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News & Trends - MedTech & Diagnostics

Landmark study claims surgery trumps medicines in diabetes management

Health Industry Hub | June 28, 2023 |

MedTech & Diagnostics News: In a landmark study hailed as the largest and longest-running comparison of its kind, the Alliance of Randomised Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) has shed new light on the effectiveness of metabolic/bariatric surgery versus medical management in treating type 2 diabetes.

The previous three-year follow-up report already hinted at the significant disparity in type 2 diabetes remission rates, favouring surgery over medical management (37.5% versus 2.6% respectively). However, long-term results were crucial to inform clinical decision-making and settle debates within the medical community.

At the esteemed American Diabetes Association (ADA) congress this week, ARMMS-T2D principal investigator Dr John Kirwan unveiled the eagerly anticipated findings. “The longer the study duration, the stronger the message in terms of remission of type 2 diabetes,” he emphasised. The study aimed to address the durability of glycaemic control after surgery, assess longer-term efficacy and safety, and understand why some patients experience relapses.

Over a span of seven years, a total of 355 individuals with type 2 diabetes were randomly assigned to either undergo metabolic/bariatric surgery or medical management. Of the 305 eligible participants, a remarkable 262 (86%) agreed to take part in the present study, which boasted a median follow-up period of 11 years (ranging from 7 to 15 years). Notably, 25% of the participants crossed over to the metabolic/bariatric surgery group during the study, but the analysis adhered to the intention-to-treat (ITT) principle to address the primary outcome.

The seven-year results were particularly striking. The metabolic/bariatric surgery group showcased a more significant reduction in weight (19.9% versus 8.3%, p<0.001) and a 1.6% drop in HbA1c levels compared to a 0.2% reduction in the medical management group (difference: -1.4%, p<0.001).

Importantly, the study also revealed that diabetes remission rates were significantly higher in the metabolic/bariatric surgery group (18.2% versus 6.2%, p=0.02). However, it’s worth noting that adverse events such as anaemia, fractures, and gastrointestinal issues were more common among those who underwent surgery.

To further validate the findings, researchers looked specifically at individuals with lower degrees of obesity (BMI <35 kg/m2). Surprisingly, even this subgroup experienced superior glycemic control with metabolic surgery, showcasing the procedure’s potential beyond patients with severe obesity.

Dr Kirwan expressed his enthusiasm for the increasing recognition of metabolic surgery as a viable treatment option for type 2 diabetes. However, despite its proven effectiveness, less than 1% of eligible patients actually undergo these procedures. This low uptake is primarily attributed to concerns surrounding long-term safety and durability, shared by patients, healthcare providers, and payers.

Dr Mary-Elizabeth Patti, senior investigator and endocrinologist at the Joslin Diabetes Centre and Associate Professor of Medicine at Harvard Medical School, commented on the significance of the study’s results. “The results tell us that surgical management is an important treatment approach that anyone who is seeing patients with type 2 diabetes should be discussing with their patients,” she affirmed.

The ARMMS-T2D study has undoubtedly paved the way for a more comprehensive understanding of the role of surgery in combating type 2 diabetes. With its promising long-term outcomes, it is poised to reshape clinical practices and spark conversations about expanding the accessibility of this life-changing procedure.

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