Fernando Gómez Peralta
Coordinator of the Diabetes Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and head of the Endocrinology and Nutrition Unit at the General Hospital of Segovia
It is an interesting study because of the large sample size, the length of follow-up and the relatively recent data.
It is also important because achieving remission of type 2 diabetes mellitus is a critical goal after the emergence of treatments that have demonstrated their feasibility (bariatric surgery and GLP1 and similar therapies).
It is probably a further confirmation that non-pharmacological or non-surgical treatment, i.e. lifestyle measures, at least conventional ones, are minimally effective under real-life conditions. It is therefore a further call to administrations and health systems to include the new drugs (in addition to or instead of bariatric surgery) in early stages of type 2 diabetes mellitus or even in what we currently call pre-diabetes.
The fundamental questions to be answered in the latter respect would be:
- In which groups these interventions would be really cost-effective (the population with pre-diabetes in developed countries is huge, possibly similar to the prevalence of type 2 diabetes mellitus).
- In which cases would bariatric surgery remain the first option.
The main limitations of the study are that it was conducted in a Hong Kong population, so we do not know to what extent these data can be extended to other populations or ethnicities; and the lack of data to explain weight loss and the methods used (including surgery).