Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Borgeraas, Heidi; Hofsø, Dag; Hertel, Jens Kristoffer; Hjelmesæth, Jøran

doi:10.1111/obr.13011

Cited by 72 publications

(42 citation statements)

References 59 publications

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“…The Fourth Global International Federation for the Surgery of Obesity (IFSO) Registry in 2018 reported that of the 190,177 primary metabolic operations, sleeve gastrectomy (SG) was the most common (87,467; 46.0%) followed by Roux-en-Y gastric bypass (RYGB) (72,645; 38.2%) and one-anastomosis gastric bypass (OAGB) (14,516; 7.6%) [ 18 ]. Previously published standard pairwise meta-analyses have produced inconsistent findings [ 19 – 22 ]. With the evolution of procedures and the increasing use and understanding of one-anastomosis gastric bypass [ 23 ], an updated comparative efficacy assessment is required to aid healthcare decision making.…”

Section: Introductionmentioning

confidence: 99%

Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

et al. 2021

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Background Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB. Methods MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3–5 years), trial-defined T2DM remission at any time point and perioperative complications. Results Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3–5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points. Conclusion OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO ) Graphical abstract

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Section: Introductionmentioning

confidence: 99%

Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

et al. 2021

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“…Recently published network meta-analysis on diabetes remission after bariatric surgeries shows that in the follow-up over 3 years of length after LSG, the diabetes remission rate is on the level of 39.9% [ 33 ]. Moreover, the latest published systematic review of literature shows that there is no significant difference between diabetes remission in 2- to 5-year follow-up between RYGB and LSG (50% vs 45%, 95% CI (0.94–1.20)) [ 34 ]. This data however is hard to interpret due to combining 2- to 5-year follow up in one analysis—overall 5-year follow-up diabetes remission results are sparse.…”

Section: Discussionmentioning

confidence: 99%

Type 2 Diabetes Remission 5 Years After Laparoscopic Sleeve Gastrectomy: Multicenter Cohort Study

et al. 2020

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Purpose Bariatric surgery is no longer considered only as a weight loss surgery but also a way of treating obesity-related comorbidities such as type 2 diabetes mellitus (T2DM). Short-term T2DM remissions in patients undergoing laparoscopic sleeve gastrectomy (LSG) have been shown, but there are very few reports on the mid-term results. We aimed to assess the remission rate of T2DM in obese patients after LSG throughout 5-year follow-up. Materials and Methodology We performed a retrospective multicenter cohort analysis of 240 patients who underwent LSG. We assessed the remission rate of T2DM 1 year and 5 years after surgery. Results Forty-six percent of patients achieved T2DM remission 5 years after LSG. The remission group had better weight loss results (median% of total weight loss 5 years after: 30.1% (22.9–37.0) vs 23.0% (13.7–30.2), p < 0.001) and were significantly younger than the no remission group (43 (38–52) vs 52 (44–58) years, p < 0.001). Duration of T2DM was significantly shorter (2 (1–5) vs 5 (3–10) years, p < 0.001) with less insulin requirement and less diabetes-related complications (7.2% vs 19.8%, p < 0.001) and significantly lower median DiaRem score (4.0 (IQR 2.0–6.0) vs 12.0 (IQR 5.0–16.0), p < 0.001). Preoperative body mass index (BMI) had no effect on remission. Conclusions Our study suggests that diabetes remission after laparoscopic sleeve gastrectomy occurs frequently, and in the 5-year follow-up, it may remain at the level of 46%. We identified the age of patients, duration, and severity of T2DM as factors affecting mid-term diabetes remission. Nevertheless, further well-designed trials are needed to support our findings.

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“…Over the last decade, randomised controlled trials (RCTs) [1][2][3][4][5], systematic reviews, meta-analyses [6,7] and international guidelines [8][9][10][11] have indicated the benefits of bariatric-metabolic surgery for patients with type 2 diabetes mellitus (T2DM) and severe obesity compared to medical therapy alone. 'Bariatric' surgery that produces weight loss overlaps with 'metabolic' or 'diabetes' surgery where the aim is to improve conditions such as T2DM [12].…”

Section: Introductionmentioning

confidence: 99%

Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes: Data from the IFSO Global Registry 2015–2018

Welbourn

Hollyman

Kinsman³

et al. 2021

OBES SURG

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Background Comparative international practice of patients undergoing bariatric-metabolic surgery for type 2 diabetes mellitus (T2DM) is unknown. We aimed to ascertain baseline age, sex, body mass index (BMI) and types of operations performed for patients with T2DM submitted to the IFSO Global Registry. Materials and Methods Cross-sectional analysis of patients having primary surgery in 2015–2018 for countries with ≥90% T2DM data completion and ≥ 1000 submitted records. Results Fifteen countries including 11 national registries met the inclusion criteria. The rate of T2DM was 24.2% (99,537 of 411,581 patients, country range 12.0–55.1%) and 77.1% of all patients were women. In every country, patients with T2DM were older than those without T2DM (overall mean age 49.2 [SD 11.4] years vs 41.8 [11.9] years, all p < 0.001). Men were more likely to have T2DM than women, odds ratio (OR) 1.68 (95% CI 1.65–1.71), p < 0.001. Men showed higher rates of T2DM for BMI <35 kg/m2 compared to BMI ≥35.0 kg/m2, OR 2.76 (2.52–3.03), p < 0.001. This was not seen in women, OR 0.78 (0.73–0.83), p < 0.001. Sleeve gastrectomy was the commonest operation overall, but less frequent for patients with T2DM, patients with T2DM 54.9% vs without T2DM 65.8%, OR 0.63 (0.63–0.64), p < 0.001. Twelve out of 15 countries had higher proportions of gastric bypass compared to non-bypass operations for T2DM, OR 1.70 (1.67–1.72), p < 0.001. Conclusion Patients with T2DM had different characteristics to those without T2DM. Older men were more likely to have T2DM, with higher rates of BMI <35 kg/m2 and increased likelihood of food rerouting operations.

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Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Cited by 72 publications

References 59 publications

Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

Type 2 Diabetes Remission 5 Years After Laparoscopic Sleeve Gastrectomy: Multicenter Cohort Study

Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes: Data from the IFSO Global Registry 2015–2018

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