ARMMS-T2D study alliance continues to show benefits of MBS over medical interventions for those with T2DM

The 12-year Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) clinical trial continues to provide significant findings on the benefits of bariatric surgery over medical management, according to two sub-studies presented during the 84th annual American Diabetes Association Scientific Sessions in Orlando, FL.

The ARMMS-T2D study combined independent single-centre randomized trial data from four centres in the US - Cleveland Clinic, Joslin Diabetes Center/Brigham and Women’s Hospital, University of Pittsburgh and University of Washington. The original trials, which were conducted between May 2007 and August 2013, evaluated the effectiveness of bariatric surgery compared to intensive lifestyle and medication therapy involving oral and injectable diabetes medications including insulin for adults with type 2 diabetes and overweight or obesity.

The investigators from the four individual studies pooled their data to provide a larger and more geographically diverse data set to evaluate efficacy, durability, and safety of bariatric surgery to treat type 2 diabetes. Follow-up data were collected through July 2022.

The first study, ‘Quality of Life and Health Utility 12 Years after Randomization to Bariatric Surgery vs. Medical Therapy in Patients with Type 2 Diabetes and Obesity-The ARMMS-T2D Study,’ presented by Dr Donald Simonson of Brigham and Women's Hospital, Boston, MA, reported that bariatric/metabolic surgery yields greater long-term improvements in physical components of quality-of-life compared with medical management with a subset of ARMMS-T2D participants.

For this aspect of the ARMMS-T2D study, 228 patients with type 2 diabetes participated, with 152 patients receiving metabolic/bariatric surgery interventions and 76 receiving medical/lifestyle intervention. The study showed that metabolic/bariatric produced sustained weight loss that correlated with better general health, physical function, energy, and less pain.

In the second study, ‘Association of Social Determinants of Health with Efficacy of Metabolic Bariatric Surgery (MBS) vs. Medical Therapy (MT) for Type 2 Diabetes,’ presented by Dr Mary-Elizabeth Patti of Joslin Diabetes Center, Boston, MA, presented that the adverse impact of social vulnerability is greater for individuals treated with medical therapy when compared against metabolic/bariatric surgery.

Social determinants of health are known to impact a person’s metabolic health, and this study showed that in the 262 participants in this subset of the ARMMS-T2D study, metabolic/bariatric surgery is particularly beneficial for those with high social vulnerability when compared to traditional medical/lifestyle intervention.

“This is the largest and longest running study of its kind, and as we analyse subsets of the study, we continue to see the benefits of metabolic/bariatric surgery for patients living with type 2 diabetes,” said Dr John Kirwan, principal investigator of the ARMMS-T2D alliance and Executive Director and the George A. Bray, Jr. Endowed Super Chair in Nutrition at Pennington Biomedical. “This is the second year in a row that we are able to present major findings from ARMMS-T2D at the ADA Scientific Sessions, and I am proud of the outstanding team effort that brought together scientists from Pennington Biomedical, Cleveland Clinic, Harvard, Pittsburgh and Seattle to collaborate and contribute to this milestone study.”