Long-Term Efficacy of Bariatric Surgery Compared to Modern Medical Therapy in Type 2 Diabetes and Obesity: A Systematic Review.

This systematic review evaluates the comparative effectiveness of bariatric surgery versus medical therapy in managing obese patients with type 2 diabetes mellitus (T2DM). A decade-long literature search from January 2014 to January 2024 identified 10 randomized controlled trials (RCTs) involving diverse populations, interventions, and outcomes. The analysis demonstrates that bariatric procedures, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and metabolic surgery, consistently outperform medical interventions, including GLP-1 receptor agonists, SGLT2 inhibitors, and intensive lifestyle modifications, in achieving superior glycemic control, weight reduction, and metabolic improvement. Surgical interventions also led to favorable outcomes in terms of quality of life, beta-cell function, and renal protection, particularly in high-risk groups such as adolescents and patients with diabetic kidney disease. The risk of bias assessment showed that most trials were of low risk or some concern, lending moderate to high confidence to the conclusions. These findings highlight the potential of metabolic surgery as a transformative strategy for durable diabetes remission in appropriately selected patients, supporting its integration into clinical guidelines alongside pharmacotherapy.