Diabetic gastroparesis is associated with substantial symptom burden and may complicate long-term glycemic management. A retrospective multicenter cohort study published in JAMA Surgery evaluated whether surgical therapy for gastroparesis was associated with improved glycemic control and reduced diabetes-related complications compared with nonoperative management.

The analysis used a national electronic health record database including more than 100 million patients across over 70 US health care organizations. Adults with concurrent diagnoses of diabetes and gastroparesis between 2010 and 2023 were included. Surgical therapies included gastric electrical stimulation, pyloroplasty, and gastric peroral endoscopic myotomy. Propensity score matching generated 2 balanced cohorts of 2,272 patients each.

Findings

• A total of 95,328 eligible patients were identified, including 2,272 patients (2.4%) who underwent surgical therapy.
• Mean hemoglobin A1c (HbA1c) decreased by 0.51 percentage points in the surgical cohort and increased by 0.28 percentage points in the nonoperative cohort during follow-up.
• At 5 years, mean HbA1c was 6.29% in the surgical group versus 7.21% in the nonoperative group (between-group difference 0.92 percentage points; P < .001).
• The surgical cohort showed higher probability of achieving HbA1c <7%, lower rates of severe hyperglycemia, and lower initiation of insulin therapy.
• Diabetes-related complications occurred in 53.2% of surgical patients versus 63.3% of nonoperative patients (odds ratio 1.52; 95% confidence interval 1.34-1.71; P < .001).
• Emergency department visits and hospitalizations were less frequent in the surgical cohort, while 5-year mortality did not differ between groups.

Surgical therapy for diabetic gastroparesis was associated with improved glycemic control, lower insulin utilization, and fewer diabetes-related complications during long-term follow-up. The findings suggest metabolic outcomes may warrant consideration alongside symptom control when evaluating surgical treatment options for gastroparesis.