Metabolic surgery may be the most effective intervention for obese patients with type 2 diabetes

Compared with patients who received standard pharmacotherapy, obese individuals with type 2 diabetes who underwent weight loss surgery had improved diabetes control, and reduced risks of adverse cardiovascular events and medication requirement.

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Obese patients with co-incident type 2 diabetes often have increased risks of suffering adverse cardiovascular events and/or related mortality. In a novel retrospective, observational study, researchers from the Cleveland Clinic (OH, USA) have analyzed data on more than 13,000 obese, diabetic patients and observed that those who underwent ‘metabolic’ surgery lost more weight, had improved diabetes control and required fewer diabetes and cardiovascular medications, compared with patients who received standard medical treatments.

Close to 40% of adult American population is classified as obese. Obesity is often co-morbid with indications such as type 2 diabetes, heart failure or stroke. Adults with type 2 diabetes are up to four times more likely to die as a result of cardiovascular disease compared with individuals who do not have diabetes.

In the study, researchers compared data on 2287 obese, diabetic patients from the Cleveland Clinic Health System who underwent one of the four major metabolic surgeries listed with 11,435 diabetic and characteristically matched comparators who received standard pharmacotherapy treatment.

Frequently asked questions:

The primary study endpoint was the occurrence of all-cause mortality or any one of five major complications known to be associated with co-incident diabetes and obesity: kidney disease, atrial fibrillation, coronary artery events, heart failure and cerebrovascular events.

Patients who underwent metabolic surgery had 41% lower all-cause mortality compared with patients who received standard medical treatments.

Furthermore, metabolic surgery patients had a mean 15% greater weight loss result than matched standard care recipients.

Steven Nissen, senior study author and Chief Academic Officer of the Heart & Vascular Institute at Cleveland Clinic, commented: “Cardiovascular complications from obesity and diabetes can be devastating. Now that we've seen these remarkable results, a well-designed randomized controlled trial is needed to definitively determine whether metabolic surgery can reduce the incidence of major heart problems in patients with type 2 diabetes and obesity.”


Aminian A, Zajichek A, Arterburn DE et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA. doi:10.1001/jama.2019.14231 (Epub ahead of print) (2019);

What is metabolic surgery?

Metabolic surgery forms include gastric bypass, duodenal switch, sleeve gastrectomy and gastric banding interventions.

How does gastric bypass work?

Gastric bypass surgery, the most common form of which is roux-en-Y surgery, comprises altering the route that ingested food takes through the digestive system such that there is less time for food to be absorbed.  

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Ilana Landau

Assistant Editor, Future Science Group

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