Why type 2 diabetes can be effectively managed with bariatric surgery?

Research indicates that bariatric surgery provides longer-term benefits than lifestyle changes for the management of type 2 diabetes. They stated that compared to medication or lifestyle modifications, bariatric surgery is a more effective strategy to decrease triglycerides and cholesterol.

Surgery is now not covered by most health insurance providers if the patient's body mass index is less than 35. A study published today in the journal JAMA by researchers at the University of Pittsburgh School of Medicine indicates that bariatric surgery is a more effective treatment for type 2 diabetes than lifestyle changes.

Participants in one of four randomized clinical trials with obesity and type 2 diabetes were recruited for the study between May 2007 and August 2013. The participants completed a medical and lifestyle regimen based on tried-and-true techniques that reduce the risk of diabetes, or they underwent bariatric surgery.

Among the therapies were counseling, medication, stress management, exercise, nutrition monitoring, and enhanced communication with a medical team. Before the creation of GLP-1 receptor agonist medications, such as Ozempic, which are used to treat diabetes and promote weight loss, investigations were conducted.

For a total of twelve years, the researchers observed the majority of the subjects.

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Findings from the study on weight loss surgery and diabetes therapy

The researchers discovered that bariatric surgery outperformed medicine and lifestyle modifications in lowering triglycerides and cholesterol. High cholesterol is one of the risk factors for heart disease.

At each follow-up visit, the surgical group consistently had lower HbA1c values, a sign of better blood sugar control, despite having higher baseline levels at the start of the experiment.

Among the further findings were:

• 6% of participants in the medical and lifestyle groups and 18% of the overall group had achieved diabetes remission at the seven-year follow-up.
• At the 12-year follow-up, the surgical patients dropped an average of 19% of their body weight, while there are groups that got medical and lifestyle interventions lost slightly less than 11%.
• Anemia, fractures, and uncomfortable gastrointestinal symptoms like nausea and abdominal discomfort were more common among individuals who had bariatric surgery.

Researchers discovered that those who made lifestyle changes still had better blood sugar control and required less medication, even when they did not achieve diabetic remission.

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Reaction to the bariatric surgery study

Dr. Mir Ali, a non-participating bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Centre at Orange Coast Medical Centre in California, said, "In my experience, patients who undergo weight loss surgery can effectively stop taking their diabetes, high blood pressure, and cholesterol-lowering drugs,"

The findings, which demonstrated that bariatric surgery is superior to lifestyle modifications, did not come as a surprise to Dr. Anita Courcoulas, chief of the University of Pittsburgh School of Medicine's Section of Minimally Invasive Bariatric and General Surgery and one of the study's authors.

The spokesperson told Medical News Today, "This is the largest study of its kind, and the follow-up period of seven to twelve years is the longest." Furthermore, 37% of trial participants were classed as class 1 obese due to having a body mass index (BMI) of less than 35. Long-term outcomes in this subgroup showed that surgery was more successful than medication or lifestyle changes.

 These findings, when combined with the current information, offer strong support for the use of bariatric surgery as a treatment for type 2 diabetes in patients who are unable to achieve glycemic control without it.

Dr. Eliud Sifonte is an endocrinologist who practices at NYU Langone Medical Associates in West Palm Beach. He was not involved in the study. He stated, "This study confirms previously known findings showing the efficacy of early interventions in the progression of a diabetic and the benefits of bariatric surgery in those with metabolic diseases like diabetes." 

It also verifies the weight-centered approach to metabolic disease treatment, which differs from the traditional glucose-centric strategy.

Sifonte went on to say, "I think this confirmation could be crucial in assisting some patients in choosing to have bariatric surgery, especially since it offers the chance of remission, which is something many people with newly diagnosed diabetes are interested in." "Regardless of the usual threshold, I usually discuss bariatric surgery with patients who have a history of obesity with metabolic complications in my practice."

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BMI and bariatric surgery

The results of the study, which demonstrated that patients with body mass indices (BMIs) between 35 kg/m2 and fewer benefited similarly from surgery, the researchers claimed remained true for all weight class groups. Generally speaking, surgeons advise patients with BMIs under 35 to avoid surgery.

"BMI is not an ideal marker of metabolic disease," said Dr. Mitchell Roslin, the chief of bariatric surgery at Northwell Lenox Hill Hospital in New York and an unaffiliated party in the study. Indeed, even those with high blood sugar miss a great deal of people. Every major murderer in the West is linked to metabolic disease. This includes neurological degenerative disorders, cancer, and heart disease.

"The best and maybe only treatment to provide long-term control of metabolic syndrome is bariatric surgery, which reduces hunger and prolongs satiety, and provides a long-lasting control mechanism that better matches the brain and GI tract," Roslin stated to Medical News Today. Even while metabolic [disease] is more common among obese individuals, many individuals with lower BMIs also suffer from metabolic disease. Furthermore, metabolic disease increases with age.

He went on to say, "Therefore, I have no hesitation to recommend bariatric surgery to low BMI patients who have metabolic syndrome." As with any therapy, certain things will undoubtedly happen and others will be avoided. The advantage includes a higher risk of osteoporosis and anemia but a lower risk of heart disease and cancer. Postoperative surveillance, exercise, and diet, in my opinion, can lower this risk.

The researchers found no differences in mortality or noteworthy cardiovascular events between the weight class groups.

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