Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery.
To identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes.



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.



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.



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.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA karen.j.coleman@kp.org.
Karen J
KJ
Coleman
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
Sebastien
S
Haneuse
Group Health Research Institute, Group Health Cooperative, Seattle, WA.
Eric
E
Johnson
RAND Corporation, Santa Monica, CA.
Andy
A
Bogart
Department of Research, Kaiser Permanente Northern California, Oakland, CA.
David
D
Fisher
HealthPartners Institute, HealthPartners, Minneapolis, MN.
Patrick J
PJ
O'Connor
HealthPartners Institute, HealthPartners, Minneapolis, MN.
Nancy E
NE
Sherwood
Department of Research, Kaiser Permanente Northern California, Oakland, CA.
Steve
S
Sidney
Group Health Research Institute, Group Health Cooperative, Seattle, WA.
Mary Kay
MK
Theis
Group Health Research Institute, Group Health Cooperative, Seattle, WA.
Jane
J
Anau
Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Emily B
EB
Schroeder
Department of Research, Kaiser Permanente Northern California, Oakland, CA.
Rebecca
R
O'Brien
Group Health Research Institute, Group Health Cooperative, Seattle, WA.
David
D
Arterburn
D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult