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Bariatric surgery is more effective than medical and lifestyle modifications in achieving long-term control and remission of type 2 diabetes, according to new research.
In the largest and longest randomized follow-up study to date, researchers also found that bariatric surgery improved cholesterol and triglyceride levels more effectively than medical and lifestyle modifications.
Since diabetes and cholesterol are major risk factors for heart disease, controlling both can help reduce heart attacks, strokes, and other complications.
“This analysis is the strongest evidence we have to date that bariatric surgery is a safe and effective tool for achieving diabetes control and remission,” says senior author Anita Courcoulas, a professor in the department of surgery at the University of Pittsburgh and head of the Center for Minimal Invasion. UPMC Bariatric Surgery Program.
Researchers compared several outcomes (measures of blood sugar control (HbA1c), weight loss, as well as use of insulin and other diabetes medications) for participants enrolled in four separate randomized clinical trials conducted between May 2007 and August. of 2013.
All four trials included patients with type 2 diabetes and obesity who underwent bariatric surgery or participated in a medical and lifestyle program based on established interventions that have been shown to reduce the risk of diabetes. The researchers then combined the data into a study completed in 2022. Long-term outcomes were analyzed seven and, when possible, 12 years after randomization.
Patients in the bariatric surgery group consistently had lower HbA1c levels, reflecting better blood sugar control, than the medical/lifestyle group at each follow-up point, despite starting the study with lower baseline values. high.
By year seven, 18.2% of participants in the surgery group had achieved diabetes remission, compared with 6.2% in the medical/lifestyle group.
At year 12, the difference was even starker: No patients in the medical/lifestyle group were in diabetes remission, compared with 12.7% in the surgery group. Even in those who did not experience remission, bariatric surgery led to superior blood sugar control with less use of diabetes medications than medical or lifestyle treatment.
The results were consistent across all weight class groups, demonstrating that surgery is equally beneficial for patients with body mass indexes (BMI) below and above 35 kg/m2, the typical limit for bariatric surgery treatment. .
“This indicates that people with type 2 diabetes, even those who are below the BMI threshold for bariatric surgery for weight loss alone, should be offered bariatric surgery as a treatment for poorly controlled diabetes,” Courcoulas says. “These results further support the need for flexible, patient-centered care based on each individual’s health problems and goals.”
Although the goal of this study was to analyze diabetes control and remission rates, the researchers also found that bariatric surgery was superior to medical/lifestyle interventions in terms of lasting weight loss. At year 12, surgical patients had suffered an average weight loss of 19.3%, compared with 10.8% for patients in the medical/lifestyle intervention group.
The researchers found no differences in mortality or major cardiovascular events between the two groups. However, anemia, fractures, and adverse gastrointestinal symptoms, such as nausea and abdominal pain, were more common among participants who underwent bariatric surgery.
The analysis used data from randomized clinical trials conducted at the University of Pittsburgh, the Cleveland Clinic, the Joslin Diabetes Center, Brigham and Women’s Hospital, the University of Washington and Kaiser Permanente Washington. Altogether, the trials included 355 patients with type 2 diabetes. The trials were conducted before the widespread availability of GLP-1 agonist medications for diabetes control and weight loss.
Medical and lifestyle interventions at the four sites were based on national standards for intensive diabetes management and included physical activity and nutrition tracking, increased engagement with the health care team, stress management, group support and medications available at the time of study enrollment. . Bariatric surgery procedures included Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
The study is published in JAMA.
Additional co-authors come from Harvard Medical School, Cleveland Clinic, Kaiser Permanente, Harvard Medical School, University of Kansas Medical Center, Metamor Institute, Weill Cornell Medicine, University of Washington, and University Louisiana State.
Fountain: university of pittsburgh