echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Endocrine System > "The Lancet": Metabolic surgery can extend the life expectancy of severely obese type 2 diabetes patients by nearly 10 years|Clinical Discovery

    "The Lancet": Metabolic surgery can extend the life expectancy of severely obese type 2 diabetes patients by nearly 10 years|Clinical Discovery

    • Last Update: 2021-06-02
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com
    WHO data shows that about 13% of people worldwide suffer from obesity.

    Obesity is closely related to type 2 diabetes, hyperlipidemia, high blood pressure, certain cancers, and premature death.
    It also significantly increases the risk of macrovascular disease and all-cause death.

    The latest data show that the rising incidence of obesity has caused about 5 million deaths and 160 million people become disabled [1, 2].

    Therefore, obesity management plays a very important role in global public health management.

    Changing the capacity of the digestive tract and the path of the digestive tract (such as intestinal bypass surgery) can achieve the goal of weight loss.
    This way of weight loss is called metabolic surgery.

    In many countries, metabolic surgery has long been approved for the treatment of severe obesity.

    In recent years, metabolic surgery has gradually gained attention because it not only reduces weight, but also helps to improve metabolic comorbidities, including type 2 diabetes, dyslipidemia, and obstructive sleep apnea hypopnea syndrome.

    However, the long-term impact of metabolic surgery on life and health still lacks reliable and accurate data support.
    Related research will have important clinical significance and affect public health policies.

    Recently, a research team led by Asim Shabbir, National University of Singapore, published important research results in the top medical journal "The Lancet".
    They found that metabolic surgery significantly reduced all-cause mortality and extended the life expectancy of severely obese patients by 5.
    3 years.
    The life expectancy of patients with type 2 diabetes is prolonged by nearly 10 years [3].

    Screenshot of the original homepage In fact, in clinical practice, doctors hold a conservative attitude towards metabolic surgery.
    About 184 million people worldwide suffer from severe obesity, but less than 1% of them undergo metabolic bariatric surgery [4].

    The Asim Shabbir team’s research provides an evidence basis for metabolic surgery in severely obese patients, especially in patients with type 2 diabetes, through rigorous research design and data analysis.

    Let's review the main content of this research.

    This study aims to analyze the impact of metabolic surgery on the long-term survival of obese patients, and to obtain more reliable and accurate data through meta-analysis.

    First, the researchers systematically reviewed the literature on metabolic surgery in obese patients by searching Pubmed, Scopus, and MEDLINE journal databases.

    The literature inclusion criteria include the following aspects: ①The publication date is as of February 3, 2021; ②The study population is obese patients; ③The types of studies include randomized clinical trials, prospective controlled studies and matched cohort studies; ④Compared in the study All-cause mortality of patients undergoing metabolic surgery and non-surgical treatment; ⑤A matched cohort study must provide a cumulative morbidity function or Kaplan-Meier curve.

    Those including end-stage renal failure and type 1 diabetes (except type 2 diabetes) and other special comorbidities, adolescents, and related studies of uncontrolled studies and case reports were excluded.

    Finally, 17 research results (including 16 matched cohort studies and 1 prospective controlled clinical trial) were included in this study.

    Research flow chart Later, the researchers will use the Kaplan-Meier curve and the Cox risk model to analyze the patient’s all-cause mortality, based on the Cox risk model analysis, calculate the number of treatments required (NNT); use the Reverse Kaplan-Meier method to calculate the median follow-up time ; Use the Gompertz proportional hazard model to infer life expectancy.

    Let's take a look at the results of the study.

    This study involved 170,000 people.
    The median follow-up time was 69.
    4 months.
    The overall mortality rate was 7712/1156376 person-years.
    The all-cause mortality rate for metabolic surgery was 1813/496671 person-years, and the all-cause mortality rate for conventional non-surgical patients was 5899.
    /659605 person-years.

    Compared with the conventional non-surgical treatment group, the HR (hazard ratio) of the metabolic surgery group was 0.
    508, which means that the risk of death was reduced by 49.
    2%.

    The researchers found that at the 10-year follow-up, the NNT preventing additional deaths was 24.
    4; at the 20-year follow-up, the NNT was 10.
    8. (Note: The smaller the NNT, the higher the value of the corresponding intervention.
    ) In addition, compared with the conventional non-surgical treatment group, the metabolic surgery group prolonged the median life expectancy by 6.
    1 years.

    The mortality of severely obese patients with metabolic surgery and conventional non-surgical treatment groups.
    Considering the close relationship between obesity and diabetes, based on the presence or absence of type 2 diabetes at baseline, the researchers conducted a subgroup analysis to analyze the effects of metabolic surgery on obesity and type 2 diabetes.
    The patient's survival benefit.

    Researchers found that after metabolic surgery in patients with non-type 2 diabetes, all-cause mortality was reduced by 29.
    6% (HR=0.
    704).

    At the 10-year follow-up, the NNT to prevent additional deaths was 29.
    8; at the 20-year follow-up, the NNT was 19.
    0.

    The median life expectancy has been extended by 5.
    1 years.

    What surprised the researchers even more was the results obtained in patients with type 2 diabetes: after metabolic surgery in patients with type 2 diabetes, all-cause mortality was reduced by 59.
    1% (HR=0.
    409).

    At the 10-year follow-up, the NNT to prevent additional deaths was 8.
    4; at the 20-year follow-up, the corresponding data result was 5.
    3.

    The median life expectancy has increased by 9.
    3 years.

    The mortality rate of metabolic surgery and conventional non-surgical treatment groups in severely obese patients with type 2 diabetes can be seen.
    Metabolic surgery is more effective in patients with type 2 diabetes.
    Therefore, severely obese patients with type 2 diabetes should be treated with life>
    Finally, in order to quantify the impact of metabolic surgery on the overall survival benefits of the world, the researchers assumed that about 30% (55.
    2 million) of the 184 million severely obese patients had diabetes before surgery, which is in line with the published prevalence of severe obesity combined with diabetes.
    Unanimous.

    On this basis, for every 1.
    0% increase in the utilization rate of metabolic surgery, the global potential life-year for diabetic patients is 5133600 years, while the global potential life-year for non-diabetics is 6,568,800 years. For example, if the global utilization rate of metabolic bariatric surgery for diabetic and non-diabetic patients was 1.
    0% in 2014, increasing the utilization rate to 2.
    5% and 1.
    5%, respectively, would generate 10,984,800 additional potential life years.

    Potential life-years for every 1% increase in the use of metabolic surgery in severely obese patients with or without diabetes.
    This study confirms that the benefits of metabolic surgery are long-lasting and supports the use of metabolic surgery in the management of obesity (especially type 2 diabetes) The role of.

    Obesity and diabetes are public health problems.
    This study has a certain clinical guiding role, which can arouse the attention of general practitioners, endocrinologists and cardiologists to this underutilized weight loss method, and help improve clinical management and public health decision-making.
    . References: [1]GBD 2019 Risk Factors 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(10258):1223 -1249.
    doi:10.
    1016/S0140-6736(20)30752-2.
    [2]Roth GA, Mensah GA, Johnson CO, et al.
    Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study.
    J Am Coll Cardiol.
    2020;76(25):2982-3021.
    [3]Syn NL, Cummings DE, Wang LZ, et al.
    Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes : a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants.
    Lancet.
    2021;S0140-6736(21)00591-2.
    doi:10.
    1016/S0140-6736(21)00591-2.
    [4 ]NCD Risk Factor Collaboration (NCD-RisC).
    Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants [published correction appears in Lancet.
    2016 May 14;387(10032):1998].
    Lancet.
    2016;387(10026):1377-1396.
    doi:10.
    1016/S0140-6736(16)30054-X.
    Editor in chargeBioTalker
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.