Compelling Outcomes in Metabolic Surgery Over Time
Time ticks by. Millions of people live with obesity and its complications. Meanwhile, a steady stream of new studies offers compelling data on metabolic surgery outcomes. This week, it was a ten-year study in Lancet. This study provides the first data for an RCT of surgery versus medical therapy for type 2 diabetes beyond five years.
The results yielded a simple conclusion:
“Metabolic surgery is more effective than conventional medical therapy in the long-term control of
type 2 diabetes.”
A Small, Randomized Trial
Randomized clinical trials are powerful, because they are the best tools we have for showing a therapy works. But for surgery, they present a challenge. Most people want to make their own choice to have surgery – or not. It’s a big deal. But in an RCT, that choice is made by chance. So running an RCT of metabolic surgery is no small feat. Collecting ten-year outcome data is an even bigger deal.
The results in this case are quite satisfying, though.
After ten years, only 5.5 percent of patients receiving medical therapy alone for diabetes were in remission. But for patients in the surgery group, the rate of was dramatically higher. Among patients who received a BPD procedure, 50 percent were in remission after ten years. For gastric bypass, the ten-year remission rate was lower – 25 percent.
In a commentary alongside this study, Alexander Miras and Carel le Roux explain why these findings are so important:
“During the past 12 years, 12 other randomised controlled trials have shown consistent findings, thus providing confidence in the robustness of the data. New generations of diabetologists are now more open to the use of metabolic surgery for patients with suboptimal responses to medical treatments. These methods contrast with older approaches that included endless intensification of insulin therapies and attributing the blame for poor response to inadequate patient compliance.”
Data in Younger Patients
In the January issue of SOARD, similar observations come from a comparison of outcomes for teens with severe obesity and type 2 diabetes. In this case, the study is not randomized. It is a comparison of two cohorts with similar profiles at baseline. One key difference to note is that patients in the surgical cohort have a higher risk for cardiovascular events at baseline. The other cohort received only medical and behavioral therapy for their diabetes.
But the outcomes are starkly different after five years of follow-up. Cardiovascular disease risk scores were cut in half for the surgery group compared to the medical group. Over time, the risks for the medical group grew while the risks for the surgery group dropped.
Of course, this study was retrospective and observational. So it has real limitations. Nevertheless, as time goes by and data accumulates, it’s hard to deny the benefits from metabolic surgery showing up in clinical outcomes.
Click here for the study in Lancet, here for the commentary, and here for the study in SOARD. For further perspective, click here.
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January 23, 2021
January 23, 2021 at 4:33 pm, Andrew Carey said:
That’s an interesting finding but the control group, if how you’ve phrased is right, has been set up wrong. Take this:
“After ten years, only 5.5 percent of patients receiving medical therapy alone for diabetes were in remission. But for patients in the surgery group, the rate of was dramatically higher. Among patients who received a BPD”
So what I want to know is what is the remission rate for those who received neither. And for all 3 groups (the one not mentioned by you and the two that were), what was the cost that was imposed on others.