Clinical Edge

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Bariatric Surgery & Macrovascular Disease in T2D

JAMA; 2018 Oct 16; Fisher, Johnson, et al

In patients with type 2 diabetes (T2D) and severe obesity, bariatric surgery was associated with a lower risk of incident major macrovascular events, a new study found. Patients with severe obesity aged 19‒79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the US (n=5,301) were matched to 14,934 control patients on site, age, body mass index (BMI), hemoglobin A1c, insulin use, observed diabetes duration, and prior health care utilization, with follow-up through September 2015. Researchers found:

  • At the end of the study period, there were 106 macrovascular events in the surgical patients and 596 events in the matched control patients.
  • Bariatric surgery was associated with a significantly lower risk of macrovascular events at 5 years’ follow-up (2.1% vs 4.3%; hazard ratio [HR], 0.60), as well as a lower incidence of coronary artery disease (1.6% vs 2.8%; HR, 0.64).
  • The incidence of cerebrovascular disease was not significantly different between groups at 5 years.


Fisher DP, Johnson E, Haneuse S, et al. Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity. JAMA. 2018;320(15):1570–1582. doi:10.1001/jama.2018.14619.