Weight loss surgery offers long-term benefits for type 2 diabetes

More than 38 million people nationwide suffer from diabetes. It occurs when blood sugar or glucose levels are too high. Over time, excess blood sugar levels can cause serious health problems such as heart disease, stroke, nerve damage, and eye disease.

Some people with type 2 diabetes, the most common type, keep their blood sugar levels in check by making lifestyle changes such as diet and exercise. Medications can also help control blood sugar levels. Clinical trials over the past few decades have shown that bariatric surgery, or weight management surgery, also helps manage her type 2 diabetes. However, it was unclear which of these interventions resulted in better long-term outcomes.

To learn more, researchers at four NIH-supported institutions used data collected from four previous clinical trials conducted between May 2007 and August 2013. . These trials were single-center studies that compared the effectiveness of bariatric surgery to medical and lifestyle interventions. Surgery includes sleeve gastrectomy, Roux-en-Y gastric bypass, and adjustable gastric banding. Medical and lifestyle interventions include nutritional counseling, self-monitoring of blood sugar levels, and medication for diabetes treatment. By pooling data from four clinical trials, researchers were able to analyze a larger and more diverse dataset. Follow-up data were collected until July 2022, 7 to 12 years after the start of the first study.

A total of 262 study participants consented to long-term follow-up. All were between the ages of 18 and 65, and each was overweight or obese as measured by body mass index (BMI). Nearly 70% of participants were female, 31% were Black, and 67% were White. More than half (166 people) were randomized to undergo bariatric surgery. The remaining 96 people received diabetes medication and lifestyle interventions known to be effective for weight loss. Result is, American Medical Association Journal February 27, 2024.

The researchers found that seven years after the initial intervention, 54% of the surgery group had an A1c measurement of less than 7%. A1c is a blood test that measures your average blood sugar level over the past two to three months. In contrast, only 27% of the medical/lifestyle group had similar A1c values.

Furthermore, 18% of the surgical group were free of signs and symptoms of diabetes by year 7, compared to 6% of the medical/lifestyle group. The surgery group also experienced an average weight loss of 20% compared to 8% in the other groups. Differences between groups remained significant at 12 years.

No differences were detected in major side effects. The surgery group had more fractures, anemia, iron deficiency, and gastrointestinal disorders. These may be due to significant weight loss and associated nutritional deficiencies. Sleeve gastrectomy and Roux-en-Y gastric bypass were both superior to adjustable gastric banding in reducing A1c levels.

The surgery also appeared to be beneficial among people with lower BMI scores of 27 to 34 at study enrollment. This BMI range for her includes overweight and low obesity. Such people usually could not undergo bariatric surgery for diabetes. However, this finding is consistent with other recent data supporting the use of surgery for some people with a BMI less than 35.

“These results show that people with overweight or obesity and type 2 diabetes can improve their long-term health and change the trajectory of their diabetes with surgery,” said the NIH National Institute of Diabetes and Digestive Medicine. Dr. Gene Lawrence of the Kidney Disease Research Institute said: .