Obesity Abstracts

Objectives: Obesity is an established risk factor for diabetes peripheral neuropathy (DPN), peripheral vascular disease (PVD) and diabetes foot disease (DFD). Bariatric surgery (BS) is the most successful obesity treatment that results in sustained weight loss. However, the impact of BS in patients with Type 2 DM (T2D) on DPN and DFD is unknown. Hence, we conducted a population-based study examining the impact of BS on development and progression of DFD.

Methods: An age, sex, body mass index (BMI)- matched retrospective cohort study was performed using data from The Health Improvement Network (THIN), a UK electronically collected primary care patient records. Study period was 1 January 1990 to 31 January 2018. Adult patients with T2D and BMI ≥ 30 kg/m² were included in the study. The exposed group were patients who had BS after their T2D diagnosis; the unexposed group were patients without BS. The primary outcome was DFD (a composite of DPN, foot ulcer, Charcot’s neuro-arthropathy, PVD, amputation or foot coded as moderate or high risk). Secondary outcomes was examining the progression of foot from low to medium and high risk. All variables were identified using Read codes. Cox regression was used to calculate hazard ratios using Stata version15.

Results: 1126 exposed and 2219 unexposed patients were included. Mean (S.D.) age was 50 (9.3) years, 2261 (67.69%) were women, median follow-up was 3.6 years (IQR 1.7–5.9), median T2D duration for exposed vs unexposed was 4.7 (2.2–8.9) vs 4.6 (1.9–8.1) years. The mean (S.D.) preoperative HbA1c was 7.78 (1.82) % vs 7.82 (1.69) % in exposed and unexposed patients respectively. After adjusting for age, sex, smoking, alcohol, BMI, ethnicity, Townsend quintile (social deprivation), diabetes duration, baseline hypertension and HbA1c, BS was associated with reduced risk of developing DFD (adj HR 0.63, 95%CI 0.52–0.76, P<0.001). BS was also associated with reduced risk of progression from low to moderate/high risk foot (0.87, 0.77–0.997, P=0.046) and from moderate to high risk foot (adj HR 0.54, 0.33–0.90, P=0.018).

Conclusion: In patients with T2D, bariatric surgery was associated with significant reduction in the risk of development or progression of foot disease.