TOPLINE

A pooled analysis of four randomized trials found that weight-loss surgery led to significantly higher rates of type 2 diabetes (T2D) remission than intensive medical and lifestyle management during up to 14 years of follow-up. Shorter diabetes duration, no insulin use, and greater weight loss at 1 year after surgery predicted remission.

METHODOLOGY

• Metabolic-bariatric surgery outperforms medical and lifestyle interventions for T2D, but not all patients achieve remission. Earlier prediction models relied on retrospective, observational data and often did not compare procedures within a single model.
• Researchers analyzed pooled data from four US randomized trials of metabolic-bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) vs intensive medical and lifestyle management in patients with T2D and obesity to identify predictors of remission and relapse.
• A total of 262 patients were included (mean age, 49.9 years; 68% women), with 166 randomly assigned to metabolic-bariatric surgery and 96 to medical-lifestyle management. In the surgical group, 89 patients underwent gastric bypass, 41 sleeve gastrectomy, and 36 gastric banding.
• Diabetes remission was defined as an A1c below 6.5% without glucose-lowering medication for at least 3 months, assessed annually, and relapse as a rise in A1c to 6.5% or higher requiring medications.
• Median follow-up was 11 years, with a maximum of 14 years.

TAKEAWAY

• During follow-up, diabetes remission occurred in 58% of patients assigned to metabolic-bariatric surgery vs 3% of those assigned to intensive medical-lifestyle management (P < .001). Remission rates were 69% with gastric bypass, 52% with sleeve gastrectomy, and 35% with gastric banding (P = .002).
• Compared with medical-lifestyle management, remission was most likely after gastric bypass (hazard ratio [HR], 16.1; P < .001), followed by sleeve gastrectomy (HR, 10.7; P = .001) and gastric banding (HR, 6.9; P = .006).
• In addition to treatment type, three factors independently predicted remission: shorter baseline diabetes duration (P = .004), no insulin use (P = .001), and greater weight loss at 1 year after surgery (P < .001).
• Among patients who achieved remission after surgery, relapse was more likely with longer baseline diabetes duration (P = .004) and with more glucose-lowering medication classes (P = .007).

IN PRACTICE

"These observations argue for considering surgery relatively early in the course of type 2 diabetes, while remission might still be achievable. The longer patients wait for surgery after their initial diagnosis of diabetes, the less likely they are to experience remission," wrote the authors of the study.

SOURCE

The study was led by Donald C. Simonson, Brigham and Women's Hospital in Boston, and David E. Cummings, University of Washington Medical School in Seattle. It was published online in Diabetes Care.

LIMITATIONS

The sample size was relatively small, and all participants lived in the US, which may limit generalizability. Because remission and relapse were checked once a year, short-lived changes between visits would have been missed. Exercise and diet were not tracked quantitatively, so their role in remission or relapse is unknown.

DISCLOSURES

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Several authors reported receiving research grants, consulting fees, and honoraria; having advisory board roles and ownership interests; and other ties with companies and other sources.

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