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Comment on: 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

Published:November 04, 2022DOI:https://doi.org/10.1016/j.soard.2022.10.033
      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) ≥30 kg/m2. 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, 5.19–6.60], P < .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 of care.
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