Weight-Loss Surgery Led to Diabetes Remission in 58% in Long Trial
In the ARMMS-T2D study, 58% of patients assigned to surgery reached remission, against 3% on medication and lifestyle care, over a median 11 years.
People with type 2 diabetes were far more likely to reach remission after weight-loss surgery than after intensive medical and lifestyle management, according to a long-term study published in Diabetes Care. Researchers also found which patient characteristics were linked to remission and to the disease returning.
In the study, 58% of participants assigned to metabolic-bariatric surgery achieved remission, compared with 3% of those assigned to medical and lifestyle care. Participants were followed for a median of 11 years, and some for up to 14.
Who did best
Remission was more likely in people who had lived with diabetes for fewer years, did not use insulin and took fewer types of blood sugar-lowering drugs before treatment. Greater weight loss in the first year was also linked to a higher chance of remission.
The same history shaped relapse. People with longer-standing diabetes and those on more types of glucose-lowering medication before treatment were more likely to see the disease return after an initial remission. The authors say a patient's diabetes history and response to treatment may help doctors judge the likelihood of remission and how long it might last.
The analysis covered 262 people: 166 assigned to surgery and 96 to medical and lifestyle management. Remission was defined as an A1C below 6.5% without blood sugar-lowering medication. A1C is a blood test that measures average blood sugar over roughly three months.
The trial behind it
The Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is described as the largest, longest-running trial of metabolic surgery for diabetes. Its lead author is Donald Simonson of Brigham and Women's Hospital and Harvard Medical School. The principal investigator, John P. Kirwan, was named this summer executive director of the University of Oklahoma Health Harold Hamm Diabetes Center.
"For years, one of the most consequential questions in diabetes care has been whether the benefits of metabolic surgery endure," Kirwan said. "Now we have a durable answer." He added that identifying who is most likely to achieve lasting remission means surgery can be offered to the right people earlier, "rather than as a last resort".
Source: Medical Xpress