Bariatric surgery tied to larger HbA1c reduction than medical, lifestyle therapy
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Key takeaways:
- Diabetes remission was achieved by 18.2% of adults with type 2 diabetes 7 years after bariatric surgery.
- Bariatric surgery conferred improvements in HDL cholesterol and triglycerides.
Adults with type 2 diabetes and obesity who underwent bariatric surgery were more likely to achieve diabetes remission at 7 years than those treated with medication or lifestyle intervention, according to study findings published in JAMA.
In the Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) study, researchers analyzed pooled data from four randomized trials conducted from May 2007 to August 2013, assessing glycemic control among adults with type 2 diabetes who received bariatric surgery or were treated with medical or lifestyle management. At 7 years, the bariatric surgery group had a larger decrease in HbA1c than those treated with medical or lifestyle management, and 18.2% of adults receiving bariatric surgery had diabetes remission.
“These findings lend strong support to the use of bariatric surgery for people with type 2 diabetes who cannot achieve glycemic control with nonsurgical treatments,” Anita P. Courcoulas, MD, MPH, FACS, the Anthony M. Harrison chair of surgery, professor of surgery and chief of minimally invasive bariatric and general surgery at University of Pittsburgh Medical Center, told Healio. “This study lends even more support to recommendations from national and international medical organizations and expert panels to extend the use and coverage for bariatric surgery to people with class I obesity and type 2 diabetes who remain uncontrolled despite maximum medical therapy.”
The ARMMS-T2D study includes data from trials conducted at Cleveland Clinic, the Joslin Diabetes Center at Brigham and Women’s Hospital, University of Pittsburgh and University of Washington and Kaiser Permanente Washington. The study enrolled 262 adults with type 2 diabetes and a BMI between 27 kg/m2 and 45 kg/m2 (mean age, 49.9 years; 68% women; 67.2% white; mean BMI, 36.4 kg/m2; mean HbA1c, 8.5%). The participants included 166 adults who underwent bariatric surgery and 96 adults who received medical or lifestyle management. HbA1c values were assessed at baseline and 7 years. Diabetes remission was defined as having an HbA1c of less than 6.5% without using diabetes medications for at least 3 months. Secondary outcomes included changes in body weight, BMI, lipids, blood pressure, medication use, major adverse cardiovascular events and microvascular complications from baseline to 7 years.
Surgery tied to diabetes remission
At 7 years, adults receiving bariatric surgery had a decrease in HbA1c from 8.7% at baseline to 7.2% at 7 years compared with an HbA1c decline from 8.2% at baseline to 8% at 7 years for the medical and lifestyle management group (P < .001). The HbA1c decline was similar between adults undergoing Roux-en-Y gastric bypass and those who had sleeve gastrectomy, with both procedures conferring a greater HbA1c reduction than adjustable gastric banding.
At 1 year, diabetes remission was achieved by 50.8% of the bariatric surgery group compared with 0.5% of adults receiving medical or lifestyle management. At 7 years, 18.2% of the bariatric surgery group had diabetes remission vs. 6.2% of the medical and lifestyle management group (P = .02). Of the participants, 54.1% of adults who underwent bariatric surgery had an HbA1c of less than 7% at 7 years compared with 26.7% of adults in the medical and lifestyle management group(P < .001). Among the bariatric surgery group, the proportion of adults requiring diabetes medication dropped from 97.6% at baseline to 60.5% at 7 years (P < .001), whereas the medical and lifestyle management group had no change.
Weight loss, lipid changes
The bariatric surgery group lost a mean 19.9% of body weight at 7 years compared with an 8.3% weight loss for those treated with medical or lifestyle management (P < .001). Adults who underwent gastric bypass had a greater weight loss than those who had adjustable gastric banding (22.7% vs. 14%; P < .001), but no difference was observed between sleeve gastrectomy and the other bariatric surgery procedures. At 7 years, 14.4% of the bariatric surgery group achieved a BMI of 25 kg/m2 or less compared with 2.7% of the medical and lifestyle management group.
Adults who underwent bariatric surgery had a 37.4% increase in HDL cholesterol from baseline to 7 years compared with a 20.5% increase for adults receiving medication and lifestyle management (P < .001). The bariatric surgery group had a 19% decline in triglycerides vs. a 2.3% increase for the medical and lifestyle management group (P = .002).
Adults who underwent bariatric surgery were more likely to report fractures, anemia and low iron levels than the medical and lifestyle management group. More gastrointestinal events occurred among adults undergoing bariatric surgery vs. medical and lifestyle management. No differences in other adverse events were found.
Courcoulas noted the four trials in the study were conducted before the availability of newer diabetes and obesity medications. She said similar trials could be conducted in the future to see how bariatric surgery compares with newer treatments.
“As well, future studies should address the role of these newer medications before, during and after bariatric surgery as potential adjunctive and supportive therapeutic options,” Courcoulas said.
For more information:
Anita P. Courcoulas, MD, MPH, FACS, can be reached at courcoulasap@upmc.edu.
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