Bariatric surgery outcomes in people with and without type 2 diabetes: population-based studies and a systematic review

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Singh, Pushpa ORCID: https://orcid.org/0000-0001-5321-6567 (2022). Bariatric surgery outcomes in people with and without type 2 diabetes: population-based studies and a systematic review. University of Birmingham. Ph.D.

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Abstract

Background
Impact of bariatric surgery on vascular complications and mortality using real-world data are lacking. In addition, there is lack of robust prediction model to predict diabetes remission.
Hence, in this thesis I undertook series of population- based studies examining outcomes of bariatric surgery and a systematic review to recognise prediction-model for diabetes remission following bariatric surgery.

Methods
Retrospective cohort matched controlled studies utilising IQVIA Medical Research Data (IMRD)database to assess the impact of bariatric surgery on 1) incident cardiovascular disease (CVD), and all-cause mortality in patients with obesity; 2) diabetes related microvascular complications in patients with obesity and type 2 diabetes compared to routine care.
Systematic literature search was undertaken. Studies developing or validating prediction model for diabetes remission in adults after bariatric surgery were included and performance assessed

Results
Project 1- Bariatric surgery was associated with a lower incident composite CVD (adjusted HR 0.79, 95% CI 0.62 to 1.02, p=0.074), which was statistically significant in the RYGB group mainly driven by reduction in incidence heart failure. It was also associated with 30% reduction in all-cause mortality compared to routine care.

Project 2- Bariatric surgery was associated with reduction in incident composite microvascular complications (adjusted HR 0.63, 95% CI 0.51-0.78, p<0.001), better glycaemic status, higher proportion achieving target HbA1c on less glucose lowering medications.

Project 3- Identified 16 prediction models. ABCD and DiaRem had been widely externally validated. Newer prediction models showed excellent performance in limited validation studies.

Conclusions
Bariatric surgery was associated with reduction in incidence cardiovascular and diabetes related microvascular complications, and all- cause mortality. Improvements in provision of bariatric surgery can help reduce the burden of obesity. Further validation studies are needed.
Systematic literature search was undertaken. Studies developing or validating prediction model for diabetes remission in adults after bariatric surgery were included and performance assessed.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):

Supervisor(s)	Email	ORCID
Tahrani, Abd	UNSPECIFIED	orcid.org/0000-0001-9037-1937
Nirantharakumar, Krishnarajah	UNSPECIFIED	orcid.org/0000-0002-6816-1279
Bellary, Srikanth	UNSPECIFIED	orcid.org/0000-0002-5924-5278