ARMMS-T2D: MBS produces lasting diabetes remission
People with type 2 diabetes were much more likely to achieve remission after metabolic-bariatric surgery (MBS) than after intensive medical and lifestyle management, according to a long-term study by researchers from the University of Oklahoma. They also identified patient characteristics linked to remission and to the likelihood of diabetes returning.
The study found that 58% of participants assigned to metabolic-bariatric surgery achieved diabetes remission, compared with 3% of those assigned to medical and lifestyle management. Participants were followed for a median of 11 years, with some followed for up to 14 years.
“For years, one of the most consequential questions in diabetes care has been whether the benefits of metabolic surgery endure,” said the study’s principal investigator, Dr John P Kirwan, who this summer was named executive director of the University of Oklahoma Health Harold Hamm Diabetes Center, who also serves as Vice Provost for Diabetes Programs at the University of Oklahoma and holds the Chickasaw Nation Endowed Chair in Diabetes Research. “Now we have a durable answer. Over 14 years, 58% of surgical patients achieved remission, compared with just 3% on medication and lifestyle alone. By identifying who is most likely to achieve lasting remission, including shorter diabetes duration, no insulin use, and greater early weight loss, we can offer surgery to the right people earlier, rather than as a last resort.”
Researchers found that people who had lived with diabetes for fewer years, did not use insulin, and took fewer types of blood sugar-lowering medications before treatment were more likely to achieve remission. Greater weight loss during the first year after treatment was also associated with a higher likelihood of remission.
The Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is the largest, longest-running trial of metabolic surgery for diabetes. The study’s lead author is Dr Donald Simonson, of Brigham and Women’s Hospital and Harvard Medical School in Boston.
The analysis also identified factors associated with diabetes returning after an initial remission. People who had lived with diabetes longer and those taking more types of blood sugar-lowering medications before treatment were more likely to relapse. The findings suggest that a patient’s history of diabetes and response to treatment may help physicians assess the likelihood of remission and its potential duration.
Researchers analysed data from 262 people with type 2 diabetes. Of those participants, 166 were assigned to metabolic-bariatric surgery and 96 to medical and lifestyle management. The study defined remission as an A1C below 6.5% without medication to lower blood sugar. A1C is a blood test that measures average blood sugar levels over approximately three months.
Kirwan, who has led the study since its inception, through his years at the Cleveland Clinic and at the Pennington Biomedical Research Center at Louisiana State University, now brings his expertise in translational and clinical research to the OU Harold Hamm Health Campus.
The findings were reported in the paper, ‘Predictors of Type 2 Diabetes Remission and Relapse After Metabolic-Bariatric Surgery or Medical-Lifestyle Therapy in the ARMMS-T2D Study’, published in Diabetes Care. To access this paper, please click here (log-in maybe required)
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