Impact of Metabolic Surgery on Obesity Outcomes and Framingham Risk Score in Iranian Diabetic Patients: A Short- and Long-Term Follow-Up Study

Type 2 diabetes mellitus (T2DM) and obesity are closely interlinked conditions, contributing significantly to health complications. Metabolic surgery (MS) could help to improve metabolic conditions, including diabetes, hypertension, and hyperlipidemia, which are significant risk factors for cardiovascular disease. This study aimed to evaluate the short-term and long-term effects of MS on obesity outcomes and the Framingham Risk Score (FRS) in Iranian diabetic patients. This multicenter, retrospective study included T2DM patients with body mass index (BMI) ≥ 30 kg/m² who underwent MS in Ahvaz, Iran, from 2019 to 2023. Of the 151 patients, 105 with a follow-up of at least one year were included. Among them, 29 patients (27.6%) had a long-term follow-up (four to five years). Anthropometric and biochemical parameters, comorbidities, and FRS were evaluated at baseline and at one-year and long-term follow-ups. One year postoperatively, there were significant reductions in weight, BMI, systolic and diastolic blood pressure, FRS, triglycerides, low-density lipoprotein (LDL), liver enzymes, fasting blood glucose, and hemoglobin A1c (HbA1c), with an increase in high-density lipoprotein (HDL) levels. The percentage of total weight loss (%TWL) and excess weight loss (%EWL) were 29.13 ± 8.42 and 71.03 ± 20.88, respectively. The median FRS decreased from 11.70 pre-surgery to 4.50 and 6.30 at one-year and long-term follow-ups (P<0.0001). Complete remission of T2DM, hypertension, and hyperlipidemia was achieved in 75.2%, 48.2%, and 35.1% of patients, respectively, and improvements were sustained throughout the follow-up period. The type of MS had no significant impact on changes in weight or BMI (P>0.05). Surgery-related side effects were observed in four cases (3.80%). MS is a safe and effective procedure for reducing obesity-related complications, including T2DM, hypertension, hyperlipidemia, and cardiovascular risk in both the short and long term. These findings highlight the promising potential of MS in managing diabetes.