Hormonal
Long-term remission of Type 2 Diabetes following metabolic surgery is not sustained for the majority of patients, with remission rates dropping significantly after 5 years.
While surgery often puts Type 2 Diabetes into remission initially, this effect often wears off after several years. Most patients will eventually need to restart diabetes medications to maintain blood sugar control, meaning surgery is a tool for disease management rather than a permanent cure.
With regards to long-term remission of T2DM, the metabolic benefits of bariatric surgery appear to fatigue with time and a proportion of patients will not maintain normoglycaemia without pharmacotherapy... 5-year follow-up data... suggested 50% of the surgically treated patients and none of the medically treated patients were in remission; however, using the stricter ADA definition, in fact, none of the patients in either group met the criteria for remission.
Why this rating
Supported by long-term RCTs (STAMPEDE, 5-year follow-up) and prospective cohort studies.
Source
Review of multimodal treatment for type 2 diabetes: combining metabolic surgery and pharmacotherapy
Alexis Sudlow et al. · Therapeutic Advances in Endocrinology and Metabolism · 2019
DOI 10.1177/2042018819875407
More from this paper
- Metabolic surgery provides superior short-term remission of type 2 diabetes and greater weight loss compared to pharmacotherapy alone, but long-term remission rates decline significantly over time.Good
- A multimodal treatment approach combining metabolic surgery with adjuvant pharmacotherapy (specifically GLP-1 agonists or other anti-obesity drugs) is superior to surgery alone for maintaining long-term glycemic control and remission.Good
- Adjuvant pharmacotherapy with anti-obesity medications (AOMs) such as Liraglutide, Lorcaserin, or Naltrexone/Bupropion is effective and well-tolerated for managing weight regain or insufficient weight loss after bariatric surgery.Moderate
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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