TOPLINE:

Metabolic bariatric surgery provided superior long-term glycemic control and weight-loss outcomes compared with medical and lifestyle therapies in patients with type 2 diabetes (T2D), regardless of social vulnerability.

METHODOLOGY:

• Social determinants of health, defined by the World Health Organization as nonmedical factors influencing health outcomes, significantly affect the prevalence and severity of chronic diseases; however, it was unclear whether they alter long-term outcomes of medical and lifestyle therapies compared with metabolic bariatric surgery in patients with T2D.
• Researchers assessed whether social vulnerability modified the comparative effectiveness of metabolic bariatric surgery compared with medical and lifestyle interventions on glycemic control and weight-loss outcomes in 258 participants with T2D (mean age, 49.8 years; 68% female) pooled from four clinical trials that were part of the ARMMS-T2D consortium.
• Participants were randomly assigned in the parent trials to metabolic bariatric surgery or medical therapy (based on the Diabetes Prevention Program and Look AHEAD interventions); those who consented to participate in this study were followed up for 7-12 years.
• Social vulnerability at randomization was measured using the Area Deprivation Index (ADI), an address-based metric; the cohort was stratified into high (> 75) and low (≤ 75) ADI groups, with higher scores indicating greater social vulnerability.
• The co-primary outcomes were glycemia — measured by the absolute change in A1c levels — and weight loss — measured by percent change in BMI.

TAKEAWAY:

• Surgery showed greater effectiveness than medical therapy in reducing A1c levels among participants with a high ADI (net difference, -1.29%; 95% CI, -1.95% to -0.63%) and those with a low ADI (net difference, -0.95%; 95% CI, -1.29% to -0.62%).
• Weight-loss outcomes were also superior with surgery across ADI groups, with net differences of -10.6% (95% CI, -15.2% to -5.9%) for the high ADI group and -13.3% (95% CI, -15.7% to -10.9%) for the low ADI group.
• The interaction between ADI and the intervention group was not statistically significant for either A1c level (P = .37) or BMI (P = .31).

IN PRACTICE:

“We did not detect statistically significant differences in the comparative advantage of surgery over medical therapy by ADI. However, associations were stronger for the medical treatment group, suggesting that social vulnerability may modify outcomes, particularly when the ongoing need for medical therapy for diabetes and obesity is greater,” the authors of the study wrote.

SOURCE:

The study was led by Mary Elizabeth Patti, MD, Joslin Diabetes Center and Harvard Medical School, Boston. It was published online in Annals of Internal Medicine.

LIMITATIONS:

The study was limited by its small sample size, and the parent trials were not originally designed to address effect modification by ADI. Additionally, weight-loss medications were not a core component of medical therapy at study onset, which may affect the generalizability of findings to current medical interventions that incorporate pharmacotherapy for weight loss. The study population may not have been fully representative of patients from historically disadvantaged backgrounds.

DISCLOSURES:

The study received support through cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases. Three authors acknowledged support from the Diabetes Research Center at Joslin Diabetes Center, the Chicago Center for Diabetes Translation Research, and the Louisiana Clinical and Translational Science Center. Some authors declared serving as consultants, receiving grants or contracts and travel support, holding stock options, and having other ties with various organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.