PATIENTS with Type 2 diabetes who underwent bariatric surgery have demonstrated favourable long-term diabetes control, when compared those receiving medical management and lifestyle interventions. Those undergoing surgery had higher rates of remission up to 12 years on.
The current study combined four randomised design studies from the Cleveland Clinic, Ohio; Joslin Diabetes Center/Brigham and Women’s Hospital, Boston, Massachusetts; the University of Pittsburgh, Pennsylvania; and the University of Washington, Seattle; all in the USA. These studies evaluated the effectiveness of bariatric surgery against intensive lifestyle and medication therapy with oral and injectable diabetes medication, including insulin. A total of 262 participants from the four original studies enrolled, of whom 166 were randomised to surgery and had undergone one of the three common procedures: sleeve gastrectomy, gastric bypass, or gastric banding. The remaining 96 participants in the cohort were randomised to medical and lifestyle management. This group received treatment that was previously shown as effective for weight loss. All participants were aged 18–65 years, and were classified as overweight or obese according to their BMI. Primary endpoint results were taken at 7 years, with follow-up through to 12 years.
At 7 years, the surgery group experienced an average 20% weight loss, compared to 8% in the lifestyle group. Greater improvement in blood glucose control, found with the haemoglobin A1c test, was also seen in the surgery group, with 54% of participants achieving haemoglobin A1c of less than 7%. Meanwhile, only 27% experienced this in the management group. Superior results were also seen in terms of diabetes remission in the surgery group. These findings remained significant at the 12-year mark.
The researchers did note the importance of vitamin supplementation and continued monitoring of people who undergo bariatric surgery, in response to the nutritional deficiencies which could explain fractures and anaemia. No difference in adverse events occurred between the groups, but there were incidences of fracture, anaemia, low iron, and gastrointestinal events in the surgery group.
“These results further reinforce the confidence we have in metabolic surgery,” was how Philip Schauer, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA, described the study. The investigation is expected to guide diabetes treatment selection in the near future, promoting use of surgery.
