Surgery for Diabetic Gastroparesis May Improve HbA1c and Reduce Complications

Diabetic gastroparesis, a complication of long-standing diabetes marked by delayed gastric emptying in the absence of mechanical obstruction, is notoriously difficult to manage. Medical therapies often provide incomplete symptom relief, and the condition is associated with significant morbidity, including poor nutritional status, recurrent hospitalizations, and worsening metabolic control. A new study published in JAMA Surgery now offers evidence that surgical intervention may do more than relieve symptoms—it may also improve blood sugar management and reduce downstream complications.¹

Investigators from Allegheny Health Network in Pittsburgh used a national electronic health record (EHR) database to compare outcomes between patients with diabetic gastroparesis who underwent surgical therapy and those who received nonoperative management. After propensity score matching to account for baseline differences, the study identified meaningful improvements in hemoglobin A_1C (HbA_1c) levels and reductions in diabetes-related complications in the surgical cohort.

HbA_1c Trajectories Diverge After Surgery

The study tracked mean HbA1c levels over time in both the surgical and nonoperative cohorts. In patients who underwent surgery, procedures including pyloroplasty, gastric peroral endoscopic myotomy (G-POEM), and gastrectomy, HbA_1c levels declined and remained lower relative to the nonoperative group throughout follow-up. The nonoperative cohort, by contrast, showed less favorable HbA_1c trajectories, suggesting that unresolved gastroparesis contributes to ongoing metabolic dysregulation.

“Surgical therapy for diabetic gastroparesis is associated with improved glycemic control and reduced diabetes-related complications compared with nonoperative management, supporting the role of surgical intervention in the multidisciplinary management of this challenging condition,” wrote the study authors.

Reduced Diabetes-Related Complications

Beyond HbA_1c, the surgical cohort experienced lower rates of diabetes-related complications over the follow-up period. This finding is clinically significant because it suggests that addressing the underlying motility disorder, rather than simply adjusting pharmacologic regimens, may interrupt a cycle of metabolic instability that drives end-organ injury. Erratic gastric emptying creates unpredictable nutrient absorption, which in turn complicates blood sugar management and may precipitate repeated episodes of hypoglycemia or hyperglycemia.

“The unpredictable nature of gastric emptying in this population creates a therapeutic paradox, in which standard approaches to blood sugar management become difficult to calibrate without addressing the underlying motility disorder,” wrote the study authors.

Surgical Options and Patient Selection

The study included patients who underwent a range of surgical procedures. Pyloroplasty, a procedure that widens the pyloric channel to facilitate gastric drainage, is among the most commonly performed interventions for gastroparesis and has demonstrated favorable symptom outcomes in prior institutional series. A 2025 comparative study found that both laparoscopic pyloroplasty and G-POEM achieved symptom relief in the majority of gastroparesis patients, with favorable outcomes in 78% or more of cases across both approaches, with no significant difference between the 2 techniques.²

The current national-scale EHR analysis extends those single-center findings by demonstrating that surgical benefit is not limited to symptom scores; it extends to objective metabolic end points, including HbA_1c and downstream complications.¹

Study Design and Limitations

This was a retrospective cohort study using real-world EHR data, which carries inherent limitations, including potential residual confounding despite propensity score matching. The database does not capture granular procedural details, exact gastroparesis severity scores, or patient-reported symptom burden. Selection bias is also possible, as patients selected for surgery may represent a more motivated or medically optimized subset of the gastroparesis population. Despite these limitations, the national scope of the dataset lends the findings considerable generalizability.

Implications for Practice

For clinicians managing patients with refractory diabetic gastroparesis, these findings provide a new dimension to the surgical referral conversation. Surgery has historically been considered a last resort, reserved for patients who have failed all medical and endoscopic options. This study suggests that earlier surgical referral may offer metabolic benefits beyond symptom relief, potentially reducing the long-term burden of diabetes-related complications. Multidisciplinary coordination between endocrinologists, gastroenterologists, and foregut surgeons will be essential to identify which patients are most likely to benefit and at what stage of disease.

References

1. Sadda VR, Verma R, Aly AE, et al. Glycemic control and diabetes outcomes after surgical therapy for diabetic gastroparesis. JAMA Surg. Published online May 27, 2026. doi:10.1001/jamasurg.2026.1593
2. Eriksson SE, Chrysostome M-L, Sarici IS, et al. Pyloric drainage interventions for gastroparesis: a comparison of laparoscopic pyloroplasty and gastric peroral endoscopic myotomy (G-POEM) outcomes. Surg Endosc. 2025;39(6):3514-3524 doi:10.1007/s00464-025-11731-3