Background

The United States spends billions annually on diabetic care, but there are significant hidden costs such as the increased burden of cardiovascular disease. Metabolic surgery is known to provide remission in 50-80% of Type 2 Diabetes Mellitus (T2DM). This study aimed to assess the impact of metabolic surgery on the cardiovascular outcomes of patients with T2DM.

Methods

Using the National Inpatient Samples (2016-19), we performed a 1:5 case-match analysis on patients with T2DM. We compared patients with or without history of bariatric surgery, matched for age, gender, race, socioeconomic status, and Charlson comorbidity index. Logistic regression analysis was performed to examine occurrence, estimated cost, length of stay, and mortality controlling for matched variable and BMI. Additionally, estimates of annual reduction in occurrence and cost savings were calculated if obese patients were T2DM undergo metabolic surgery.

Results

Receiving metabolic surgery were associated with a significantly reduced risk of developing myocardial infarction, congestive heart failure, cerebrovascular accident and requiring coronary bypass, coronary angioplasty, and lower limb amputation. Metabolic surgery was associated with reduced mortality, length of stay, and cost of admission of these diseases and procedures (Table). Projecting these results to all obese patients with T2DM anticipates > 2 billion dollar saving annually.

Conclusions

History of metabolic surgery in patients with T2DM is associated with fewer cardiovascular events and improved related outcomes. Metabolic surgery in obese patients with T2DM may prevent a significant number of cardiovascular events, disease burden, and mortality with millions of dollars annual national saving.