Long-Term Remission Rates of Type 2 Diabetes Following Metabolic Surgery vs. Intensive Medical Therapy: A 10-Year Prospective Cohort Study

T2D is a progressive chronic illness that is associated with outstanding microvascular or macrovascular complications, poor quality of life, and premature death. Even though intensive medical therapy may have an effect on glycemic control, medication alone does not contribute to long-term T2D remission. Metabolic (bariatric) surgery has emerged as a mode of treatment that may have rapid and sustained effects with respect to glycemia. This report aimed to discuss the T2D remission rate, glycemic control, weight loss, medication, diabetes complications, and quality of life over the period of 10 years in patients who had metabolic surgery versus those who received intensive medical treatment. This is a prospective cohort study of 111 adult (30-65 years) patients with T2DM and obesity (BMI 70kg/m2) recruited to undergo either metabolic surgery (Roux-en-Ys gastric bypass or sleeve gastrectomy; n656) or intensive medical management according to the latest ADA/EASD guidelines (n656). The primary endpoint was complete remission of diabetes (HbA1c < 6.0% without any medication). Secondary outcomes included partial remission, HbA1c, fasting plasma glucose, homeostatic model assessment for insulin resistance (HOMA-IR), body weight, medication use, diabetes related complications, adverse events, and Short-Form 36 (SF-36) / DQOL health-related quality of life scores. Complete remission at 10 years was 33.9% in surgical and 1.8% in medical patients.  The percentage of patients using insulin was reduced to 50.0 in the surgical arm and increased to 47.3 in the medical arm at 10 years. The adjusted and hazard ratio of major adverse cardiovascular events was 0.28 (95% CI 0.09086) was in favor of surgery. The rate of surgical complications (8.9% perioperative), nutritional deficiencies (25%), and major hypoglycemia was found to be lower with surgery (0.6 vs. 3.1 per 100 patient years). Quality-of-life scores were higher in the surgical group at the 10-year follow-up. Metabolic surgery achieved a remarkable improvement in remission of T2D, better glucose control, better weight loss, a reduction in medication burden, and diabetes complications with good safety in this group of patients compared to intensive medical treatment. Our analysis suggests that metabolic surgery should be considered as an effective long-term treatment in a restricted population with T2D and obesity.