Bariatric Surgery Linked to Better Long-term Glycemic Control Versus Medical, Lifestyle Management

A recent study published in JAMA sought to determine the long-term efficacy and safety of bariatric surgery compared with medical/lifestyle management.

“Randomized clinical trials of bariatric surgery have been limited in size, type of surgical procedure, and follow-up duration,” investigators from the Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes wrote. They conducted a pooled analysis of 4 single-center, randomized trials between May 2007 and August 2013 in the United States, with an observational follow-up through July 2022.

Participants were randomized to either medical/lifestyle management or 1 of 3 bariatric surgical procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. The primary objective was to assess the change in hemoglobin A1c (HbA1c) over a 7-year period, with data reported for up to 12 years. Of the 305 participants eligible for inclusion, 262 (86%) were enrolled in the long-term follow-up.

At the 7-year mark, the medical/lifestyle group experienced a modest decrease in HbA1c of 0.2%, while the bariatric surgery group demonstrated a remarkable reduction of 1.6%. This trend persisted at the 12-year follow-up, with a between-group difference of −1.1%. The reduction in HbA1c was associated with a significant decrease in the use of antidiabetes medications in the bariatric surgery group.

Diabetes remission rates were also higher in the bariatric surgery group, with 18.2% achieving remission at 7 years compared with 6.2% in the medical/lifestyle group. The gap widened further at the 12-year mark, with 12.7% remission in the surgery group compared with no remission in the medical/lifestyle group.

While the study demonstrated superior glycemic control and diabetes remission in the bariatric surgery group, it also identified specific safety considerations. Anemia, fractures, and gastrointestinal adverse events were more prevalent in the surgery cohort, highlighting the importance of careful monitoring and management of potential complications associated with these procedures.

According to the investigators, “These results, combined with existing evidence, support the use of bariatric surgery for treatment of type 2 diabetes in people with obesity.”