Long-term study finds weight-loss surgery more often put type 2 diabetes into remission

A long-term study found that people assigned to weight-loss surgery were far more likely to see type 2 diabetes go into remission than those who received medical and lifestyle treatment.

During follow-up, remission occurred in 58% of the surgery group compared with 3% of the comparison group. Participants were tracked for a median of 11 years, and some were followed for as long as 14 years.

The results suggest that surgery can provide lasting benefits for some patients, although remission was not guaranteed and diabetes could return. The study also pointed to factors linked with a higher or lower chance of remission.

Researchers reviewed data from 262 people with type 2 diabetes who had taken part in randomized trials. Among them, 166 were assigned to metabolic-bariatric surgery and 96 to intensive medical and lifestyle management.

In the study, remission was defined as an HbA1c level below 6.5% without medication to reduce blood sugar. HbA1c is a blood test that reflects average blood sugar over about three months.

The 58% figure refers to participants who reached remission at some point during follow-up. It does not mean that 58% stayed in remission continuously for the entire 14-year period.

People who had diabetes for a shorter time were more likely to achieve remission. Not using insulin and taking fewer blood sugar medicines before treatment were also tied to a better chance of remission.

Greater weight loss in the first year after treatment was another factor associated with remission. These patterns help describe the study results, but they do not predict with certainty what will happen for any one patient.

A longer duration of diabetes and the use of more blood sugar medicines before treatment were linked to a higher chance of diabetes returning after an initial remission.

The findings appeared in Diabetes Care. Donald Simonson of Brigham and Women’s Hospital and Harvard Medical School led the analysis, and John Kirwan, now at the University of Oklahoma, was the study’s principal investigator.

Weight-loss surgery is a major treatment decision, and the right approach depends on a person’s health, preferences and medical situation. The study compared treatments over a long period, but it does not mean surgery is suitable or effective for everyone.

The analysis used data from a set of randomized trials known as ARMMS-T2D. Random assignment helps make treatment groups similar at the start, though later comparisons of patient characteristics and outcomes still show associations rather than proof of cause and effect.

The results offer a clearer picture of both the potential for remission and the risk of relapse. They also raise new questions for future research about who is most likely to benefit from different treatments.

For further reading, see articles on managing diabetes with a low-carb diet and on whether intermittent fasting could help reverse type 2 diabetes.

For more information, see articles on the best and worst diets for obesity, according to science, and the right diet for weight loss in type 2 diabetes.

Source: University of Oklahoma.