In the recent 2019 paper published in JAMA, authors from the Cleveland Clinic reported on the care of over 13,000 individuals with type 2 diabetes. And similar to prior randomized controlled trials, and other large matched cohort studies, this carefully designed matched cohort study of diabetes care found large reductions in stoke, heart attack, mortality, and renal failure among patient undergoing metabolic surgery compared to those managed medically. The size of the effect over 8 years was large, with 40- 50% reductions in cardiac events and mortality compared to current medical management.
As in other large studies, this paper by Aminian and colleagues shows a significant survival advantage compared to medical management of diabetes, and the advantage appears to widen further over time. These data correlate with the 12 published randomized, controlled trials (RTCs) of metabolic surgery compared to intensive medical management of diabetes which demonstrate a profound superiority in glycemic control with surgery.
After surgery, most individuals with Type 2 diabetes enjoy a significant period of remission, defined by euglycemia without medications. The American Diabetes Association now recommends metabolic surgery for all patients with Type 2 diabetes and a BMI over 35. The American Heart Association now recommends consideration of metabolic surgery for patients with hypertension and BMI of 35 or greater.