Bariatric‐metabolic surgery for <scp>NHS</scp> patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry
No Thumbnail Available
Authors
Currie, A.
Blockmans, R.
Askari, A.
Byrne, J.
Ahmed, A.R.
Batterham, R.L.
Mahawar, K.
Miras, A.D.
Pring, C.M.
Small, P.K.
Issue Date
2023
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Surgery , Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Diabetology
Alternative Title
Abstract
Abstract
Aim: Bariatric-metabolic surgery is approved by the National Institute of Health and Care Excellence (NICE) for people with severe obesity and type 2 diabetes (T2DM) (including class 1 obesity after 2014). This study analysed baseline characteristics, disease severity and operations undertaken in people with obesity and T2DM undergoing bariatric-metabolic surgery in the UK National Health Service (NHS) compared to those without T2DM.
Methods: Baseline characteristics, trends over time and operations undertaken were analysed for people undergoing primary bariatric-metabolic surgery in the NHS using the National Bariatric Surgical Registry (NBSR) for 11 years from 2009 to 2019. Clinical practice before and after the publication of the NICE guidance (2014) was examined. Multivariate logistic regression was used to determine associations with T2DM status and the procedure undertaken.
Results: 14,948/51,715 (28.9%) participants had T2DM, with 10,626 (71.1%) on oral hypoglycaemics, 4322 (28.9%) on insulin/other injectables, and with T2DM diagnosed 10+ years before surgery in 3876 (25.9%). Participants with T2DM, compared to those without T2DM, were associated with older age (p < 0.001), male sex (p < 0.001), poorer functional status (p < 0.001), dyslipidaemia (OR: 3.58 (CI: 3.39-3.79); p < 0.001), hypertension (OR: 2.32 (2.19-2.45); p < 0.001) and liver disease (OR: 1.73 (1.58-1.90); p < 0.001), but no difference in body mass index was noted. Fewer people receiving bariatric-metabolic surgery after 2015 had T2DM (p < 0.001), although a very small percentage increase of those with class I obesity and T2DM was noted. Gastric bypass was the commonest operation overall. T2DM status was associated with selection for gastric bypass compared to sleeve gastrectomy (p < 0.001).
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.
Keywords: bariatric surgery; gastric bypass; obesity; registries; type 2 diabetes mellitus.
© 2023 Diabetes UK.
PubMed Disclaimer
Similar articles
Clinical characteristics of patients undergoing primary bariatric surgery in the United Kingdom based on the National Bariatric Surgery Registry.
Bolckmans R, Askari A, Currie A, Ahmed AR, Batterham RL, Byrne J, Hopkins J, Khan OA, Mahawar K, Miras AD, Pring CM, Small PK, Welbourn R.
Clin Obes. 2023 Jun;13(3):e12585. doi: 10.1111/cob.12585. Epub 2023 Feb 21.
PMID: 36807508
Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses.
McGlone ER, Carey I, Veličković V, Chana P, Mahawar K, Batterham RL, Hopkins J, Walton P, Kinsman R, Byrne J, Somers S, Kerrigan D, Menon V, Borg C, Ahmed A, Sgromo B, Cheruvu C, Bano G, Leonard C, Thom H, le Roux CW, Reddy M, Welbourn R, Small P, Khan OA.
PLoS Med. 2020 Dec 7;17(12):e1003228. doi: 10.1371/journal.pmed.1003228. eCollection 2020 Dec.
PMID: 33285553 Free PMC article.
Remission of Type 2 Diabetes Mellitus in Patients After Different Types of Bariatric Surgery: A Population-Based Cohort Study in the United Kingdom.
Yska JP, van Roon EN, de Boer A, Leufkens HG, Wilffert B, de Heide LJ, de Vries F, Lalmohamed A.
JAMA Surg. 2015 Dec;150(12):1126-33. doi: 10.1001/jamasurg.2015.2398.
PMID: 26422580
The importance of national registries/databases in metabolic surgery: the UK experience.
Hopkins J, Welbourn R.
Surg Obes Relat Dis. 2016 Jul;12(6):1178-85. doi: 10.1016/j.soard.2016.02.030. Epub 2016 Mar 3.
PMID: 27313193 Review.
Obesity Surgery.
Fink J, Seifert G, Blüher M, Fichtner-Feigl S, Marjanovic G.
Dtsch Arztebl Int. 2022 Feb 4;119(5):70-80. doi: 10.3238/arztebl.m2021.0359.
PMID: 34819222 Free PMC article. Review.
See all similar articles
Cited by
Effectiveness of Bariatric Surgery in the Management of Type 2 Diabetes Mellitus: A Case Report and Literature Review.
Mahamud B, Suthar RK, Mohamed A, Hamid K, Mlawa G.
Cureus. 2023 Oct 27;15(10):e47843. doi: 10.7759/cureus.47843. eCollection 2023 Oct.
PMID: 38021602 Free PMC article.
Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study.
Coulman KD, Margelyte R, Jones T, Blazeby JM, Macleod J, Owen-Smith A, Parretti H, Welbourn R, Redaniel MT, Judge A.
PLoS Med. 2023 Sep 28;20(9):e1004282. doi: 10.1371/journal.pmed.1004282. eCollection 2023 Sep.
PMID: 37769031 Free PMC article.
Regulation of Human Sortilin Alternative Splicing by Glucagon-like Peptide-1 (GLP1) in Adipocytes.
Lui A, Patel RS, Krause-Hauch M, Sparks RP, Patel NA.
Int J Mol Sci. 2023 Sep 20;24(18):14324. doi: 10.3390/ijms241814324.
PMID: 37762628 Free PMC article.
References
REFERENCES
Health and Social Care Information Centre. National Diabetes Audit Report 1- Findings and Recommendations 2016-17. Health and Social Care Information Centre; 2018.
Cummings DE, Rubino F. Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia. 2018;61:257-264.
Pareek M, Schauer PR, Kaplan LM, Leiter LA, Rubino F, Bhatt DL. Metabolic surgery: weight loss, diabetes, and beyond. J Am Coll Cardiol. 2018;71:670-687.
Welbourn R, Hollyman M, Kinsman R, et al. Bariatric-metabolic surgery utilisation in patients with and without diabetes: data from the IFSO global registry 2015-2018. Obes Surg. 2021;31:2391-2400.
Rubino F, Shukla A, Pomp A, Moreira M, Ahn SM, Dakin G. Bariatric, metabolic, and diabetes surgery: what's in a name? Ann Surg. 2014;259:117-122.
Description
Citation
Currie A, Bolckmans R, Askari A, Byrne J, Ahmed AR, Batterham RL, Mahawar K, Miras AD, Pring CM, Small PK, Welbourn R. Bariatric-metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry. Diabet Med. 2023 Jun;40(6):e15041. doi: 10.1111/dme.15041. Epub 2023 Jan 19. PMID: 36648127.
Publisher
License
Journal
Volume
Issue
PubMed ID
ISSN
https://onlinelibrary.wiley.com/doi/10.1111/dme.15041