Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes
Authors' conclusion
After 7 to 12 years of follow-up, individuals originally randomized to undergo bariatric surgery compared with medical/lifestyle intervention had superior glycemic control with less diabetes medication use and higher rates of diabetes remission.
Study context
- Population
- Adults with T2D in 4 US single-center RCTs (May 2007–August 2013), follow-up through July 2022; mean age 49.9 years, mean BMI 36.4, 68.3% womenof 305 eligible
- Participants
- 262 adults
- Comparison
- Bariatric surgery vs medical/lifestyle management
- Outcome
- Change in HbA1c from baseline
- Follow-up
- 7 years
Methodological detailssingle-center trials, Median follow-up 11 years, 25% of participants randomized to medical/lifestyle underwent bariatric surgery during follow-up
- Single-center trials
- Median follow-up 11 years
- 25% of participants randomized to medical/lifestyle underwent bariatric surgery during follow-up
Pooled result
As reported in the abstract
Between-group difference
−1.4 %
95% CI −1.8% to −1.0%
P < 0.001
Change by group
Medical/lifestyle
0.2%
95% CI −0.5%–0.2%
Bariatric surgery
1.6%
95% CI −1.8%–-1.3%
Between Bariatric surgery and Medical/lifestyle
between-group difference −1.4 % (95% CI −1.8% to −1.0%); P < 0.001
Further pooled results
| Outcome | Between-group difference (%) (95% CI) | P value | |
|---|---|---|---|
| Change in HbA1c · up to 12 years | −1.1 (−1.7% to −0.5%) | P = 0.002 | |
| −2−101Difference, % (linear scale) |
Diabetes remission · 7 years
P = 0.02
Diabetes remission · up to 12 years
P < 0.001
Events
| Outcome | Bariatric surgery | Medical/lifestyle |
|---|---|---|
| Deaths | 2 | 2 |
- Deaths — Total deaths
- 4 (2.2%)
Antidiabetes medication use
- Fewer antidiabetes medications used with bariatric surgery
Safety
Other adverse events
- No differences in major cardiovascular adverse events
- Anemia, fractures and GI adverse events more common after bariatric surgery
Original publication
Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA. Published 27 February 2024. doi:10.
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