title: Effect of Contemporary Bariatric Surgical Procedures on Type 2 Diabetes Remission. A Population-Based Matched Cohort Study.
abstract: The objective of the study is to evaluate the effect of gastric banding, gastric bypass and sleeve gastrectomy on medium to long-term diabetes control in obese participants with type 2 diabetes mellitus.
  
  
  
  Matched cohort study using primary care electronic health records from the UK Clinical Practice Research Datalink. Obese participants with type 2 diabetes who received bariatric surgery from 2002 to 2014 were compared with matched control participants who did not receive BS. Remission was defined for each year of follow-up as HbA1c <6.5 % and no antidiabetic drugs prescribed.
  
  
  
  There were 826 obese participants with T2DM who received bariatric surgery including adjustable gastric banding (LAGB) 220; gastric bypass (GBP) 449; or sleeve gastrectomy (SG) 153; with four procedures undefined. Mean HbA1c declined from 8.0 % before BS to 6.5 % in the second postoperative year; proportion with HbA1c <6.5 % (<48 mmol/mol) increased from 17 to 47 %. The proportion of patients in remission was 30 % in the second year, being 20 % for LAGB, 34 % for GBP and 38 % for SG. The adjusted relative rate of remission over the first six postoperative years was 5.97 (4.86 to 7.33, P < 0.001) overall; for LAGB 3.32 (2.27 to 4.86); GBP 7.16 (5.64 to 9.08); and SG 6.82 (5.05 to 9.19). Rates of remission were maintained into the sixth year of follow-up.
  
  
  
  Remission of diabetes may continue for up to 6 years after bariatric surgical procedures. Diabetes outcomes are generally more favourable after gastric bypass or sleeve gastrectomy than LAGB.
authors.affiliation: King's College London, London, UK.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
authors.affiliation: King's College London, London, UK. helen.booth@kcl.ac.uk.
authors.forename: Helen Pascale
authors.initials: HP
authors.lastname: Booth
authors.affiliation: St George's Hospital, London, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Reddy
authors.affiliation: King's College London, London, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.affiliation: King's College London, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Fildes
authors.affiliation: King's College London, London, UK.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A Toby
authors.initials: AT
authors.lastname: Prevost
authors.affiliation: St George's Hospital, London, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Khan
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D012074:Remission Induction; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Antidiabetes drugs; Bariatric surgery; Electronic health records; Primary care; Type 2 diabetes mellitus