Endocrinologist Mary Elizabeth Patti understands that treating patients with type 2 diabetes goes beyond just looking at body mass index and blood glucose levels. She takes into account social vulnerability factors such as low income, food insecurity, and limited access to healthcare, as these are closely linked to the development of diabetes and obesity.
Patti has been involved in leading long-term clinical trials comparing bariatric surgery to medication and lifestyle management for type 2 diabetes. A study conducted in 2024 showed the superiority of bariatric surgery in terms of lower blood glucose levels, higher weight loss, reduced need for diabetes medications, remission of diabetes to the point of not needing insulin injections, and decreased risk factors for cardiovascular disease.
A secondary analysis of the trial published in the Annals of Internal Medicine examined how social determinants of health influenced outcomes of bariatric surgery compared to medical therapy for individuals with type 2 diabetes and obesity. The study found that bariatric surgery was more effective across all social backgrounds, not just in areas of higher deprivation.
The study initially included 355 participants who were randomly assigned to undergo medical therapy or one of three surgical approaches. Over time, fewer participants opted for lap band surgery, and newer obesity drugs became more available. By year 12, a significant number of participants were receiving incretin-based therapy, including both older and newer GLP-1 drugs.
While there was a slight trend towards better outcomes from surgery for individuals in high deprivation areas, it was not statistically significant. Patti emphasized the challenges patients face in navigating diabetes care along with socioeconomic obstacles like modifying diets, incorporating exercise, and maintaining access to medications.
Despite the increasing popularity of GLP-1 drugs, surgery remains a durable therapy for type 2 diabetes and obesity. Surgery and medical therapy have similar biological mechanisms for improving diabetes control, with surgery also reducing appetite and changing nutrient interactions in the intestine.
Experts believe that all therapies for obesity, including bariatric surgery and medications, are underused. While newer drugs may offer some benefits, large, well-designed studies are needed to determine the best strategy for individual patients. Patti advocates for keeping surgery as an option in the discussion, as it has shown effectiveness in improving diabetes control, reducing complications, and prolonging survival.
In conclusion, the choice between surgery and medical therapy for type 2 diabetes and obesity should be based on individual patient needs and considerations. While advancements in medications are promising, bariatric surgery remains a valuable and underutilized approach for long-term management of these conditions.
