In the world’s largest randomized trial to date, researchers also found that bariatric surgery improved cholesterol and triglyceride levels more effectively than pharmaceutical/medical interventions and lifestyle changes. .

“According to the authors of this study, this analysis is the strongest evidence we have to date that bariatric surgery is a safe and effective tool to achieve control and cure of diabetes mellitus. “The results suggest that in people with type 2 diabetes, even those who do not exceed the body mass index (BMI) threshold for weight loss surgery, bariatric surgery should be offered as a treatment in cases of poorly controlled diabetes,” he says. Mr. Panagiotis Lainas Director of the Morbid Obesity Surgery Center& Metabolic Diseases of the Metropolitan Hospital & Head of Obesity Department of HealthSpot Diagnostic Centers.

The researchers compared various outcomes, including measures of blood sugar control (glycosylated hemoglobin – HbA1c), weight loss, and the use of insulin and other diabetes medications in patients enrolled in four separate randomized clinical trials between May 2007 and August 2013. All trials involved patients with type 2 diabetes mellitus and obesity who either underwent bariatric surgery or participated in a medical-pharmaceutical program that included lifestyle changes, based on established interventions proven to reduce diabetes risk.

The researchers then pooled the data from these 4 trials into a pivotal study that was completed in 2022. Long-term outcomes were analyzed at 7 and, when possible, 12 years after patients were randomized.

Participants in the bariatric surgery group had consistently lower glycated hemoglobin levels, reflecting better blood sugar control, than the medication/lifestyle changes group at each follow-up time point, despite starting the study with higher baseline values of glycosylated hemoglobin.

At year 7, 18.2% of participants in the bariatric surgery group had achieved diabetes remission, compared with 6.2% in the medication/lifestyle changes group. At year 12, the difference was even more pronounced: no patients in the medication/lifestyle changes group experienced diabetes remission, compared with 12.7% of patients in the bariatric surgery group who achieved diabetes remission.

Even in those who did not experience complete recovery, bariatric surgery led to better blood sugar control, with a reduction in the use of antidiabetic drugs, compared to the medication/lifestyle changes group. The results were similar across weight class groups, showing that surgery is equally beneficial for patients with a body mass index (BMI) below or above 35 kg/m2 – the standard cut-off for treating morbid obesity through bariatric surgery.

Although the aim of this study was to analyze diabetes control and cure rates, the researchers also found that bariatric surgery was superior to medical interventions and lifestyle changes in terms of long-term weight loss. At year 12, operated patients had on average greater weight loss compared to non-operated patients who received medication and/or followed a program of lifestyle changes.

In total, the trials included 355 patients with type 2 diabetes and obesity. The trials were conducted before the widespread availability of GLP-1 agonists for diabetes management and weight loss. Medical interventions and lifestyle changes in all four trials were based on US national standards for the intensive management of diabetes mellitus.

Specifically, they included monitoring of patients’ physical activity and nutrition, enhanced engagement with the health care team, stress management, support groups, and medications available at trial enrollment. The bariatric surgery procedures performed were sleeve gastrectomy, Roux-en-Y gastric bypass and gastric band placement.

The findings were presented in an article published in February 2024 in the international Journal of the American Medical Association.

“In our country, for the treatment of diseases of this nature, the Center for Morbid Obesity & Metabolic Disease Surgery of the Metropolitan Hospital stands out, in which the international current practices regarding the treatment of overweight patients and obesity are followed. In this way, a multifaceted approach is offered in combination with the collaboration with specialized scientists, with the aim of preventing obesity and losing the excess weight of patients” concludes Mr. Lainas