Bariatric surgery more effective than drugs for diabetics, who are obese: study

NEW DELHI: Is bariatric surgery superior to medical management when it comes to diabetes control in an overweight/obese individual? The jury on this is still out.
But a new study, based on 11-year follow-up of more than 300 people who either underwent bariatric surgery or chose medical/lifestyle management for diabetes control in the US, claims that surgery is more effective and resulted in long-term improvement for glycaemic control while using fewer medications and weight loss.
In parallel, increased rates of diabetes remission and reductions in medication use (including insulin) were observed in surgically treated participants, the study published in the Journal of American Medical Association (JAMA) says.
The study, however, warns that the positives of surgery must be balanced against the increased risk of nutritional deficiencies (anaemia), gastrointestinal adverse events, and bone fractures in long-term follow-up after bariatric surgery.
According to the JAMA study, bariatric surgery achieved diabetes remission in 51% of patients at one year and 18% at 7 years, compared with 0.5% of patients in the medical/lifestyle group at one year and 6% at 7 years.
The reduction in remission over time after bariatric surgical procedures has also been observed in other studies, potentially related to weight regain, resolution of negative calorie balance, and progressive loss of β-cell function over time.
Hence, even among patients who experience postoperative diabetes remission, continued surveillance for relapse is warranted. The JAMA study shows that even if relapse occurred, participants in the bariatric surgery group continued to experience better glycaemic control while using fewer medications.
Dr Anoop Misra, chairman of Fortis C-Doc, told TOI the trials (enrolment for surgery and/or medical and lifestyle management for diabetes management) were carried out from 2007 to 2013 and hence did not employ effective drugs as used today.
“Further, although blood sugar control was better with surgery there was no difference in cardiovascular events between two groups, something that we wanted to see. Further there were enough adverse events from bariatric surgery for us to worry about,” Dr Misra said.
Dr Arun Prasad, senior bariatric and robotic surgeon at Delhi’s Apollo hospital, said bariatric surgery is not yet widely embraced even though it has emerged as a highly effective treatment option for long-term control of type-2 diabetes. “It's crucial to gain the confidence of endocrinologists and diabetologists, as they often serve as the primary referral source for patients considering bariatric surgery. Additionally, due to the invasive nature of surgery, many individuals exhibit reluctance and prefer exploring pharmaceutical options, particularly with the continuous introduction of new medications each year,” he said.
According to Dr Prasad, one of the key advantages of bariatric surgery is its ability to induce significant and sustained weight loss, which plays a crucial role in improving insulin sensitivity and glycaemic control. Additionally, he said, surgical interventions such as gastric bypass and sleeve gastrectomy have been shown to produce rapid and profound improvements in diabetes remission rates, with many patients experiencing complete resolution of their diabetes symptoms.