Weight-loss surgery linked to long-term type 2 diabetes remission, 14-year study finds

People with type 2 diabetes who undergo weight-loss surgery are significantly more likely to achieve remission than those receiving medication and lifestyle treatment alone, according to new research published in Diabetes Care.

The long-term study found that 58% of people assigned to metabolic-bariatric surgery achieved type 2 diabetes remission, compared with just 3% of those assigned to intensive medical and lifestyle management.

Researchers followed participants for a median of 11 years, with some monitored for up to 14 years, providing important insights into the long-term effectiveness of weight-loss surgery as a treatment for type 2 diabetes.

The findings also identified several factors that could help healthcare professionals predict which patients are most likely to achieve remission and who may be at greater risk of their diabetes returning.

The research forms part of the Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D), described by researchers as the largest and longest-running trial programme comparing metabolic surgery with medical treatment for type 2 diabetes.

Scientists analysed data from 262 people living with type 2 diabetes, including 166 assigned to metabolic-bariatric surgery and 96 assigned to medical and lifestyle management.

For the study, type 2 diabetes remission was defined as achieving an HbA1c level below 6.5% without taking blood glucose-lowering medication.

HbA1c measures average blood glucose levels over approximately two to three months and is commonly used to monitor diabetes management.

The results suggest that metabolic-bariatric surgery can offer substantial long-term benefits for some people living with type 2 diabetes, although achieving remission does not necessarily mean the condition has been permanently cured.

The study identified several characteristics associated with a greater likelihood of type 2 diabetes remission following treatment.

People who had been living with type 2 diabetes for a shorter period, were not using insulin and required fewer types of glucose-lowering medication before treatment were more likely to achieve remission.

Greater weight loss during the first year following treatment was also linked to improved chances of remission.

These findings could help clinicians identify patients who may benefit most from metabolic-bariatric surgery and support discussions about when surgical treatment should be considered.

John P. Kirwan, Ph.D., principal investigator of the study and executive director of the University of Oklahoma Health Harold Hamm Diabetes Center, said the findings provide important evidence about the lasting benefits of surgery.

He said: “For years, one of the most consequential questions in diabetes care has been whether the benefits of metabolic surgery endure.

“Now we have a durable answer. Over 14 years, 58% of surgical patients achieved remission, compared with just 3% on medication and lifestyle alone. By identifying who is most likely to achieve lasting remission, including shorter diabetes duration, no insulin use, and greater early weight loss, we can offer surgery to the right people earlier, rather than as a last resort.”

As well as examining remission rates, researchers investigated which factors were associated with type 2 diabetes returning after an initial period of remission.

They found that people who had lived with diabetes for longer before treatment were more likely to experience a relapse.

Taking a greater number of glucose-lowering medications before treatment was also associated with an increased likelihood of diabetes returning.

The research adds to growing evidence that metabolic-bariatric surgery can be an effective treatment option for appropriately selected people living with type 2 diabetes.

Importantly, the findings suggest that the duration of diabetes before treatment may influence the likelihood of achieving remission.

This could have implications for how healthcare professionals discuss surgical treatment with eligible patients, particularly those whose diabetes has been diagnosed relatively recently.

However, weight-loss surgery is not suitable for everyone. Decisions about treatment must take account of individual health circumstances, surgical risks, eligibility criteria and personal preferences.

Although the study found a substantially higher rate of remission among participants assigned to surgery, the reported 58% figure refers to participants who achieved remission during the long-term study period. It should not be interpreted as meaning that all of those participants remained continuously in remission for 14 years.

Long-term research could help guide future diabetes treatment

The study was led by Donald Simonson, M.D., MPH, Sc.D., of Brigham and Women’s Hospital and Harvard Medical School in Boston.

Kirwan, who has led the research programme since its inception, previously worked at Cleveland Clinic and Pennington Biomedical Research Center before taking up his leadership role at the University of Oklahoma Health Harold Hamm Diabetes Center.

Gary Raskob, Ph.D., Senior Vice President and Provost of the OU Harold Hamm Health Campus, said: “Recruiting Dr Kirwan to lead the Harold Hamm Diabetes Center brings to Oklahoma one of the world’s foremost authorities on long-term treatment for type 2 diabetes.

“Research of this caliber is exactly what this center, and Harold Hamm’s investment in it, was created to advance.”

The study, Predictors of Type 2 Diabetes Remission and Relapse After Metabolic-Bariatric Surgery or Medical-Lifestyle Therapy in the ARMMS-T2D Study, was published in Diabetes Care.