Bariatric surgery is more effective than medical or lifestyle interventions for diabetes management and remission: study

Bariatric surgery is more effective than medical and lifestyle modifications for achieving long-term control and remission of type 2 diabetes, according to a new study led by surgeon-scientists at the University of Pittsburgh School of Medicine. Japan Automobile Manufacturers Association.

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 or lifestyle modifications. Diabetes and cholesterol are important risk factors for heart disease, so managing both can help reduce heart attacks, strokes, and other complications.

“This analysis is the strongest evidence to date that bariatric surgery is a safe and effective tool for managing diabetes and achieving remission,” said lead author and director of Pitt Surgery said Anita Kourkoulas, MD, MPH, professor and head of the Division of Minimally Invasive Medicine. UPMC Bariatric Surgery Program.

Researchers measured glycemic control (HbA1c), weight loss, insulin and A variety of outcomes were compared, including the use of other diabetes medications.

All four trials included patients with type 2 diabetes and obesity who had undergone bariatric surgery or participated in medical and lifestyle programs based on established interventions shown to reduce the risk of diabetes. The researchers then pooled the data into his single study, which was completed in 2022. Long-term results were analyzed 7 years after randomization and, if available, 12 years.

Patients in the bariatric surgery group consistently had lower HbA1c levels than the medical/lifestyle group at each follow-up time point, reflecting better glycemic control, despite starting the study with higher baseline values are doing.

At seven years, 18.2% of participants in the surgery group achieved diabetes remission, compared with 6.2% in the medical/lifestyle group. At 12 years, the difference was even more pronounced, with no patients in the medical/lifestyle group achieving diabetes remission compared to 12.7% in the surgical treatment group. Even in those who did not experience remission, bariatric surgery resulted in reduced use of diabetes medications and better glycemic control than medical/lifestyle treatment.

Results were consistent across weight groups, showing that surgery was equally beneficial for patients with body mass index (BMI) ≤35 kg/m3 and ≥35 kg/m3. .²—Typical cutoff values ​​for bariatric surgery treatment.

“This suggests that bariatric surgery is recommended as a treatment for poorly controlled diabetes, even if patients with type 2 diabetes are below the BMI standard to be candidates for bariatric surgery for the sole purpose of weight loss.” “It shows that we should be able to do that,” Koollas said. “These results further support the need for flexible, patient-centered care based on individual health issues and goals.”

Although the purpose 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 sustained weight loss. discovered. At 12 years, surgical patients had an average weight loss of 19.3% compared to 10.8% for patients in the medical/lifestyle intervention group.

The researchers found no difference in mortality or major cardiovascular events between the two groups. However, anemia, bone 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 Pitt, Cleveland Clinic, Joslin Diabetes Center, Brigham and Women’s Hospital, the University of Washington and Kaiser Permanente Washington. In total, the study included 355 patients with type 2 diabetes. This study was conducted before GLP-1 agonist drugs for diabetes management and weight loss were widely available.

Medical and lifestyle interventions at all four sites are based on national standards for intensive diabetes management, including physical activity and nutrition tracking, increased collaboration with the medical team, stress management, support groups, and study enrollment. The available drugs were included. Surgery for bariatric patients includes Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding.