Type 2 diabetes is a progressive multifactorial disease affecting approximately 10% of the world’s population. A study recently published in the Journal of the American Medical Association (JAMA) has reported compelling evidence supporting the superior efficacy of bariatric surgery in the management of type 2 diabetes when compared to traditional medical and lifestyle interventions. Conducted at the University of Pittsburgh School of Medicine, this extensive research involved four randomized clinical trials spanning from May 2007 to August 2013.
The trials specifically focused on participants dealing with both type 2 diabetes and obesity. The researchers enrolled individuals divided into two groups: those who underwent bariatric surgery, and the others followed a medical and lifestyle program employing established interventions aimed at reducing diabetes risk. These interventions included physical activity, nutrition tracking, enhanced engagement with healthcare teams, stress management, support groups, and medication. Specifically, these trials were conducted before the availability of GLP-1 receptor agonist medications such as Ozempic, designed for diabetes management and weight loss.
Out of 305 eligible participants, approximately 86% (262 individuals) enrolled in long-term follow-up for this comprehensive pooled analysis. The participants, with a mean age of 49.9 years and a mean body mass index of 36.4, were diverse, with 68.3% being women. The results at 7 years showcased a decrease in HbA1c by 0.2% in the medical/lifestyle group and a significant reduction of 1.6% in the bariatric surgery group. The between-group difference was notable at -1.4% at 7 years and -1.1% at 12 years, favoring the bariatric surgery group. Moreover, fewer antidiabetic medications were required in this group. Diabetes remission rates were significantly higher after bariatric surgery, demonstrating its sustained impact over 7 and 12 years.
The positive effects of bariatric surgery extended to participants with a BMI between 27 and 34, covering the overweight and lower obesity ranges. Despite an increased incidence of fractures, anemia, low iron, and gastrointestinal events in the surgery group, no significant differences in major adverse events were observed between the surgery and medical/lifestyle groups. This highlights the need for careful post-surgery monitoring and nutritional supplementation.
The researchers emphasized a significant aspect of bariatric surgery, which is its profound impact on cholesterol and triglyceride levels, surpassing the effects of traditional interventions. This is significant because high levels of cholesterol are associated with heart disease, and it suggests that bariatric surgery can potentially provide some cardiovascular benefits. Participants who underwent bariatric surgery consistently demonstrated lower HbA1c levels, indicating improved blood sugar control at every follow-up point. This observation holds significant relevance given their initially elevated baseline levels at the initiation of the study.
Courcoulas and colleagues concluded that bariatric surgery emerges as a powerful approach to managing type 2 diabetes, offering not only improved blood sugar control but also substantial cardiovascular benefits. The study underscores the effectiveness of bariatric surgery across different weight class groups. While it comes with some risks, diligent post-surgery follow-up, adherence to a proper diet, and regular exercise can mitigate these concerns. Importantly, the study found no significant differences in mortality or major cardiovascular events, further supporting the potential of bariatric surgery as a transformative treatment for type 2 diabetes.
Reference
Courcoulas AP, Patti ME, Hu B, Arterburn DE, Simonson DC, Gourash WF, et al. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA. 2024 Feb 27;331(8):654–64.