Bariatric surgery more effective than medical and lifestyle interventions for diabetes control and remission 

Key Takeaways

  • A study suggests that bariatric urgery is more effective than medical and lifestyle modifications for achieving long-term type 2 diabetes control and remission.
  • The analysis is the strongest evidence to date that bariatric surgery is a safe and effective tool for achieving diabetes control and remission.

Bariatric surgery is more effective than medical and lifestyle modifications for achieving long-term type 2 diabetes control and remission, according to new research led by a University of Pittsburgh School of Medicine surgeon-scientist and published in JAMA. In the largest and longest randomized follow-up study to date, the researchers also found that bariatric surgery improved cholesterol and triglyceride levels more effectively than did medical and lifestyle modifications. Since diabetes and cholesterol are important risk factors for heart disease, the management of both may contribute to fewer 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,” said lead author Anita Courcoulas, M.D., M.P.H., professor in Pitt’s Department of Surgery and chief of the Minimally Invasive Bariatric Surgery Program at UPMC. Researchers compared various outcomes—measures of blood sugar control (HbA1c), weight loss, as well as insulin and other diabetes medication usage—for participants enrolled in four separate, randomized clinical trials carried out between May 2007 and August 2013. All four trials included patients with type 2 diabetes and obesity who either underwent bariatric surgery or participated in a medical and lifestyle program based on established interventions shown to reduce diabetes risk. The researchers then pooled the data together into one study completed in 2022. Long-term outcomes were analyzed at seven and, when possible, 12 years post-randomization.

Patients in the bariatric surgery group consistently had lower HbA1c levels—reflecting better blood sugar control—than did the medical/lifestyle group at each follow-up point, despite starting the study with higher baseline values. At year seven, 18.2% of participants in the surgery group had achieved diabetes remission, compared to 6.2% in the medical/lifestyle group. At year 12, the difference was even more stark: no patients in the medical/lifestyle group were in diabetes remission, compared to 12.7% in the surgery group. Even in those who did not experience remission, bariatric surgery led to superior blood sugar control with less diabetes medication use than did medical/lifestyle treatment.

The results were consistent across weight class groups, showing that surgery is equally beneficial for patients with body mass indexes (BMI) below and above 35 kg/m2—the typical cutoff for bariatric surgery treatment. “This indicates that people with type 2 diabetes—even those below the BMI threshold for bariatric surgery for weight loss alone—should be offered bariatric surgery as a treatment for inadequately controlled diabetes,” said Courcoulas. 

Courcoulas noted the four trials in the study were conducted before the availability of newer diabetes and obesity medications. She said similar trials could be conducted in the future to see how bariatric surgery compares with newer treatments. “As well, future studies should address the role of these newer medications before, during and after bariatric surgery as potential adjunctive and supportive therapeutic options,” Courcoulas said.

Sources:

University of Pittsburgh, Medical Xpress, February 27, 2024; see Medical Xpress article Michael Monostra, Healio Endocrine Today, February 27, 2024; see Healio article