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Bariatric surgery is more effective than medical and lifestyle modifications to achieve long-term control and remission of type 2 diabetes, according to a new study led by surgeons and scientists at the University of Pittsburgh School of Medicine and published today in JAMA. It is also said to be effective.
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 studied blood sugar control (HbA1c), weight loss, insulin and other A variety of outcomes were compared, including the use of diabetes medications. Included in all four exams. Patients with type 2 diabetes and obesity who have 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 had consistently 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. ing. 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 class groups, with surgery equally effective for patients with body mass index (BMI) below or above 35 kg/m2 (a common cutoff for bariatric surgery treatment). It has been shown to be beneficial.
“This means that patients with type 2 diabetes should be offered bariatric surgery as a treatment for poorly controlled diabetes, even if they are below the BMI threshold for bariatric surgery for the sole purpose of weight loss. “It shows that there is,” 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, 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.
Other authors of the study were Mary Elizabeth Paty, MD, of Harvard Medical School; Dr. Bo Hu, Dr. Gerald J. Beck, and Ali Aminan, M.D., all physicians at the Cleveland Clinic. David E. Arterburn, MD, of Kaiser Permanente; Donald C. Simonson, MD, and Ashley H. Vernon, MD, both of Brigham and Women’s Hospital and Harvard Medical School; Dr. John M. Jakich, University of Kansas Medical Center; Philip R. Schauer, MD, Metamor Institute; Dr. Sangeeta R. Kashyap of Weill Cornell Medicine; David E. Cummings, MD, of the University of Washington and Puget Sound Healthcare System of Virginia; and Dr. John P. Kirwan of Louisiana State University.
This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (DK114156).
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