Study: Metabolic Surgery May be Cure for Type 2 Diabetes

Sydney Jennings

Associate Editor of Patient Care Online

Compared to medication and lifestyle changes, metabolic surgery is more effective in the long-term control of severe T2D, a new study found.

Metabolic surgery is more effective vs medications and lifestyle interventions in the long-term control of severe type 2 diabetes (T2D), suggests a new clinical trial with the longest follow-up to date published in The Lancet.

“The findings from this study provide the most robust scientific evidence yet that full-blown type 2 diabetes is a curable disease, not inevitably progressive and irreversible,” said senior author Francesco Rubino, MD, chair of bariatric and metabolic surgery, King’s College London, in a press release. “In addition to represent [sic] a major advance in the treatment of diabetes, metabolic surgery is our best lead to the elusive cause of the disease.”

The results also showed that over one-third of patients who received metabolic surgery remained diabetes-free during the entire 10-year follow-up period. This shows, in the context of the most rigorous type of clinical investigation, that a “cure” for T2D can be achieved, according to the press release.

The study included 60 patients with advanced T2D who were treated at a major academic hospital in Rome, Italy, between April 2009 and October 2011. The participants were randomly assigned to receive medications plus lifestyle interventions or metabolic surgery (Roux-en Y gastric bypass [RYGB] or biliopancreatic diversion).

All participants had poorly controlled blood sugar levels and more than 5 years history of T2D at baseline; the primary endpoint was T2D remission at 2 years.

Results showed that 37.5% of surgically-treated patients were able to maintain non-diabetic glycemia without the need for diabetes medication throughout the 10-year trial period. In 2009, the American Diabetes Association released a consensus statement defining a “cure” of diabetes as, “the maintenance of stable remission of hyperglycemia for at least 5 years.”

Compared with standard medical treatment, the study also found that metabolic surgery resulted in greater weight loss, reduced medication use, lower cardiovascular risk, improved kidney function, better quality of life, and a lower incidence of T2D-related complications.

Researchers also investigated the early and long-term safety of the different intervention strategies and found that patients who underwent biliopancreatic diversion had more incidences of serious adverse events, including events associated with disease and intervention, vs those in both other groups.

Furthermore, patients treated with conventional medical therapy had significantly higher incidence of serious adverse events vs those who underwent RYGB, noted the press release.

“These data corroborate the notion that surgery can be a cost-effective approach to treating type 2 diabetes. The evidence is now more than compelling that metabolic surgery should be considered as a main therapeutic option for the treatment of patients with severe type 2 diabetes and obesity,” said first author Geltrude Mingrone, MD, professor of medicine, Catholic University of Rome, professor of diabetes and nutrition, King’s College London, in the same press release.