Effect of Social Vulnerability on Efficacy of Bariatric Surgery Versus Medical and Lifestyle Intervention for Type 2 Diabetes: Analysis of the ARMMS-T2D Consortium of Randomized Trials

BACKGROUND: Social determinants of health (SDOH) can affect metabolic health. OBJECTIVE: To determine the effect of social vulnerability on the comparative effectiveness of metabolic bariatric surgery or medical and lifestyle intervention on glycemia and weight outcomes in people with type 2 diabetes (T2D). DESIGN: Analysis of the effect modification of baseline Area Deprivation Index (ADI; a metric of social vulnerability) on longitudinal outcomes between randomized treatment groups using linear mixed-effects models. (ClinicalTrials.gov: NCT02328599). SETTING: 4 U.S. academic centers. PARTICIPANTS: 258 participants with T2D enrolled in 4 randomized controlled trials of surgical versus medical management and a longitudinal observational follow-up study. MEASUREMENTS: ) level at the end of the active intervention period (7 to 12 years). RESULTS: = 0.31). LIMITATIONS: Small sample size; parent trials were not designed to address effect modification by ADI. CONCLUSION: Surgery was superior to medical therapy for people with T2D regardless of social deprivation. This study did not detect statistically significant differences in the comparative advantage of surgery over medical therapy by ADI. PRIMARY FUNDING SOURCE: National Institutes of Health.