The Effects of Bariatric Procedures versus Medical Therapy for Obese Patients with Type 2 Diabetes: Meta-Analysis of Randomized Controlled Trials

Abstract

Objective. To assess the effects of bariatric surgery versus medical therapy for type 2 diabetes mellitus. Methods. The Cochrane library, PubMed, Embase, Chinese biomedical literature database, and Wanfang database up to February 2012 were searched. The literature searches strategies contained terms (“diabetes∗”, “surg∗”, and “medic∗” were used), combined with the medical subject headings. Randomized controlled trails (RCTs) of frequently used bariatric surgery for obese patients with type 2 diabetes were included. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results. Three randomized controlled trials (RCTs) involving 170 patients in the bariatric surgery groups and 100 patients in the medical therapy group were selected. Compared with medical therapy, bariatric surgery for type 2 diabetes can significantly decrease the levels of HbA1c, FBG, weight, triglycerides, and the dose of hypoglycemic, antihypertensive, and lipid-lowering medicine, while increasing the rate of diabetes remission (RR = 9.74, 95%CI, (1.36, 69.66)) and the levels of high-density lipoprotein. However, there are no statistical differences in serious adverse events between the surgical and medical groups (RR = 1.23, 95%CI, (0.80, 1.87)). Conclusions. Surgical procedures were more likely to help patients achieve benefits than medical therapy alone. Further intensive RCTs of high-quality, multiple centers and long-term followup should be carried out to provide more reliable evidence.

Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

“…They were able to demonstrate superior results in the surgical group in terms of the reduction of fasting plasma glucose (FDG), glycosylated hemoglobin (HbA1c) and diabetes medications [44]. Three RCTs had been selected, accounting for 270 patients overall, 170 in the surgical and medical therapy group and 100 in the medical therapy group [10, 45, 46].…”

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

“…31,[68][69][70]164 A number of reviews reported on T2DM remission results from RCTs and included largely the same studies in their meta-analyses. Gloy et al 6 used meta-analysis to combine the results of four RCTs to give a relative risk of 5.3 (95% CI 1.8 to 15.8) for T2DM remission at 1-2 years of follow-up when comparing surgery with medical management, while a review by Guo et al 71 published in the same year included two RCTs to give an OR of 9.74 (95% CI 1.36 to 69.66). One further review, again published in 2013, employed meta-analysis to combine the results of eight RCTs to show a pooled estimate of 92% remission of T2DM after surgical intervention compared with 18% in control groups.…”

The Sum of Many Parts: Potential Mechanisms for Improvement in Glucose Homeostasis After Bariatric Surgery

“…In 1995, Pories et al reported the long-term efficacy of bariatric surgery in achieving diabetes “remission” in 608 morbidly obese patients who underwent gastric bypass, with a 96.3 % follow-up rate over 14 years [19]. A later meta-analysis reported that DM was completely resolved in 76.8% of patients, however, a more recent analysis of randomized controlled trials indicates that figures may be lower [7, 20]. …”