A groundbreaking study led by a University of Pittsburgh School of Medicine surgeon-scientist, published in JAMA, unveils that bariatric surgery stands as a more effective long-term solution for controlling and achieving remission in type 2 diabetes compared to medical and lifestyle interventions.
This extensive and longest randomized follow-up study to date not only affirms the superiority of bariatric surgery in diabetes management but also highlights its effectiveness in improving cholesterol and triglyceride levels when compared to traditional interventions. As diabetes and cholesterol are pivotal risk factors for heart disease, the outcomes of this study suggest potential contributions to reducing heart attacks, strokes, and associated complications.
Lead author Anita Courcoulas, M.D., M.P.H., Professor in Pitt’s Department of Surgery, and Chief of the Minimally Invasive Bariatric Surgery Program at UPMC, emphasizes, “This analysis is the strongest evidence we have to date that bariatric surgery is a safe and effective tool for achieving diabetes control and remission.”
The study, amalgamating data from four separate randomized clinical trials conducted between 2007 and 2013, compared outcomes such as blood sugar control, weight loss, and insulin usage. Patients undergoing bariatric surgery consistently exhibited superior blood sugar control, with significantly higher rates of diabetes remission at both seven and twelve years post-randomization.
Notably, even those not achieving remission showcased improved blood sugar control with reduced diabetes medication use compared to their counterparts in the medical/lifestyle treatment group. The study reveals that bariatric surgery’s benefits extend across different weight class groups, indicating its efficacy for patients below and above the typical BMI threshold for bariatric surgery treatment.
Dr. Courcoulas notes, “This indicates that people with type 2 diabetes—even those below the BMI threshold for bariatric surgery for weight loss alone—should be offered bariatric surgery as a treatment for inadequately controlled diabetes.”
While the study primarily focused on diabetes control and remission rates, researchers observed that bariatric surgery outperformed medical/lifestyle interventions in terms of durable weight loss, sustaining an average of 19.3% weight loss at year twelve compared to 10.8% in the medical/lifestyle intervention group.
Though mortality and major cardiovascular events did not show significant differences between the two groups, certain adverse effects such as anemia, fractures, and gastrointestinal symptoms were more prevalent in the bariatric surgery group.
This groundbreaking analysis utilized data from randomized clinical trials across multiple institutions, including Pitt, Cleveland Clinic, Joslin Diabetes Center, Brigham and Women’s Hospital, and the University of Washington with Kaiser Permanente Washington. The findings underscore the importance of considering bariatric surgery as a viable and effective option for individuals struggling with inadequately controlled diabetes.
