Strengths and limitations
weight loss, T2DM
SECONDARY
The GLIDE clinical trial has several strengths. It used a randomised, double-blind, placebo-controlled design which increased the validity of the results. The study mirrors routine clinical care to reduce the patient burden taking part in the research. Finally the study provides data to power further randomised controlled trials.However, the trial has several limitations. Importantly, the study did not achieve its estimated sample size, with several reasons accounting for this. Firstly, we noted a change in clinical practice over the time of the trial, with a general preference for a LSG or RYGB procedure compared to LAGB, especially in participants with T2DM. Secondly, inclusion criteria limited the duration of T2DM for participants to <10 years, excluding many of our patients from the trial who often present with a long duration of T2DM. Thirdly, the COVID-19 pandemic significantly impacted the study, with the majority of participants either randomised just before the pandemic or reaching the critical 6 month and 12-month trial milestones during the pandemic. This resulted in missing critical primary and secondary outcome data for some participants, including weight and HbA1c data, and restricted face-to-face appointments for band adjustment. This may partly underpin the sub-optimal metabolic and weight outcomes in both groups. A further limitation was the study’s relatively short duration (26 weeks) with liraglutide 1.8 mg. The GLIDE trial showed the worsening effect of HbA1c and weight after cessation of therapy, and it would have been of interest to determine the longer-term impact of GLP-1 therapy beyond 6 months. As per its license for the treatment of T2DM, participants were given liraglutide at a maximum dose of 1.8 mg once daily. Evidence has shown more significant weight loss with liraglutide 3 mg; at 6 months, some patients may have not yet achieved their nadir weight [