Highlights
- •Bariatric surgery lowers A1c in real-world clinical care.
- •Improvements are sustained for at least 6 years.
- •Benefits were greatest for younger people and those with shorter diabetes duration.
- •Therefore, efficacy results from RCTs are generalizable to routine clinical practice.
Abstract
Background
Randomized controlled trials (RCTs) have demonstrated that bariatric surgery improves
glycemic control among people with diabetes. However, evidence from RCTs may not be
generalizable to real-world clinical care with unselected patients in routine clinical
practice.
Objectives
To examine long-term glycemic control and glucose-lowering drug regimens following
bariatric surgery for people with type 2 diabetes (T2D) in unselected patients in
routine clinical practice.
Setting
Population-based cohort study using linked routinely collected real-world data from
Ontario, Canada.
Methods
Individuals with T2D who were assessed for bariatric surgery at any referral center
in the province between February 2010 and November 2016 were identified and divided
into those who received surgery within 2 years of the initial assessment and those
who did not.
Results
There were 3674 people who had bariatric surgery and 1335 who did not. By 2 years,
people who had undergone surgery had a significantly lower HbA1C (6.3 ± 1.2 % versus
7.8 ± 1.8 %, P < .0001), and this difference persisted at 3, 4, 5, and 6 years. Even by 6 years,
half of those who had undergone surgery remained on no glucose-lowering drugs, and
they were nearly 6 times less likely to be on insulin than those who had not undergone
surgery.
Conclusions
In real-world clinical care, bariatric surgery was associated with large and sustained
improvements in glycemic control.
Key words
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Article info
Publication history
Published online: February 17, 2021
Accepted:
February 12,
2021
Received:
October 19,
2020
Identification
Copyright
© 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
