Weight loss surgery delivers lasting quality-of-life benefits for people with T2D, obesity

In the treatment of patients with type 2 diabetes (T2D) and obesity, metabolic/bariatric surgery appears to produce sustained weight loss over 12 years, translating to better physical function, general health, and vitality, as well as reduced pain, according to long-term data from the ARMMS-T2D Study.

In a subset of ARMMS-T2D participants, those who underwent metabolic/bariatric surgery achieved greater improvements in health-related quality of life (HRQoL), as measured by the SF-36, than those who underwent medical/lifestyle intervention during 12 years of follow-up. [ADA 2024, abstract 235-OR]

Specifically, the Physical Component Score (PCS) of the SF-36 significantly improved with metabolic/bariatric surgery vs medical/lifestyle intervention in the first 3–4 years. For all the subsequent years, there was a downward trend over time, which was not surprising given that participants were getting older and accumulating various morbidities, reported presenting author Dr Donald Simonson from the Brigham and Women’s Hospital in Boston, Massachusetts, US.

Nevertheless, the PCS remained significantly higher in MBS group than in the medical/lifestyle group at all time points during the follow-up (p<0.001), added Simonson.

“In contrast, the Mental Component Score (MCS) of the SF-36 showed almost no change in either group over time. There was a lot of bouncing around from the baseline, but there was no consistent trend. After 12 years, the MCS in each group pretty much ended up where it started (p=0.48),” he said.

Looking at the individual scale scores that make up the physical and mental components of the SF-36, the improvement in PCS in the surgical vs the medical/lifestyle group was driven by better general health (p<0.001), physical function (p=0.001), and reduced bodily pain (p=0.03). No substantial changes were observed in the role-physical scale, which assesses how problems with the physical health interfere with the role that an individual plays in the society, home, or work, among others.

In terms of the four scales that contribute to the mental component, those that measure social function, role-emotional, and mental health did not change appreciably or consistently and did not differ between the surgical group and the medical/lifestyle group. Only vitality showed a significant improvement in the surgical group (p=0.003). Simonson pointed out that while the vitality scale contributed more to the mental component score, it also partially factored into the physical component score.

Additionally, greater improvements in health utility, as measured by the SF-6D, was observed with metabolic/bariatric surgery vs medical/lifestyle intervention (p=0.003). Health utility in the surgical group improved particularly during the first 3–4 years and remained higher than in the medical/lifestyle group through 12 years, with a downward trend seen in both groups over time, according to Simonson.

Weight loss linked to PCS

In a separate report published in a journal recently, long-term data showed that MBS was superior to medical/lifestyle intervention in terms of HbA1c (–1.6 percent vs –0.2 percent; p<0.001), weight (–19.9 percent vs –8.3 percent), diabetes remission (18.2 percent vs 6.2 percent; p=0.02), and insulin use (16.2 percent vs 56 percent; p<0.001) outcomes. [JAMA 2024;331:654-664]

“All of these differences occurred despite the fact that 25 percent of the participants in the medical/lifestyle group had bariatric surgery during the 12-year follow-up. So, if anything, the differences were minimized between the [two intervention groups] due to all the crossovers,” Simonson said.

Notably, the PCS improvement was more pronounced in younger participants (p=0.002) and women (p=0.024) and was associated with greater reductions in BMI in both the surgical group (p<0.01) and the medical/lifestyle group (p<0.05).

“However, the change in PCS was not associated with change in HbA1c in either the surgical or the medical/lifestyle group. So, the improvements in quality of life appeared to be more due to the loss of weight rather than the improvements in glycaemic control,” Simonson explained.

Finally, discontinuation of insulin use, which according to Simonson was of particular interest, was associated with less bodily pain (p=0.025) and greater improvements in social functioning (p=0.012) and general health (p=0.003).

“These findings may help patients with T2D and obesity make informed decisions what their best treatment options are,” he said.

The current analysis included 228 participants (mean age 49.2 years, 68.4 percent female, mean BMI 36.3 kg/m², mean HbA1c 8.7 percent, 44.3 percent insulin dependent) from the ARMMS-T2D study. Of these, 152 participants were in the surgical group and 76 were in the medical/lifestyle group.

The study was limited by the use of SF-36, a generic instrument, so there were no specific measures pertaining to obesity or diabetes and mental health, Simonson pointed out. He reiterated that analysis was based on the intention-to-treat principle, with the crossovers from the medical to the surgical group having minimized the differences between the intervention groups. Finally, the sample size was not large enough to test the three different metabolic/bariatric surgical procedures against each other, and the medical treatments were not identical across sites.