In the ARMMS-T2D trial, 58 percent of people with type 2 diabetes assigned to metabolic-bariatric surgery achieved remission, against 3 percent assigned to medical and lifestyle management, over a median follow-up of 11 years.
People with type 2 diabetes were much more likely to achieve remission after weight-loss surgery than after intensive medical and lifestyle management, according to a long-term study published in Diabetes Care, the journal of the American Diabetes Association. The study followed participants for a median of 11 years, with some followed for up to 14 years.
The analysis covered 262 people with type 2 diabetes: 166 assigned to metabolic-bariatric surgery and 96 to medical and lifestyle management. Remission, defined as an A1C below 6.5 percent without blood-sugar-lowering medication, was achieved by 58 percent of the surgery group, compared with 3 percent of the medical and lifestyle group. A1C is a blood test measuring average blood sugar over about three months.
People who had lived with diabetes for fewer years, did not use insulin, and took fewer types of blood-sugar-lowering medicines before treatment were more likely to achieve remission. Greater weight loss during the first year after treatment was also linked to a higher likelihood of remission. By contrast, longer diabetes duration and more medicines before treatment were linked to a higher likelihood of relapse after an initial remission.
The trial, known as ARMMS-T2D, is described by its organisers as the largest and longest-running trial of metabolic surgery for diabetes, and the published analysis is the source for the figures above. Lead author Donald Simonson is based at Brigham and Women's Hospital and Harvard Medical School, and principal investigator John P. Kirwan now leads the University of Oklahoma Health Harold Hamm Diabetes Center. The study does not show that surgery works for every patient: it identifies who is most likely to benefit, and the comparison group received medical and lifestyle care, not no treatment at all.
The findings give doctors a firmer basis for offering surgery earlier to the right patients, rather than as a last resort, Kirwan said. Whether health systems act on that depends on surgical capacity, patient selection and long-term follow-up, and the study's predictors offer a starting point for those decisions rather than a blanket recommendation for surgery.