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 |
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| Affiliation: | 1. Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom;2. Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom;3. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom;4. Department of Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom;5. School of Life and Health Sciences, Aston University, Birmingham, United Kingdom;6. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom;7. Midlands Health Data Research, Birmingham, United Kingdom;1. Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;2. Department of Information Engineering, University of Padova, Padova, Italy;3. Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands;4. Medics Laboratory AG, Bern, Switzerland;1. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden;2. Department of Psychology, Lund University, Lund, Sweden;3. Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden;4. Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden;5. Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden;6. Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden;7. Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, Gothenburg, Sweden;8. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden;1. Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway;2. Department of Clinical Science, University of Bergen, Bergen, Norway;3. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;4. Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway;5. Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway;6. Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway;7. Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway;8. Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway;9. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Norway;1. Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas;2. Department of Surgery, Mayo Clinic, Rochester, Minnesota;1. Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina;2. OptumLabs at UnitedHealth Group, Minnetonka, Minnesota |
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| Abstract: | ![]()
BackgroundClinical 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.ObjectiveWe conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D.Setting and MethodsThis 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).ResultsA 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%).ConclusionBS 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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| Keywords: | Bariatric surgery Obesity Diabetes Glycemic HbA1C Weight Glucose-lowering medications adult |
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