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ARMMS-T2D: Surgery shows long-term success over standard diabetes management

Metabolic and bariatric surgery results in superior glycaemic control, less medication usage and high rates of remission of type 2 diabetes, compared with medical or lifestyle intervention in patients with class 1 obesity, accord to the outcomes from the Alliance of Randomized Trials of Medicine versus Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) consortium presented at the 83rd Scientific Sessions Conference by the American Diabetes Association in San Diego.

Figure 1: The 12-year study affirms that metabolic surgery provides better results, less regression, as confirmed by Pennington Biomedical researchers and partners (Credit: ARMMS-T2D)
Philip Schauer

"These landmark results further enforce the confidence we have in the success and efficacy of metabolic and bariatric surgery," said Dr Philip Schauer, Director of Metamor Metabolic Institute at Pennington Biomedical. "For those patients who are in serious need of weight loss, and for whom diet, exercise and medication did not produce the desired results, these patients can be assured that this operation is safe, and the results are well established."

The ARMMS-T2D consortium is designed to assess the durability and longer-term effectiveness of metabolic surgery (gastric sleeve (GS), gastric band (GB), or Roux-en-Y gastric bypass (RYGB)), compared with medical/lifestyle management in patients with type 2 diabetes.

A total of 316 patients with type 2 diabetes previously randomly assigned to surgery (n=195) or medical/lifestyle therapy (n=121) in the STAMPEDE, TRIABETES, SLIMM-T2D, and CROSSROADS trials were enrolled into this prospective observational cohort. The primary outcome was the rate of diabetes remission (haemoglobin A1c [HbA1c] ≤6.5% for three months without usual glucose-lowering therapy) at three years. Secondary outcomes included glycaemic control, body weight, biomarkers, and comorbidity reduction.

This study evaluated 262 participants for up to 12 years, represents the largest cohort of people assessed for the long-term durability of the two treatments. With a median follow-up of 11 years, the surgical group had greater decrease in weight (-20.1 vs -11.2 kg, p<0.001), HbA1c (-1.10% vs -0.50%, p<0.001) and greater diabetes remission (16.8% vs 2.2%, p<0.001).

Steatosis scores improved in both groups but to a greater extent after surgery (-8.5 vs -4.9, p<0.001) and fibrosis scores were stable even though patients were 6-15 years older and values did not differ between surgical vs medical groups (FIB-4 -0.01 vs -0.02, p=0.77; APRI -0.04 vs -0.01, p=0.60).

"The longer the study duration, the stronger the message in terms of remission of type 2 diabetes," said ARMMS-T2D Principal Investigator, Dr John Kirwan, Executive Director and the George A Bray, Jr. Endowed Super Chair in Nutrition, Pennington Biomedical Research Center. "The study addressed the durability of glycaemic control after surgery, the longer-term efficacy and safety, and potential reasons some patients experience relapse."


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