to 0.26) and RD -20.6 (-25.6 to -15.5) per 1000 person-years) than in those with higher socioeconomic status (RR 0.35 (0.18 to 0.66) and RD -11.5 (-16.9 to -6.0) per 1000 person-years) (Pinteraction = 0.017). No differences were observed between sexes or age groups.

Conclusion: Metabolic bariatric surgery was associated with a reduced risk of new-onset type 2 diabetes in men and women and in all age groups. The greatest benefit was observed in individuals of low socioeconomic status.

Plain language summary

Metabolic bariatric surgery reduces the risk of new-onset type 2 diabetes in individuals with obesity or severe obesity. The risk of new-onset type 2 diabetes after metabolic bariatric surgery varies between socioeconomic status subgroups. In this prospective study, new-onset type 2 diabetes occurred in 1.6% of 917 patients who underwent metabolic bariatric surgery and 9.1% of 1811 propensity score-matched controls. Risk reduction was more marked in individuals of low socioeconomic status. There were no differences between sex or age groups. The reduced risk of new-onset type 2 diabetes after metabolic bariatric surgery emphasizes the need to increase access to treatment in patients with severe obesity. As the preventive effect was most pronounced in individuals of low socioeconomic status associated with both greater burden of disease and worse access to healthcare, the findings need to be taken into account in health policies to reduce health inequalities.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study flow chart *No incident type 2 diabetes during follow-up. COPD, chronic obstructive pulmonary disease.
Fig. 2
Fig. 2
Eight-year cumulative hazard of new-onset type 2 diabetes after metabolic bariatric surgery and in matched controls Rate ratio 0.20 (95% c.i. 0.12 to 0.35), P < 0.001; rate difference –16.1 (–19.8 to –12.3) per 1000 person-years, P < 0.001.
Fig. 3
Fig. 3
Bariatric surgery and risk of new-onset type 2 diabetes compared with matched controls by patient subgroups Values are n (%) unless otherwise indicated. Rates, rate ratios (RRs), and risk differences (RDs) are shown with 95% confidence intervals. Socioeconomic status (SES): low—basic eduction, manual occupation, or residence in disadvantaged neighbourhood; high— all other combinations.
Fig. 4
Fig. 4
Bariatric surgery and risk of new-onset type 2 diabetes compared with alternative matched control groups Values are n (%) unless otherwise indicated. Rates, rate ratios (RRs), and risk differences (RDs) are shown with 95% confidence intervals.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204–1222 - PMC - PubMed
    1. Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR.. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and meta-analysis. PLoS Med 2020;17:e1003206. - PMC - PubMed
    1. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep Ket al. . Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017;377:13–27 - PMC - PubMed
    1. WHO. Global Health Observatory (GHO) Data: Overweight and Obesity. WHO, 2020
    1. GBD 2019 Risk Factor Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1223–1249 - PMC - PubMed

Publication types