Recent research has established that bariatric surgery significantly outperforms medical therapy for managing type 2 diabetes across various income levels. The study, with a sample size of 355 participants, reported surgical interventions decreased blood glucose levels. Beyond the obvious stunting of the diabetes infection, these procedures realized significant shedding of the deadweight and decrease in the reliance on diabetes medications.
The trial, conducted in cities such as Boston, Cleveland, Pittsburgh, and Seattle, assigned participants to either receive medical therapy or undergo one of three surgical procedures: gastric bypass, sleeve gastrectomy, or adjustable gastric lap banding. The follow-up period ranged from seven to twelve years. These results were unequivocal, establishing that the long-term benefits of bariatric surgery for treating diabetes exceed even the most aggressive traditional medical and lifestyle interventions.
These results reveal that participants who received bariatric surgery lost an average of 28% of their body weight. In comparison, individuals in the medical therapy group only reached a 10% weight loss. This marked difference underscores the effectiveness of surgical methods in achieving sustainable weight loss, which is critical for diabetes management. Furthermore, post-surgery, there was a decrease in patients requiring insulin injections, demonstrating its ability to induce remission in diabetes conditions.
Bariatric surgery demonstrated a reduction in cardiovascular disease risk factors, a significant benefit considering the high correlation between obesity, diabetes, and heart health. Despite its incredible effectiveness and safety record, bariatric surgery is highly underutilized, even just reaching 1-2% of eligible patients.
In this post, researchers Patti and her team walk us through their analysis of data from 258 adults. These people had either had bariatric surgery or medical and lifestyle intervention. The team noted that bariatric surgery seemed to work better, even for those in more deprived settings. Yet the differences they uncovered were not statistically significant.
“We can look at epidemiology and large population studies, and they all show that bariatric surgery is more effective at improving diabetes control, improving diabetes remission, reducing complications, and prolonging survival,” – Patti
Moreover, by the twelfth year post-surgery, over a quarter of participants from the surgical groups were still receiving incretin-based therapy. This further emphasizes the chronic nature of diabetes management and ongoing treatment modalities.
Despite advancements in treatment options for type 2 diabetes, including medications and lifestyle changes, the researchers stress that obesity is a chronic disease requiring lifelong management. Melanie Jay emphasized this point by stating, “Obesity is a disease that often needs to be managed lifelong. We don’t have a cure yet, right?”
As the study’s findings indicate, a multifaceted approach to diabetes management is essential for success. Jay further commented on the expanding treatment landscape by saying, “There’s so many more options now for people, which is great. And people might end up needing more than one modality.”
As clinicians and our patient’s decision makers carefully review treatment options available for each individual patient, the question becomes how do we decide what approach is best. Patti noted the importance of personalized care: “You know, when we’re talking to an individual patient, the question is, what’s the best choice for that particular patient?”
In spite of these remarkable results, patient access to bariatric surgery remains a challenge. Patti remarked on the challenges faced by patients lacking advocacy within the healthcare system: “If you don’t have an advocate in the health care system and you really don’t have a way to keep up with the need for approvals or prior authorizations, being an advocate for yourself — that’s really hard when you are having many social, financial and other stressors.”
The findings call for large-scale, well-designed trials, the study authors point out. These pragmatic trials will help inform the best treatment strategies for our diverse patient populations. The excitement around the next-generation incretin-based agents stems from their potential to increase treatment efficacy. They understand that issues related to durability, tolerability, adherence and affordability will be the real test in deciding how well these agents perform outside of controlled settings.
“Ultimately, we need large, long-term, well-designed studies to clarify the best strategy for a given patient.”
