Key Points:
- The study compares bariatric surgery to medical/lifestyle intervention in treating T2DM over 7–12 years.
- Bariatric surgery leads to better glycemic control, higher diabetes remission rates, and reduced medication usage.
- Results highlight bariatric surgery’s long-term efficacy and safety in managing T2DM in individuals with obesity.
A recent study published in the Journal of American Medical Association (JAMA) has shed light on the long-term effectiveness of bariatric surgery compared to medical and lifestyle interventions in patients with type 2 diabetes mellitus (T2DM). The study conducted by researchers from the United States provides compelling evidence supporting the superiority of bariatric surgery in achieving better glycemic control and long-term outcomes for individuals with T2DM.
T2DM affects millions of adults globally and imposes significant economic burdens. While bariatric surgery has shown promise in treating the condition, limited randomized controlled trials (RCTs) have hindered widespread recommendations. The Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) consortium aimed to address this gap by conducting an extensive pooled analysis of long-term observational data from four US single-center RCTs.
The study included 262 type 2 diabetes mellitus patients with a body mass index (BMI) ranging from 27 to 45 kg/m2, randomized to receive intensive medical and lifestyle management or bariatric surgery. The primary outcome measured was the change in glycated hemoglobin (HbA1c) levels from baseline to seven years, with extended follow-up data up to 12 years.
Key findings from the study revealed that patients undergoing bariatric surgery consistently maintained significantly lower HbA1c levels than those receiving medical/lifestyle management, with sustained improvements observed over the 7 to 12-year period. Additionally, bariatric surgery resulted in higher rates of diabetes remission, reduced diabetes medication usage, and significantly greater weight loss than medical intervention.
Furthermore, the study highlighted the safety and durability of bariatric surgery, with similar rates of adverse events observed between the surgery and medical groups. Notably, bariatric surgery was associated with improved metabolic parameters, including higher high-density lipoprotein (HDL) levels and lower triglycerides.
While the study provides robust evidence supporting the benefits of bariatric surgery for T2DM patients, it is limited by its open-label design, heterogeneous treatments, and changes in surgical procedures and medication use during follow-up. Nevertheless, the findings endorse bariatric surgery as a viable treatment option for individuals with type 2 diabetes mellitus and obesity, emphasizing its potential to improve glycemic control and long-term outcomes.
