Bariatric‐metabolic surgery for National Health Service (NHS) patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry
Authors' conclusion
NHS bariatric-metabolic surgery is used for people with T2DM much later in the disease process when it is less effective. National guidance on bariatric-metabolic surgery and data from multiple RCTs have had little impact on clinical practice.
Study context
- Population
- People undergoing primary bariatric-metabolic surgery in the NHS, National Bariatric Surgical Registry (NBSR), 2009–2019
- Participants
- 51,715 people
- Exposure
- T2D vs no T2D in patients undergoing bariatric-metabolic surgery
- T2DMn = 14,948
- Outcome
- Prevalence of T2D and its characteristics among surgical patients
Methodological detailsnational registry, multivariate logistic regression
- National registry
- Multivariate logistic regression
Main finding
As reported in the abstract
T2DM
28.9%
14,948
- T2D patients on oral hypoglycaemics
- 10,626 (71.1%)
- T2D patients on insulin/other injectables
- 4322 (28.9%)
- T2D diagnosed 10+ years before surgery
- 3876 (25.9%)
Observational data: associations, not effects.
Further findings
| Outcome | OR (CI) | P value | |
|---|---|---|---|
| Characteristics associated with T2D vs no T2DT2DMvs Without T2DMDyslipidaemia | 3.58 (3.39–3.79) | P < 0.001 | |
| Characteristics associated with T2D vs no T2DT2DMvs Without T2DMHypertension | 2.32 (2.19–2.45) | P < 0.001 | |
| Characteristics associated with T2D vs no T2DT2DMvs Without T2DMLiver disease | 1.73 (1.58–1.90) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
- Characteristics associated with T2D vs no T2D — Older age with T2D
- p < 0.001
- Characteristics associated with T2D vs no T2D — Male sex with T2D
- p < 0.001
- Characteristics associated with T2D vs no T2D — Poorer functional status with T2D
- p < 0.001
Characteristics associated with T2D vs no T2D
- No difference in BMI
Trends over time · after 2015
- Fewer people receiving surgery had T2D
- P < 0.001
- Very small percentage increase of those with class I obesity and T2D
Procedure selection
- T2D status associated with selection for gastric bypass vs SG
- P < 0.001
- Gastric bypass was the commonest operation overall
Original publication
Bariatric‐metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry. Diabet Med. Published 19 January 2023. doi:10.
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