medwireNews: People are much more likely to achieve lasting type 2 diabetes remission with surgical rather than medical intervention, even if they have only mild obesity, shows 3-year follow-up of four randomized trials.
The ARMMS-T2D study recruited 316 people with type 2 diabetes who had been randomly assigned to undergo metabolic surgery or medical management in four clinical trials: STAMPEDE, TRIABETES, SLIMM-T2D, and CROSSROADS. The participants’ baseline BMI averaged 37 kg/m2.
“Our study includes a substantial proportion of patients who were only overweight or had mild/moderate obesity,” stress John Kirwan (Pennington Biomedical Research Center, Baton, Rouge, Louisiana, USA) and co-researchers.
After 3 years of follow-up, 37.5% of people who underwent surgery had remission of diabetes, defined as glycated hemoglobin (HbA1c) of no more than 6.5% (48 mmol/mol) without use of antihyperglycemic medications. By comparison, just 2.6 % of people in the medical management group achieved this goal.
In the surgery group, the proportion of people not taking diabetes medications increased from 2.6% at baseline to 52.2% at 3 years and the proportion taking insulin fell from 52.3% to 18.2%. HbA1c fell by an average of 1.9% in the surgery group relative to the medical management group, bodyweight by 17.6 kg, and BMI by 6.3 kg/m2.
“Despite growing evidence that metabolic surgery is the most effective treatment for type 2 diabetes, it is estimated that <1% of eligible patients actually undergo such operations,” write the researchers in Diabetes Care.
They observe that participants of the DiRECT trial achieved type 2 diabetes remission with diet alone, but stress that participants of this trial had relatively mild diabetes of shorter duration (maximum 6 years). In ARMMS-T2D, the average diabetes duration was 9 years.
Kirwan and colleagues also note that medications such as high doses of semaglutide are able to produce weight loss equivalent to that of surgery in some people. But they add: “Whether this amount of weight loss is sustainable with medication remains to be determined.”
With regard to adverse events, the team says that there were too few to “draw firm, long-term safety conclusions.”
There were eight cardiovascular events in the surgical group versus 16 in the medical management group. Conversely, there were many more gastrointestinal and nutrition-related adverse events among people who underwent surgery.
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Diabetes Care 2022; doi:10.2337/dc21-244