Meta-analysis of metabolic surgery <i>versus</i> medical treatment for microvascular complications in patients with type 2 diabetes mellitus

Billeter, Adrian T.; Scheurlen, Katharina M.; Probst, Pascal; Eichel, Sebastian; Nickel, Felix; Kopf, Stefan; Fischer, Lars; Diener, Markus K.; Nawroth, Peter P.; Müller‐Stich, Beat P.

doi:10.1002/bjs.10724

Cited by 67 publications

(38 citation statements)

References 44 publications

(145 reference statements)

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“…The importance of operating earlier rather than later is further supported by the findings of the SOS study, which shows that metabolic surgery has a lower impact on the reduction of macro- and microvascular events the longer the T2DM existed prior to surgery [2,18]. In contrast, a recent meta-analysis did not find a relationship between the duration of T2DM and the efficacy of metabolic operations regarding the reduced incidence or improvement of microvascular complications [8]. Lastly, a recent study by Ahlqvist et al [20] found that there seem to be several subtypes of T2DM with different underlying causes such as high insulin resistance or insulin deficiency, and that these pose differing risks for the development of T2DM-related complications.…”

Section: Assessment Of Patients Suitable For Metabolic Surgerymentioning

confidence: 63%

“…Studies from our institution and others over the last few years have demonstrated that metabolic surgery, or the use of bariatric procedures to treat metabolic diseases, is an effective therapy for metabolic disease regardless of a patient's body weight/BMI. Furthermore, research demonstrates that metabolic surgical procedures also improve existing diabetic complications such as neuropathy and nephropathy [7,8,9,10]. In contrast to these findings, concerning non-severely obese patients with severe metabolic disease, there is also ample evidence that patients with a high degree of obesity can be metabolically healthy [11,12,13].…”

Section: Introductionmentioning

confidence: 90%

“…Metabolic surgery should be recommended to patients with a BMI ≥ 40 kg/m 2 and coexisting T2DM, irrespective of glycemic control or the complexity of their antidiabetic medication. The newest meta-analyses show that these patients even benefit from an improvement of microvascular complications such as existing neuropathy or nephropathy [7,8,9,10]. The new S3 guidelines specified that metabolic surgery should be recommended to patients with a BMI between 35 and 40 kg/m 2 who do not achieve the treatment goal with medical therapy.…”

Section: Indications For Metabolic Surgery For Type 2 Diabetes Mellitusmentioning

confidence: 99%

“…All of these methods, even in combination, only show a poor reduction in T2DM-related complications, including micro- and macrovascular complications as well as mortality [21]. In comparison, metabolic surgery is a very effective treatment option for T2DM as it reduces the development of micro- and macrovascular complications and mortality [6,7,8,10,22,23,24]. Several meta-analyses show the superiority of metabolic surgery for T2DM remission and glycemic control in comparison to medical therapies.…”

Section: Indications For Metabolic Surgery For Type 2 Diabetes Mellitusmentioning

confidence: 99%

“…The latest studies indicate that metabolic surgery may even induce the cure of existing end-organ damage, e.g. diabetic microvascular complications such as nephropathy, neuropathy, and retinopathy, or other obesity-associated diseases such as non-alcoholic steatohepatitis (NASH) [7,8,9]. …”

Section: Introductionmentioning

confidence: 99%

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Comorbidities as an Indication for Metabolic Surgery

et al. 2018

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Metabolic diseases, comprising type 2 diabetes mellitus (T2DM), dyslipidemia, and non-alcoholic steatohepatitis (NASH), are rapidly increasing worldwide. Conservative medical therapy, including the newly available drugs, has only limited effects and does neither influence survival or the development of micro- or macrovascular complications, nor the progression of NASH to liver cirrhosis, nor the development of hepatocellular carcinomas in the NASH liver. In contrast, metabolic surgery is very effective independent of the preoperative body mass index (BMI) in reducing overall and cardiovascular mortality in patients with T2DM. Furthermore, metabolic surgery significantly reduces the development of micro- and macrovascular complications while being the most effective therapy in order to achieve remission of T2DM and to reach the targeted glycemic control. Importantly, even existing diabetic complications such as nephropathy as well as the features of NASH can be reversed by metabolic surgery. Here, we propose indications for metabolic surgery due to T2DM and NASH based on a simple but objective, disease-specific staging system. We outline the use of the Edmonton Obesity Staging System (EOSS) as a clinical staging system independent of the BMI that will identify patients who will benefit the most from metabolic surgery.

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Section: Assessment Of Patients Suitable For Metabolic Surgerymentioning

confidence: 63%

Section: Introductionmentioning

confidence: 90%

Section: Indications For Metabolic Surgery For Type 2 Diabetes Mellitusmentioning

confidence: 99%

Section: Indications For Metabolic Surgery For Type 2 Diabetes Mellitusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comorbidities as an Indication for Metabolic Surgery

et al. 2018

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Benefits and Risks of Bariatric Surgery in Adults

Arterburn

Telem

Kushner

et al. 2020

JAMA

698

437

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he most effective long-term treatments for severe obesity complicated by type 2 diabetes are bariatric procedures. Few clinicians and patients have conversations about these procedures, mainly because of persistent concerns that the short-and long-term risks of surgery outweigh the benefits. 1 Indeed, bariatric procedures have a checkered history. The jejunoileal bypass, vertical banded gastroplasty, and laparoscopic adjustable gastric banding (AGB) procedures have been largely abandoned due to intolerable adverse effects, high rates of reoperation, or poor long-term efficacy. In contrast, the long-term evidence base for the Roux-en-Y gastric bypass (RYGB) procedure has substantially improved. A relatively new procedure, the sleeve gastrectomy, is now the most commonly performed bariatric proce-dure worldwide (Box 1). The goal of this review is to update clinicians on the latest evidence for the most common bariatric procedures, with a focus on the long-term outcomes for major obesity-related comorbidities, weight loss, and safety outcomes to guide shared decision-making conversations. MethodsThis narrative review was based on articles found by searching PubMed from its inception until January 2020 for the terms bariatric surgery, gastric bypass, and sleeve gastrectomy. Our search was limited to English-language articles. Priority was given to evidence IMPORTANCE Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with these conditions choose to undergo bariatric surgery. Summaries of the expanding evidence for both the benefits and risks of bariatric surgery are needed to better guide shared decision-making conversations.OBSERVATIONS There are approximately 252 000 bariatric procedures (per 2018 numbers) performed each year in the US, of which an estimated 15% are revisions. The 1991 National Institutes of Health guidelines recommended consideration of bariatric surgery in patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 40 or higher or 35 or higher with serious obesity-related comorbidities. These guidelines are still widely used; however, there is increasing evidence that bariatric procedures should also be considered for patients with type 2 diabetes and a body mass index of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes. Substantial evidence indicates that surgery results in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions, regardless of the type of procedures used. The 2 most common procedures used currently, the sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes and similar safety through at least 5-year follow-up. However, emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable...

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Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass

McTigue¹,

Wellman²,

Nauman³

et al. 2020

JAMA Surg

151

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; for the PCORnet Bariatric Study Collaborative IMPORTANCE Bariatric surgery can lead to substantial improvements in type 2 diabetes (T2DM), but outcomes vary across procedures and populations. It is unclear which bariatric procedure has the most benefits for patients with T2DM. OBJECTIVE To evaluate associations of bariatric surgery with T2DM outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study. Adult patients with T2DM who had bariatric surgery between January 1, 2005, and September 30, 2015, were included. Data analysis was conducted from April 2017 to August 2019. INTERVENTIONS Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). MAIN OUTCOME AND MEASURES Type 2 diabetes remission, T2DM relapse, percentage of total weight lost, and change in glycosylated hemoglobin (hemoglobin A 1c). RESULTS A total of 9710 patients were included (median [interquartile range] follow-up time, 2.7 [2.9] years; 7051 female patients [72.6%]; mean [SD] age, 49.8 [10.5] years; mean [SD] BMI, 49.0 [8.4]; 6040 white patients [72.2%]). Weight loss was significantly greater with RYGB than SG at 1 year (mean difference, 6.3 [95% CI, 5.8-6.7] percentage points) and 5 years (mean difference, 8.1 [95% CI, 6.6-9.6] percentage points). The T2DM remission rate was approximately 10% higher in patients who had RYGB (hazard ratio, 1.10 [95% CI, 1.04-1.16]) than those who had SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% (95% CI, 57.7%-60.7%) and 55.9% (95% CI, 53.9%-57.9%), respectively, at 1 year and 86.1% (95% CI, 84.7%-87.3%) and 83.5% (95% CI, 81.6%-85.1%) at 5 years postsurgery. Among 6141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG (hazard ratio, 0.75 [95% CI, 0.67-0.84]). Estimated relapse rates for those who had RYGB and SG were 8.4% (95% CI, 7.4%-9.3%) and 11.0% (95% CI, 9.6%-12.4%) at 1 year and 33.1% (95% CI, 29.6%-36.5%) and 41.6% (95% CI, 36.8%-46.1%) at 5 years after surgery. At 5 years, compared with baseline, hemoglobin A 1c was reduced 0.45 (95% CI, 0.27-0.63) percentage points more for patients who had RYGB vs patients who had SG. CONCLUSIONS AND RELEVANCE In this large multicenter study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycemic control compared with those who had SG. These findings can help inform patient-centered surgical decision-making.

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Meta-analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus

Abstract: In patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment . Metabolic surgery improved pre-existing diabetic nephropathy compared with medical treatment.

Cited by 67 publications

References 44 publications

Comorbidities as an Indication for Metabolic Surgery

Comorbidities as an Indication for Metabolic Surgery

Benefits and Risks of Bariatric Surgery in Adults

Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass

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