Effect of Social Vulnerability on Efficacy of Bariatric Surgery Versus Medical and Lifestyle Intervention for Type 2 Diabetes: Analysis of the ARMMS-T2D Consortium of Randomized Trials
Authors' conclusion
Surgery was superior to medical therapy for people with T2D regardless of social deprivation. This study did not detect statistically significant differences in the comparative advantage of surgery over medical therapy by ADI.
Study context
- Population
- People with T2D in 4 RCTs of surgical vs medical management and a longitudinal observational follow-up study, 4 U.S. academic centers; stratified by high vs low Area Deprivation Index (ADI)
- Participants
- 258 people4 RCTs
- Comparison
- Metabolic bariatric surgery vs medical and lifestyle intervention, by ADI
- Primary endpoint
- Effect modification by baseline ADI of weight loss and HbA1c
- Follow-up
- End of the active intervention period (7 to 12 years)
Methodological detailseffect modification analysis, linear mixed-effects models, 4 U.S. academic centers, Limitations: small sample size; parent trials not designed to address effect modification by ADI
- Effect modification analysis
- Linear mixed-effects models
- 4 U.S. academic centers
- Limitations: small sample size; parent trials not designed to address effect modification by ADI
Primary result
As reported in the abstract
end of active intervention (7 to 12 years)
Each group vs medical therapyEstimate (95% CI)
Surgery
net difference, HbA1c, high ADI −1.29 %(−1.95% to −0.63%)
Surgery
net difference, HbA1c, low ADI −0.95 %(−1.29% to −0.62%)
Surgery
net difference, weight loss, high ADI −10.6 %(−15.2% to −5.9%)
Surgery
net difference, weight loss, low ADI −13.3 %(−15.7% to −10.9%)
- Interaction between ADI and intervention group, hemoglobin A1c (HbA1c): not significant
- P = 0.37
- Interaction between ADI and intervention group, weight loss: not significant
- P = 0.31
Original publication
Effect of Social Vulnerability on Efficacy of Bariatric Surgery Versus Medical and Lifestyle Intervention for Type 2 Diabetes: Analysis of the ARMMS-T2D Consortium of Randomized Trials. Ann Intern Med. Published 20 January 2026. doi:10.
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