The external validity and impact of therapeutic strategies tested in randomized controlled
clinical trials (RCTs) are confirmed either by other RCTs or when RCT results are
replicated in large and well-designed analyses of the same therapies in population-based
studies. In this issue, Singh et al. [
- Singh P.
- Adderley N.J.
- Subramanian A.
- et al.
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.
] present the results of a retrospective, population-based, match-controlled cohort
study examining the impact of metabolic and bariatric surgery (MBS) on glycemic control
and medication use in patients with type 2 diabetes (T2D) and body mass index (BMI)
. By using nationally representative primary care electronic records covering nearly
6% of the population in the United Kingdom (IQVIA Medical Research Data), the authors
compared patients with obesity and T2D, matched 1:2 for age, sex, BMI, and T2D duration,
divided into 2 groups: 1126 patients who received MBS to 2219 control participants
who received the standard of care. The MBS group had patients submitted to laparoscopic
adjustable gastric band (LAGB, 22.1%), laparoscopic sleeve gastrectomy (LSG, 22.7%),
laparoscopic Roux-en-Y gastric bypass (LRYGB, 52.2%), and laparoscopic duodenal switch
(LDS, 1.1%). After a median follow-up period of 3.6 years, a significant reduction
in hemoglobin A1C (HbA1C) was observed in the MBS group while an increase in HbA1C
was noted in the control group, with a difference in mean change of 1.6 (95% confidence
interval [CI], 1.4–1.8) favoring MBS. Patients who underwent MBS were significantly
more likely to achieve and maintain HbA1C ≤6% (adjusted hazard ratio = 5.86 [95% CI,
< .001). MBS also led to a reduction in the proportion of patients taking glucose-lowering
medications, including insulin (from 92.2% to 66.5%), while an increase in those patients
was observed in the control group (from 85.3% to 90.2%). Importantly, while there
were in between surgery technique differences in glycemic control, both the overall
and individual glycemic outcomes of any type of MBS were superior to the standard