Bariatric surgery outperforms medical management in long-term diabetes management

Type 2 diabetic patients who underwent bariatric surgery had much better long-term blood sugar control than those who received medical management and lifestyle interventions, according to a new study published today. Japan Automobile Manufacturers Associationor American Medical Association Journalis funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.

Additionally, participants who underwent bariatric surgery, also known as metabolic or weight loss surgery, were more likely to no longer need diabetes medications and had higher rates of diabetes remission up to 12 years after surgery. Pennington Biomedical’s Dr. John Kirwan and Dr. Philip Schauer are principal investigators of a 12-year study entitled “Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes” (ARMMS-T2D). I was alone.

This is the largest and longest study of its kind and provides important insights that metabolic surgery improves long-term remission in type 2 diabetes over standard disease management. As the principal investigator of this multicenter trial, I am a leader of the outstanding team that brought together and collaborated scientists from Pennington Biomedical, Cleveland Clinic, Harvard University, Pittsburgh, and Seattle and contributed to this groundbreaking research. I’m very proud of our efforts. ”

Dr. John Kirwan, MS, PhD, Executive Director, Pennington Biomedical Research Center, George A. Bray, Jr. Endowed Superchair in Nutrition

The study combined independent, single-center, randomized trial data from four institutions in the United States: Cleveland Clinic, Joslin Diabetes Center/Brigham and Women’s Hospital, University of Pittsburgh, and University of Washington. The first trial, conducted from May 2007 to August 2013, tested adults with type 2 diabetes who were overweight or obese and tested them with intensive lifestyle changes and oral and injectable diabetes medications, including insulin. We evaluated the effectiveness of bariatric surgery compared to therapy.

Some participants in this study were prescribed GLP-1 agonists as part of their medical management of diabetes, but these drugs were not specifically tested in the study. Researchers in four separate studies provide a larger, more geographically diverse dataset to evaluate the effectiveness, durability, and safety of bariatric surgery to treat type 2 diabetes We pooled the data for. Follow-up data was collected until July 2022.

A total of 262 participants from the four original studies enrolled in the current study. Of these, 166 were randomly assigned to surgery and had undergone one of his three common bariatric surgery procedures: sleeve gastrectomy, gastric bypass, and gastric banding. . The remaining 96 participants were randomly assigned to the medical/lifestyle management group. Participants in the lifestyle intervention received treatments previously shown to be effective for weight loss. All participants were between the ages of 18 and 65 and were overweight or obese as measured by BMI. The primary outcome was measured over a 7-year period and continued for 12 years.

At 7 years, participants in the surgery group experienced an average weight loss of 20% compared to 8% for participants in the medical/lifestyle group. Glycemic control as measured by HbA1c improved significantly in the surgery group, with 54% of participants in the surgery group achieving an HbA1c below 7% compared to only 27% of participants in the medical/lifestyle group. did. More participants who underwent surgery achieved diabetes remission compared to participants in the medication/lifestyle group. The proportion of participants using drugs to treat diabetes decreased from 98% to 61% in the surgery group, but there was little change in the medication/lifestyle group.

Results and differences between groups remained significant at 12 years.

“We are pleased to participate in this groundbreaking study. These results further strengthen our confidence in metabolic surgery,” said Metamor Director Dr. Schauer.^TM Pennington Biomedical’s Metabolic Laboratory. Dr. Schauer, a metabolic surgeon, operated on these patients during his previous tenure at the Cleveland Clinic. “For patients with type 2 diabetes and obesity who are at serious risk of heart attack, stroke, premature death, or diabetic complications, metabolic surgery, especially gastric bypass and sleeve gastrectomy, is safe, established, and life-saving.” It’s an effective option to change. A lot.”

Additional exploratory analyzes in this study showed that bariatric surgery had a significant and beneficial effect on HbA1c and weight loss in participants with a BMI of 27 to 34 (within the overweight and underobese range). Shown.

There were no differences in major adverse events between the two groups, but the incidence of fractures, anemia, iron deficiency, and gastrointestinal disorders was higher in the surgical group. Malnutrition can be a cause of bone fractures and anemia, highlighting the importance of vitamin supplementation and continued monitoring in people undergoing bariatric surgery.

Study participant Judge Parker had a similar family history of diabetes and obesity and underwent bariatric surgery by Dr. Schauer in December 2008. After surgery and regular check-ups, his weight dropped from 306 pounds before surgery to 195 pounds. Additionally, Parker is not diabetic, does not take any diabetes medication, and his A1C level is 5.6 percent.

“The surgery was a lifesaver for me,” Parker said. “I was on diabetes medication and insulin, but what I mostly remember is that it was hard to walk around, I was tired, and I didn’t feel well. I’m over 100 pounds lighter now. , we are raising them to be free from diabetes and able to go out. Sleep apnea and lower blood pressure.”

This study is known as the Alliance for Randomized Trials of Medicine Versus Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) and is supported by NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Cooperative Agreement U01DK114156.

“Obesity and type 2 diabetes are complex conditions with many common risk factors and long-term complications,” said NIDDK Director Dr. Griffin P. Rogers. “This study shows how public investment in obesity and diabetes research can lead to real clinical advances and provide long-term health benefits for the millions of Americans who experience these conditions. It exemplifies what can be brought to the table.”

This study represents a long-term collaboration of researchers from a variety of reputable research centers and clinics, including the Pennington Biomedical Research Center, the University of Pittsburgh Department of Surgery, the Joslin Diabetes Center Research Division, and the Harvard Medical School School of Quantitative Health. It represents. Department of Science and Surgery at the Cleveland Clinic, Kaiser Permanente Washington Health Research Institute, Department of Endocrinology and its Department of General and Gastrointestinal Surgery at Brigham and Women’s Hospital, Department of Internal Medicine at the University of Kansas Medical Center, Endocrinology, Diabetes, Department of Internal Medicine at Weill Cornell Medical Center; Department of Metabolism, University of Washington School of Medicine, Department of Physical Activity and Weight Management, VA Puget South Healthcare System.