Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom.
Singh, Pushpa Adderley, Nicola J Subramanian, Anuradhaa Gokhale, Krishna Hazlehurst, Jonathan Singhal, Rishi Bellary, Srikanth Tahrani, Abd A Nirantharakumar, Krishnarajah
Singh, Pushpa
Adderley, Nicola J
Subramanian, Anuradhaa
Gokhale, Krishna
Hazlehurst, Jonathan
Singhal, Rishi
Bellary, Srikanth
Tahrani, Abd A
Nirantharakumar, Krishnarajah
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2022-08-08
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Abstract
Background: Clinical trials have shown that bariatric surgery (BS) is associated with better glycemic control and diabetes remission in patients with type 2 diabetes (T2D) compared with routine care.
Objective: We conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D.
Setting and methods: This was a retrospective, matched, controlled cohort study conducted between January 1, 1990, and January 31, 2018, using IQVIA Medical Research Data, a primary care electronic records database. Adults with body mass index (BMI) ≥30 kg/m2 and T2D who had BS (surgical) were matched for age, sex, BMI, and diabetes duration to two controls (with T2D and no BS).
Results: A total of 1126 patients in the surgical group and 2219 patients in the control group were analyzed. Mean (standard deviation) age was 50.0 (9.3) years, 67.6% were women, baseline glycocylated hemoglobin (HbA1C) was 7.8% (1.7 mmol/mol), and diabetes duration was 4.7 years (range, 2.0-8.4 years). Over a median (interquartile range) follow-up of 3.6 years (1.7-5.9 years), a higher proportion of patients in the surgical group achieved an HbA1C of ≤6.0% than the control group (65.8% versus 22.8%). The surgical group showed a decrease in mean HbA1C of 1.5% (95% confidence interval [CI]: 1.4%-1.7%), 1.4% (1.2%-1.5%), and 1.3% (1.1%-1.5%) at 1-, 2-, and 3-year follow-up, respectively, whereas HbA1C increased in the control group. The proportion of patients receiving glucose-lowering medications decreased in the surgical group (92.2% to 66.5%) but increased in the control group (85.3% to 90.2%).
Conclusion: BS is associated with significant improvement in glycemic control, achievement of normal HbA1C levels, and reduced need for glucose-lowering therapy in patients with T2D.
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Singh P, Adderley NJ, Subramanian A, Gokhale K, Hazlehurst J, Singhal R, Bellary S, Tahrani AA, Nirantharakumar K. Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom. Surg Obes Relat Dis. 2022 Dec;18(12):1366-1376. doi: 10.1016/j.soard.2022.08.001. Epub 2022 Aug 8
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