A recently published study in the Journal of the American Medical Association (JAMA) reveals that bariatric surgery, commonly known as weight loss surgery, provides better long-term blood sugar control and reduces the need for medications in individuals with type 2 diabetes compared to non-surgical management with insulin and metformin. The research, conducted by experts from the University of Pittsburgh and other institutions, randomly assigned 262 participants to either weight loss surgery or non-surgical approaches, such as medication and lifestyle changes, after seven to 12 years.
The findings indicate that those who underwent weight loss surgery experienced significantly lower blood sugar levels and required fewer diabetes medications compared to their non-surgical counterparts. Moreover, the surgery group demonstrated a higher likelihood of achieving diabetes remission, defined as maintaining non-diabetic blood sugar levels for at least three months without medication. Dr. Thomas A. Wadden, a professor of psychology, emphasized that this research provides the most robust evidence to date regarding the long-term efficacy of bariatric surgery in improving type 2 diabetes control.
Understanding Bariatric Surgery and its Impact on Type 2 Diabetes
Bariatric surgery involves altering the digestive tract, typically by reducing the size of the stomach, to aid in weight loss. Dr. Marilyn Tan, Chief of the Endocrinology Clinic at Stanford Health Care, explained that this procedure not only results in weight loss but also induces neurohormonal changes that lower blood sugar levels, effectively treating type 2 diabetes. While being a more invasive option than traditional medications, Dr. Tan notes that bariatric surgery represents a substantial investment in long-term health.
Presently, health-care providers recommend weight loss surgery for individuals with a body mass index (BMI) of 35 or higher. However, Dr. Wadden suggests that the study’s results support extending the use of bariatric surgery to those with a BMI less than 35 who struggle to control blood sugar with medical management alone. He hopes this will encourage insurers to cover the surgery for patients with type 2 diabetes and a BMI of 30 to 34.9, asserting that it is a highly effective, long-term therapy for this group.
Weighing the Pros and Cons of Bariatric Surgery for Type 2 Diabetes
Non-surgical medical management for type 2 diabetes involves lifestyle changes and medications like metformin, aiming to lower hemoglobin A1c below 7%. Dr. Tan shared cases where patients, despite extensive insulin use, couldn’t achieve desired A1c levels, highlighting the limitations of non-surgical approaches. The study underscores the heart health benefits of weight loss surgery, showing improvements in HDL cholesterol and lower triglycerides.
Despite the advantages, people often hesitate due to the invasive nature and associated risks of weight loss surgery. Complications such as anemia, bone fractures, and gastrointestinal issues were more common in those who underwent surgery. Additionally, the study revealed that while 51% achieved full diabetes remission one year post-surgery, only 18% maintained remission at seven years, primarily due to a combination of weight regain and loss of insulin-producing cells.
