Type 2 diabetes is one of the fastest-growing long-term health conditions in the world.
It develops when the body cannot use insulin properly or does not make enough of it to keep blood sugar under control.
Many people with type 2 diabetes are also overweight or obese, making it even harder to manage the disease and increasing the risk of heart disease, kidney disease, nerve damage, vision loss, and other serious complications.
For many years, treatment for type 2 diabetes has focused on healthy eating, regular exercise, weight management, and medicines that lower blood sugar.
While these approaches help many people, they do not always provide enough control. In recent years, metabolic bariatric surgery, often called weight-loss surgery, has become another treatment option for people whose diabetes remains difficult to manage.
A new study led by Dr. Mary Elizabeth Patti from the Joslin Diabetes Center and Harvard Medical School suggests that surgery may provide greater benefits than standard medical treatment, regardless of where a person lives or their financial circumstances. The findings were published in the Annals of Internal Medicine.
The researchers wanted to know whether a person’s social and economic background affected how well surgery worked. To investigate this, they used the Area Deprivation Index (ADI), which measures neighbourhood disadvantage using factors such as income, education, employment, and housing.
People living in areas with higher ADI scores often face greater challenges in accessing healthcare, healthy food, and opportunities for regular physical activity.
The research included 258 adults with type 2 diabetes who took part in four randomised clinical trials at medical centres across the United States. Participants were randomly assigned to receive either metabolic bariatric surgery or standard medical treatment combined with lifestyle advice.
Some participants came from more disadvantaged communities, while others lived in areas with greater social and financial resources.
The results clearly favoured surgery. People who underwent metabolic bariatric surgery achieved much better blood sugar control than those receiving medical treatment alone.
Their haemoglobin A1c (HbA1c), a blood test that reflects average blood sugar over the previous two to three months, fell by about one percentage point more than in the medication group. This level of improvement can significantly reduce the risk of long-term diabetes complications.
Surgery also produced much greater weight loss. Depending on participants’ social background, those who had surgery lost around 10% to 13% more body weight than people treated with medicines and lifestyle changes alone. Maintaining this degree of weight loss can make diabetes easier to manage and improve overall health.
One of the most important findings was that social disadvantage did not reduce the benefits of surgery. People living in neighbourhoods with fewer resources experienced improvements similar to those living in wealthier areas.
However, among participants who received only medical treatment, outcomes varied more according to their social circumstances. This suggests that people facing financial hardship or limited healthcare access may find it more difficult to follow long-term medication schedules and healthy lifestyle plans.
The researchers believe these findings support the growing role of metabolic bariatric surgery as a treatment for type 2 diabetes, particularly for people who struggle to achieve good blood sugar control through medicines alone.
Although surgery is not suitable for everyone and requires careful medical assessment and lifelong follow-up, it may offer lasting improvements in blood sugar control, weight, and overall health across people from all backgrounds.
The study provides further evidence that effective diabetes treatment should be available to everyone, regardless of where they live or their financial situation.
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