People with diabetes who underwent surgery for gastroparesis appeared to have improved glycemic control, reduced insulin use, and lower rates of diabetes-related complications than similar patients who did not undergo surgery, according to a new study.

Using data from the TriNetX national electronic health record database, researchers identified 2272 adult patients (mean age, 54.9 years; 64.2% women) who underwent procedures such as gastric electrical stimulation, pyloroplasty, and gastric peroral endoscopic myotomy. They then used propensity-score matching to create a comparable group of 2272 patients whose gastroparesis was managed with nonsurgical approaches such as diet modification and medication.

At 1 year, the mean A1c level was 6.16% vs 7.20% in the surgical group vs the control group, reported Shahin Ayazi, MD, surgeon at Allegheny Health Network and director of the Chevalier Jackson Esophageal Research Center, in Pittsburgh, and colleagues. At 5 years, the mean A1c levels were 6.29% and 7.21%, respectively.

“These findings support further prospective investigation to define the relationship between gastric emptying and glycemic regulation, ideally incorporating objective gastric emptying assessments and continuous glucose monitoring,” the authors wrote.

“If confirmed, improved metabolic control may represent an additional consideration when evaluating surgical therapy for diabetic gastroparesis.”

The findings were published in JAMA Surgery.

Improvements Beyond Symptom Relief

The study suggested that diabetic gastroparesis may affect more than gastrointestinal symptoms, Ayazi told Medscape Medical News.

“When we think about gastroparesis, we typically focus on nausea, vomiting, early satiety, and quality of life,” Ayazi said. “However, delayed and unpredictable gastric emptying can also make diabetes much harder to manage by creating a mismatch between nutrient absorption and insulin action.”

To date, the metabolic consequences of surgical treatment for diabetic gastroparesis have been poorly defined. As a result, current guidelines emphasize symptom control as the primary indication for surgical intervention.

“This was an observational study, so we cannot conclude that surgery directly caused these improvements, and I would not change practice based on this study alone,” Ayazi said.

“However, the consistency of the findings suggests that the effects of gastroparesis on diabetes may be more important than we have traditionally appreciated,” he added. “As clinicians evaluate patients with refractory diabetic gastroparesis, metabolic outcomes may deserve consideration alongside symptom relief.”

Reduced Insulin Use, Fewer Complications

Results from secondary endpoints also strengthened the case for further investigation of surgical approaches.

Among patients not using fast-acting insulin at baseline, initiation of fast-acting insulin during follow-up was less common after surgery than after nonoperative management (11.9% vs 27.9%; hazard ratio, 2.54; P < .001).

By 5 years, diabetes-related complications had occurred in 1209 patients (53.2%) vs 1438 patients (63.3%) in the surgical group vs the control group, corresponding to an absolute risk difference of 10.1 percentage points (odds ratio [OR], 1.52; P < .001).

Fewer patients in the surgery group visited the emergency department during the 5-year study period than in the matched group (41.7% vs 54.7%; OR, 1.69; P < .001). Hospitalizations were also less common among surgical patients (45.5% vs 59.0%; OR, 1.72; P < .001).

However, 5-year mortality did not differ between groups (10.4% in both groups; P > .99).

Ayazi said the findings warrant further investigation.

“The next step is prospective studies that combine clinical outcomes with objective physiologic measurements, including gastric emptying assessments and other measures of metabolic control,” he said. “Those studies will help determine whether improving gastric emptying can directly influence diabetes outcomes and identify which patients are most likely to benefit.”

Expert Perspective

Michael Camilleri, MD, DSc, gastroenterologist at the Mayo Clinic in Rochester, Minnesota, and a spokesperson for the American Gastroenterological Association (AGA), described the findings as “potentially very interesting and important.”

Camilleri has spent much of his career seeking approaches to the diagnosis and treatment of diabetic gastroparesis and is a co-author of the AGA’s 2025 Clinical Practice Guideline on Management of Gastroparesis.

Surgical procedures such as pyloroplasty may allow for better synchronization between insulin administration and the timing of food delivery to the intestine, which is disrupted in gastroparesis, Camilleri told Medscape Medical News.

He said that it stands to reason that these treatments could improve diabetes control, as suggested by the study authors.

“I certainly believe the data because they look pretty objective, and they make physiological sense,” Camilleri said.

Ayazi and co-authors reported no conflicts of interest. Camilleri received National Institutes of Health research funding to study the effects of semaglutide and tirzepatide on gastric function. He also served as an adviser to Lilly but received no personal financial remuneration.

Kerry Dooley Young is a freelance journalist based in Washington, DC. She has covered medical research and healthcare policy for more than 20 years.