medwireNews: Bariatric surgery improves glycemic control, reduces the need for medication, and increases the rate of diabetes remission compared with medical or lifestyle management, suggests the ARMMS-T2D pooled analysis of four single-center US trials.
Anita Courcoulas (University of Pittsburgh, Pennsylvania, USA) and colleagues analyzed data for 262 individuals aged a mean of 49.9 years, 68.3% of whom were women; the mean BMI was 36.4 kg/m2. Among those enrolled, 96 were randomly assigned to receive medical/lifestyle management and 166 underwent either roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding.
After 7 years of follow-up, bariatric surgery was associated with an average 1.6% decrease in glycated hemaglobin (HbA1c) from 8.7% (71.6 mmol/mol) at baseline versus a reduction of just 0.2% from a baseline of 8.2% (66.1 mmol/mol) with medical and lifestyle management. The intergroup difference in the reduction of HbA1c was 1.4% and 1.1% at 7 years and 12 years, respectively, in favor of bariatric surgery, the investigators say in JAMA.
Diabetes medication use reduced from 97.6% at baseline to 38.0% in the first year after bariatric surgery and remained significantly lower, at 60.5%, at the 7-year follow-up. Notably, insulin use in the bariatric surgery group at 7 years was significantly lower than with the medical and lifestyle intervention, at 16 versus 56%, the researchers report.
Compared with medical and lifestyle interventions, bariatric surgery also led to a statistically significant increased rate of diabetes remission – defined as HbA1c below 6.5% (47 mmol/mol) and no need for diabetes medications – at both 7 years (18.2 vs 6.2%) and 12 years (12.7 vs 0.0%).
The researchers point out that “even among patients who experience postoperative diabetes remission, continued surveillance for relapse is warranted,” but suggest that even short-term remission has benefits, noting that the “risk of microvascular disease has been estimated to be reduced by 19% for each year of achieved remission.”
Among the participants of the bariatric surgery group, anemia, fractures, and gastrointestinal complaints were “more common” than in the medical/lifestyle intervention group, the authors say. They therefore suggest that “[m]icronutrient deficiencies may contribute to the higher fracture rate after bariatric surgery, and the potential for these and other deficiencies should be proactively monitored and measured life-long in patients after undergoing bariatric surgical procedures.”
In an accompanying editorial, Thomas Wadden, from Perelman School of Medicine, University of Pennsylvania in Philadelphia, USA, and colleagues remark that “we encourage clinicians to consider the long-term benefits of bariatric surgery—a vastly underutilized intervention—for individuals with type 2 diabetes not adequately controlled by medical and lifestyle therapies.”
Doing so can be “cost-effective relative to usual medical care starting at 4 to 5 years after surgery, with better outcomes observed over longer periods,” they say.
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