Cleveland Clinic is among four centers participating in a long-term study that found durable impact of gastric bypass and gastric sleeve surgeries on blood-sugar control and body weight.
A new study is offering hope to individuals with obesity and diabetes, showing that bariatric surgery can help to improve both conditions, even putting diabetes into remission in some cases, according to a bariatric surgeon from global health system Cleveland Clinic who co-authored the study.
Ali Aminian, MD, Director of Cleveland Clinic’s Metabolic and Bariatric Institute, explains that obesity and diabetes go hand in hand – the accumulation of excess body fat can cause and exacerbate type 2 diabetes.
“When we treat obesity effectively, associated conditions such as diabetes, as well as high cholesterol and high blood pressure, are likely to improve too. Bariatric surgery also results in favorable hormonal changes that can improve diabetes control,” says Dr. Aminian. “In this study, we wanted to compare the impact of weight-loss surgery on diabetes as compared to medications or lifestyle changes typically used in diabetes management.”
The study, known as the Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D), in particular investigated the long-term durability of diabetes control resulting from bariatric surgery and included pooled results of patients at Cleveland Clinic and three other U.S. centers, who were studied over a period of up to 12 years.
“The ARMMS-T2D study is significant as previous randomized clinical trials of bariatric surgery were limited in size, surgery type, and follow-up duration,” says Dr. Aminian. “Our findings have confirmed the results of many of these smaller studies; demonstrating that bariatric surgery leads to superior diabetes control as compared with medical and lifestyle interventions. Post-bariatric surgery, fewer diabetes medications were needed, and more patients had diabetes remission than was the case of patients in the group using medication and lifestyle interventions.”
Glucose Levels, Insulin Use, and Diabetes Remission
The study compared the results of patients’ hemoglobin A1C blood tests. These tests measure a patient’s average blood sugar levels over the preceding three months, and a level of 6.5% or above classifies the patient as having diabetes. The results showed patients in the post-bariatric surgery group had better hemoglobin A1C results than the medical/lifestyle group, at 1.4% lower at the seven-year point, and 1.1% lower at 12 years.
Insulin usage was also significantly lower in the bariatric group when measured after seven years, at 16% versus 56%. Dr. Aminian points out this is an important benefit as it can be challenging to adjust insulin doses for some patients, with serious consequences if blood sugar falls too low, and also because insulin can cause weight gain and is an expensive medication.
The study also looked at how many patients had achieved diabetes remission, meaning they no longer needed to take insulin or any other medications to control their blood sugar. Diabetes remission was greater after bariatric surgery, with 18.2% of this group achieving remission compared with 6.2% in the medical/lifestyle group at seven years. At the 12-year mark, 12.7% of the surgical group was still in remission compared to 0.0% of the medical/lifestyle group.
Two other notable durable benefits of bariatric surgery over lifestyle and medical interventions were found in the study. Over time, many post-bariatric patients had healthier cholesterol levels and those with high blood pressure appeared to need fewer medications to control it.
Dr. Aminian is quick to point out that the study does not suggest that all patients with obesity and diabetes should rush to undergo bariatric surgery. “Lifestyle changes and medications are the first line treatments, but where the adequate response is not achieved, bariatric surgery is an excellent option. It is also one that should not be delayed for too long – diabetes is a progressive disease that, if not properly managed, can cause serious long-term complications and even death. In addition, the shorter the duration of the patient having diabetes, the more likely long-term remission following bariatric surgery will be achieved,” he explains.
While new classes of diabetes medicine made available recently also support weight loss, the study points out that these can be costly and require long-term use, while the durability of their efficacy has not yet been determined.
“For suitable candidates who have diabetes and obesity – particularly those with a very high body mass index, who are less likely to respond to medication – surgery can be a great choice. Surgeries are safer than ever before, and bariatric surgeries can prevent the serious long-term health consequences of obesity and diabetes.”
