We welcome the article,
Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes—the Sunderland (UK) Experience, by Dr. Samuel and colleagues [
1], reporting the impact of preoperative control of diabetes in patients undergoing metabolic bariatric surgery. They examined the rate of perioperative complications (anastomotic leak, bleeding and wound infection) as the primary outcome and rates of re-operation and 30-day readmission, postoperative hospital stay, glycaemic control and weight loss at 6 and 12 months as secondary outcomes amongst three groups:
Group 1, those without diabetes (HbA1c < 6.5%,
n = 979);
Group 2, with adequately controlled diabetes (HbA1c between 6.5 and 8.4%,
n = 350); and
Group 3, with suboptimally controlled diabetes (HbA1c ≥ 8.5%,
n = 90). All 1419 patients had undergone either laparoscopic Roux-en-Y gastric bypass (LRYGB), one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (LSG) at their centre and were followed up for at least 1 year. The mean length of stay was 2 days, while 30-day readmission rate was 3% for each group. They report an early complication rate of 1% for each group, and significant weight loss and improvement in HbA1c at 6 and 12 months, with no significant difference between groups. They have concluded that, when it is not possible to achieve adequate glycaemic control despite optimal medical therapy including high insulin requirements, proceeding with metabolic surgery is acceptable. They have further hypothesised that postoperative control of diabetes may be a better predictor of patient outcomes than preoperative control. …
