Health-Related Quality of Life and Health Utility after Metabolic/Bariatric Surgery vs. Medical/Lifestyle Intervention in Individuals with Type 2 Diabetes and Obesity: The ARMMS-T2D Study
Objective: Type 2 diabetes and obesity are associated with reduced health-related quality of life (HRQoL) and health utility (HU), but long-term effects of metabolic/bariatric surgery (MBS) compared to medical/lifestyle intervention (MLI) on these outcomes are unclear. Research Design and Methods: We studied 228 individuals with type 2 diabetes and obesity randomized to MBS (Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric band; n=152) or MLI (n=76) in the ARMMS-T2D study. HRQoL (SF-36, including Physical Component Score [PCS] and Mental Component Score [MCS]) and HU (SF-6D) were measured annually up to 12 years. Results: At baseline, participant’s age was 49.2±8.0 years, 68.4% were female, BMI was 36.3±3.4 kg/m², and HbA1c was 8.7±1.6%. PCS improved significantly more in MBS vs. MLI over 12 years (+2.37±0.53 vs. -0.95±0.73; difference = 3.32±0.85, p<0.001). MBS was associated with better general health (p<0.001), physical function (p=0.001) and vitality (p=0.003). Reduction in BMI was greater after MBS vs. MLI (p<0.001) and correlated with improved PCS (r=-0.43, p<0.001). Change in PCS was not associated with change in HbA1c. MCS changed minimally from baseline and was similar between MBS and MLI during follow-up (-0.21±0.61 vs. -0.89±0.84; difference = 0.68±0.97, p=0.48). Improvements in HU were greater in MBS vs. MLI over 12 years (+0.02±0.01 vs. -0.01±0.01; difference = 0.03±0.01, p=0.003). Conclusions: Metabolic surgery produces sustained weight loss and improves PCS, general health, physical function, vitality, and health utility in individuals with type 2 diabetes and obesity compared to medical therapy up to 12 years after intervention.