The Long-Term Effects of Bariatric Surgery for Type 2 Diabetes: Systematic Review and Meta-analysis of Randomized and Non-randomized Evidence

Abstract

This study aims to assess the long-term effects of bariatric surgery on type 2 diabetic patients. We searched Cochrane Library, PubMed, and EMbase up to Dec 2013. Randomized controlled trials (RCTs) and cohort studies of bariatric surgery for diabetes patients that reported data with more than 2 years of follow-up were included. We used rigorous methods to screen studies for eligibility and collected data using standardized forms. Where applicable, we pooled data by meta-analyses. Twenty-six studies, including 2 RCTs and 24 cohort studies that enrolled 7883 patients, proved eligible. Despite the differences in the design, those studies consistently showed that bariatric surgery offered better treatment outcomes than non-surgical options. Pooling of cohort studies showed that BMI decreased by 13.4 kg/m(2) (95 % confidence interval (CI), -17.7 to -9.1), fasting blood glucose by 59.7 mg/dl (95 % CI, -74.6 to -44.9), and glycated hemoglobin by 1.8 % (95 % CI, -2.4 to -1.3). Diabetes was improved or in remission in 89.2 % of patients, and 64.7 % of patients was in remission. Weight loss and diabetes remission were greatest in patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery may achieve sustained weight loss, glucose control, and diabetes remission. Large randomized trials with long-term follow-up are warranted to demonstrate the effect on outcomes important to patients (e.g., cardiovascular events).

Medication and nutritional supplement use before and after bariatric surgery

“…10 A more recent study that assessed the long-term effects of bariatric surgery on diabetic patients observed that glucose control and remission from diabetes were possible in 89.2% and 64.7% of the patients, respectively. 30 Similar findings had already been reported previously. 31 Furthermore, reduction of diabetes has been found to occur more frequently among patients who underwent gastric bypass surgery that excluded the duodenum from the nutrient pathway and changed the bowel metabolism, thus reducing insulin resistance faster.…”

The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up

“…Close follow-up of 88 patients revealed a satisfactory result in weight loss. Recent large meta-analyses and reviews have shown that weight loss and diabetes remission are greatest and last longer in patients undergoing biliopancreatic diversion and gastric bypass [28]. But sleeve gastrectomy also provides satisfactory results.…”

Is Bariatric Surgery an Effective Treatment for Type II Diabetic Kidney Disease?

“…The greatest amount and durability of weight lost as well as degree of remission of diabetes occur with the (infrequently used) biliopancreatic diversion with duodenal switch followed, in order, by the Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding (22). One finding common to all bariatric surgeries is that, over time and on average, patients regain some of the weight that they initially lost.…”