Weight-Loss Surgery Helped 58% of Patients Achieve Type 2 Diabetes Remission, Study Finds

What would it take to lower blood sugar without diabetes medication? A long-term study of people with type 2 diabetes, run across a group of U.S. institutions, points to one answer: weight-loss surgery. Far more patients who had it reached remission than those managed with medication and lifestyle changes alone.

Researchers randomly assigned participants to one approach or the other, then followed them for years, long enough to see who reached remission and who slipped back. Both outcomes mattered. A patient’s medical history before treatment seemed to align with the outcome, and the study’s principal investigator is using that to argue for when patients should be offered surgery.

The findings were published last week, and the University of Oklahoma announced them on Monday. The headline number is eye-catching, but what was actually measured, and who it applies to, is what makes it worth reading closely.

Two Groups, Followed For Years

This study’s staying power sets it apart.

The project is called ARMMS-T2D, short for the Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes.

The University of Oklahoma calls it the largest, longest-running trial of metabolic surgery for diabetes, with teams from Duke University, the University of Pittsburgh, Joslin Diabetes Center, and other U.S. institutions involved.

This analysis covers 262 people with type 2 diabetes. Of them, 166 were assigned to metabolic-bariatric surgery and 96 to medical and lifestyle management. Participants were followed for a median of 11 years, and some for as long as 14.

Over that stretch, 58% of the surgery group achieved remission. In the medical and lifestyle group, the figure was 3%. Donald Simonson, M.D., of Brigham and Women’s Hospital and Harvard Medical School in Boston, led the paper, which appeared in Diabetes Journal on Oct. 20.

What “Remission” Really Means

Here, it comes down to one blood test and a list of medications.

Researchers counted someone in remission when their A1C fell below 6.5% without any medication to lower blood sugar.

A1C is a blood test that reflects average blood sugar over about three months, so it gives a longer view than a single day’s reading.

The key takeaway is that medication-free condition. The outcome was drug-free blood sugar control, not simply weight loss.

It also helps to know what the 58% doesn’t claim. Some participants were followed for 14 years, but the median was 11, so the figure doesn’t mean 58% of surgery patients stayed in remission for 14 years straight.

Who Did Best, And Who Slipped Back

A patient’s history showed up on both sides of the ledger.

Four things were linked to reaching remission: fewer years living with diabetes, no insulin use before treatment, fewer types of blood sugar-lowering medications beforehand, and more weight lost during the first year after treatment.

Remission didn’t always hold. Diabetes returned for some people who had reached remission, and the factors tied to relapse echoed the first list: a longer history with the disease and more types of medication before treatment.

These are patterns across a group. No specific cutoff for years with diabetes or first-year weight loss has been reported, so no one can plug in their own numbers and get a forecast.

Related: 8 Conventional Foods That Help Build a More Diabetes-Friendly Plate

The Case For Considering Surgery Earlier

That pattern underpins the study’s strongest argument.

John P. Kirwan, Ph.D., the study’s principal investigator, reads the findings as a reason to rethink timing. By identifying who is most likely to achieve lasting remission, he said, doctors can “offer surgery to the right people earlier, rather than as a last resort.”

That is his interpretation of the data. No revised treatment guidelines have been announced, and the findings do not amount to advice for everyone with type 2 diabetes.

Kirwan has led the study since it began, including during his years at Cleveland Clinic and at Pennington Biomedical Research Center at Louisiana State University. He was named executive director of the University of Oklahoma Health Harold Hamm Diabetes Center this past summer, and the university highlighted both roles when it announced the findings.

Questions The Results Leave Open

A few missing details will decide how far these results can travel.

Start with the surgery itself. The operations are grouped under the umbrella term metabolic-bariatric surgery, so it’s unclear whether some procedures worked better than others. The comparison group’s treatment isn’t spelled out either, which means the results can’t be used to rank surgery against any particular drug.

Risks are another gap. The study doesn’t report complications, side effects, or other longer-term burdens of surgery, nor does it report costs or insurance coverage. Participants’ ages, starting weight, and dropout rates would also help readers judge who these results apply to.

The biggest unknown may be the one the study itself raises. Researchers found that diabetes came back for some patients, but how many, and how long after remission, hasn’t been laid out.

If surgery came up early after a type 2 diabetes diagnosis, what would you want your doctor to explain first?

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