Bariatric surgery is more effective for Type 2 diabetes patients than medical and lifestyle interventions, including GLP-1 use, according to a clinical trial among four health systems.
Between 96 patients who underwent medical or lifestyle management and 166 people who had surgical treatment between 2007 and 2013, the latter group had superior glycemic control, less medication usage and higher rates of remission seven years later, according to a Feb. 27 news release from UPMC.
Diabetes remission rates were 6.2% in the medical/lifestyle group and 18.2% in the bariatric surgery cohort.
The surgeries include Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric banding. All three produced better weight loss results than medical/lifestyle changes; after 12 years, bariatric surgeries shed 19.3% of patient's weight, and the other group lost 10.8%.
For weight loss, Roux-en-Y gastric bypass was more effective than adjustable gastric banding, and sleeve gastrectomy did not differ significantly.
No differences were found in mortality or major cardiovascular events. Side effects, including anemia, fractures, nausea and abdominal pain, were more common among the surgery patients, the release said.
Across the U.S., the frequency of bariatric surgeries has dropped 15% after the introduction of popular GLP-1s such as Ozempic and Wegovy. The results, which are the largest and longest follow-up study to date, provide a stronger case for Type 2 diabetes patients to undergo surgery.
"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," Anita Courcoulas, MD, chief of UPMC's minimally invasive bariatric surgery program, said in the release.
The trial was conducted at the University of Pittsburgh, Cleveland Clinic, Boston's Joslin Diabetes Center/Brigham and Women's Hospital, and Seattle's University of Washington/Kaiser Permanente Washington. The results were published Feb. 27 in JAMA.