Bariatric Surgery Effective than Medical Management in Achieving Diabetes Remission: Study

A new review published in the journal of Diabetes, Obesity and Metabolism highlighted the remarkable effectiveness of bariatric surgery in patients with type 2 diabetes mellitus (T2DM), placing it well ahead of conventional medical management in terms of diabetes remission and the prevention of certain microvascular complications.

This research analyzed studies sourced from PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials, with strict inclusion criteria of comparing bariatric surgery with medical management in T2DM patients and had at least one year of follow-up. Outcomes of interest included diabetes remission, microvascular complications like kidney disease or retinopathy, and macrovascular complications like heart attack or stroke.

At the one-year mark, 53.1% of the patients undergoing surgery achieved diabetes remission, when compared to only 5.4% of those managed medically. This translated into a risk ratio (RR) of 8.26, signaling a more than 8-fold higher chance of remission with surgery. Importantly, the advantage persisted over time: at 2 years, patients who underwent surgery were over 7-times more likely to achieve remission, while at 3 years, the risk rose nearly 17-fold. Even after 5 years or more, surgery continued to demonstrate superior outcomes, with a remission rate over 4-times higher than medical therapy.

When considering microvascular events, bariatric surgery showed a protective effect. The patients who had undergone surgery experienced a 58% reduced risk of these complications when compared to those who received only medical care. Within this category, the most notable improvement was in albuminuria, a marker of kidney damage, with surgery lowering the risk by 63%. However, the trials did not demonstrate significant reductions in the progression of diabetic retinopathy.

Also, when looking at macrovascular complications, which include heart disease, stroke, and peripheral vascular disease, the difference between bariatric surgery and medical management was not statistically significant. The risk ratio was close to unity, suggesting that surgery does not substantially alter the risk of major cardiovascular events when compared to standard care.

Overall, these findings positions bariatric surgery as a powerful tool for achieving diabetes remission and protecting against microvascular damage in patients with T2DM. However, longer-term trials with broader surgical representation remain needed to fully assess its cardiovascular benefits.

Source:

Cheng, J., Yu, H., Gu, Y., Ma, C., Li, C., Pan, Z., & Yuan, M. (2025). Diabetes remission and diabetic complications of bariatric surgery vs. medical management in patients with type 2 diabetes: A meta-analysis of randomized controlled trials. Diabetes, Obesity & Metabolism. https://doi.org/10.1111/dom.70152