Long-Term Metabolic Outcomes After Surgery vs Intensive Therapy

An ARMMS‑T2D pooled analysis examined long-term comparative outcomes of bariatric/metabolic surgery versus intensive medical and lifestyle therapy in adults with type 2 diabetes and obesity. Overall, the analysis showed a consistent advantage for surgery on metabolic outcomes relative to the non-surgical intensive approach.

The analysis pooled participant-level data from four randomized U.S. clinical trials and followed a combined cohort of 262 participants for as long as 12 years. Bariatric/metabolic surgery produced greater improvements in glycemic control and weight than intensive medical and lifestyle therapy. The article describes a “marked advantage” for surgery over extended follow-up, citing superior blood sugar control and weight loss compared with the non-surgical arm.

To assess whether socioeconomic context modified comparative outcomes, the investigators stratified participants by social vulnerability using the Area Deprivation Index, which reflects neighborhood-level factors such as income, education, housing, and employment. The surgery advantage over medical and lifestyle intervention was observed in both higher- and lower-vulnerability strata. Participants characterized as more socially vulnerable had worse absolute glycemic outcomes and less weight loss than less vulnerable peers, even with improvement observed with surgery across groups.