Bariatric Surgery versus Non-Operative Treatment for Diabetes Management: Five-Year Outcomes

A recent study compared disease remission rates, weight loss, and changes in metabolic parameters in patients with type 2 diabetes who underwent bariatric surgery versus non-operative patients.

Patient data were collected from the 2006 to 2017 Hospital Authority database on patients with diabetes who did and did not receive bariatric surgery; operative and non-operative patients were propensity score-matched 1:5. Five-year outcomes included remission rates of diabetes, hypertension, and dyslipidemia; other outcomes included changes in weight loss measurements (body mass index [BMI], percentage of total weight loss [%TWL], percentage of excess weight loss [%EWL], and percentage of rebound in excess weight loss [%REWL]) and metabolic parameters (hemoglobin A1c, systolic blood pressure [SLP], diastolic blood pressure [DBP], and low-density lipoprotein cholesterol).

Final analysis included 401 surgical patients (310 restrictive surgeries and 91 bypass surgeries) and 1,894 non-operative patients. Operative patients, compared with non-operative patients, had higher rates of diabetes and dyslipidemia, as well as better glycemic control at 12 to 60 months (P<0.01 for all). At 12 months, the operative group had significantly lower SBP and DBP, and after 12 months, levels were similar between the groups. BMI was significantly lower in the operative group during follow-up. At 60 months, the operative group had higher %TWL (15.7% vs. 3.7%, respectively) and %EWL (48.8% vs. 12.0%, respectively; P<0.001 for all). There were no significant between-group differences in %REWL. In the operative group, restrictive and bypass surgeries showed similar effectiveness, with restrictive surgeries somewhat superior in terms of diabetes remission.