Predictors of Type 2 Diabetes Remission and Relapse After Metabolic-Bariatric Surgery or Medical-Lifestyle Therapy in the ARMMS-T2D Study
Donald C. Simonson, David E. Cummings, Philip R. Schauer, Ali Aminian, Bo Hu, David E. Arterburn, John M. Jakicic, Sangeeta R. Kashyap, Ashley H. Vernon, William F. Gourash, Anita P. Courcoulas, Mary Elizabeth Patti, John P. KirwanOBJECTIVE
Metabolic-bariatric surgery (MBS) is effective in promoting remission of type 2 diabetes, but this outcome is not universally achieved. We identified baseline patient characteristics that predict diabetes remission and subsequent relapse after various MBS procedures versus intensive medical-lifestyle intervention.
RESEARCH DESIGN AND METHODS
Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is a 14-year, multicenter study of health outcomes in 262 patients with type 2 diabetes (68% women, age 49.9 ± 8.3 years, BMI 36.4 ± 3.5 kg/m2, HbA1c 8.5 ± 1.5%) previously randomized to MBS (n = 166) or medical-lifestyle management (n = 96). Predictors of remission (defined as HbA1c <6.5% on no glucose-lowering medications) and relapse were determined using univariate time-to-event analyses of prespecified candidate predictors plus agnostic, multivariate least absolute shrinkage and selection operator.
RESULTS
Throughout a median of 11 years (maximum 14 years) of follow-up, 58% of participants randomized to MBS achieved diabetes remission versus 3% with medical-lifestyle management. Predictors of diabetes remission in univariate analyses included shorter diabetes duration, no insulin use, fewer glucose-lowering medication classes used, greater body weight, higher fasting C-peptide and insulin levels, and weight loss at 1 year (all P < 0.05). Diabetes remission predictors in multivariate analyses included baseline diabetes duration, insulin use, and weight change at 1 year (all P < 0.01). Diabetes relapse after initial remission in the MBS group was predicted by longer baseline diabetes duration and greater number of glucose-lowering medication classes used.
CONCLUSIONS
Baseline predictors of diabetes remission and subsequent relapse among participants randomized to one of three MBS procedures or a medical-lifestyle intervention should help inform personalized selection of diabetes treatment.