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Original Investigation
June 2018

Association Between Bariatric Surgery and Rates of Continuation, Discontinuation, or Initiation of Antidiabetes Treatment 6 Years Later

Author Affiliations
  • 1Department of Statistics, Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, Paris, France
  • 2Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France
  • 3University of Bretagne Occidentale, Equipe d’Accueil 3878 Groupe d’Étude de la Thrombose en Bretagne Occidentale (GETBO), Brest, France
  • 4Department of Nutrition, Hôpital Européen Georges-Pompidou, Centre Spécialisé Obésité Ile de France Sud, Assistance Publique–Hôpitaux de Paris, Paris, France
  • 5The University Paris Descartes, Paris, France
  • 6Department of Heart and Nutrition, The Institute of Cardiometabolism and Nutrition, Assistance Publique–Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France,
  • 7University Pierre et Marie Curie Paris 6, Paris, France
  • 8Department of General, Digestive and Metabolic Surgery, Louis Mourier Hospital, Assistance Publique–Hôpitaux de Paris, Diderot University Paris 7, Colombes, France
  • 9Department of Surgery, Centre Hospitalier Universitaire Montpellier, Faculty of Medicine of Montpellier, Montpellier, France
JAMA Surg. 2018;153(6):526-533. doi:10.1001/jamasurg.2017.6163
Key Points

Question  What are the rates of discontinuation or initiation of antidiabetes treatment 6 years after bariatric surgery?

Findings  In this nationwide population-based cohort study of more than 30 000 adults, bariatric surgery was associated with a significantly higher 6-year postoperative antidiabetes treatment discontinuation rate compared with an obese control group, as well as with a low antidiabetes treatment initiation rate, with gastric bypass being the most effective procedure.

Meaning  Patients and physicians should be aware that morbid obesity remains a chronic disease even after bariatric surgery because 50.1% of patients with preexisting antidiabetes treatment remained on treatment 6 years after surgery.

Abstract

Importance  Few large-scale long-term prospective cohort studies have assessed changes in antidiabetes treatment after bariatric surgery.

Objective  To describe the association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years after bariatric surgery compared with a matched control obese group.

Design, Setting, and Participants  This nationwide observational population-based cohort study extracted health care reimbursement data from the French national health insurance database from January 1, 2008, to December 31, 2015. All patients undergoing primary bariatric surgery in France between January 1 and December 31, 2009, were matched on age, sex, body mass index category, and antidiabetes treatment with control patients hospitalized for obesity in 2009 with no bariatric surgery between 2005 and 2015.

Exposures  Bariatric surgery, including adjustable gastric banding (AGB), gastric bypass (GBP), and sleeve gastrectomy (SG).

Main Outcome and Measure  Reimbursement for antidiabetes drugs. Mixed-effects logistic regression models estimated factors of discontinuation or initiation of antidiabetes treatment over a period of 6 years.

Results  In 2009, a total of 15 650 patients (mean [SD] age, 38.9 [11.2] years; 84.6% female; 1633 receiving antidiabetes treatment) underwent primary bariatric surgery, with 48.5% undergoing AGB, 27.7% undergoing GBP, and 22.0% undergoing SG. Among patients receiving antidiabetes treatment at baseline, the antidiabetes treatment discontinuation rate was higher 6 years after bariatric surgery than in controls (−49.9% vs −9.0%, P < .001). In multivariable analysis, the main predictive factors for discontinuation were the following: GBP (odds ratio [OR], 16.7; 95% CI, 13.0-21.4), SG (OR, 7.30; 95% CI, 5.50-9.50), and AGB (OR, 4.30; 95% CI, 3.30-5.60) compared with no bariatric surgery, as well as insulin use (OR, 0.17; 95% CI, 0.13-0.22), dual therapy without insulin (OR, 0.38; 95% CI, 0.32-0.45) vs monotherapy, lipid-lowering treatment (OR, 0.76; 95% CI, 0.63-0.91), antidepressant treatment (OR, 0.67; 95% CI, 0.55-0.81), and age (OR, 0.96; 95% CI, 0.95-0.97) per year. For patients without antidiabetes treatment at baseline, the 6-year antidiabetes treatment initiation rate was much lower after bariatric surgery than in controls (1.4% vs 12.0%, P < .001). In multivariable analysis, protective factors were GBP (OR, 0.06; 95% CI, 0.04-0.09), SG (OR, 0.08; 95% CI, 0.06-0.11), and AGB (OR, 0.16; 95% CI, 0.14-0.20) vs controls, and risk factors were as follows: body mass index category (OR, 2.04; 95% CI, 1.68-2.47 for ≥50.0 vs 30.0-39.9 and OR, 1.68; 95% CI, 1.49-1.90 for 40.0-49.9 vs 30.0-39.9), antihypertensive treatment (OR, 1.49; 95% CI, 1.33-1.67), low income (OR, 1.43; 95 % CI, 1.26-1.62), and age (OR, 1.04; 95 % CI, 1.03-1.05) per year.

Conclusions and Relevance  Bariatric surgery was associated with a significantly higher 6-year postoperative antidiabetes treatment discontinuation rate compared with baseline and with an obese control group without bariatric surgery.

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