Clinical research study
Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis

https://doi.org/10.1016/j.amjmed.2008.09.041Get rights and content

Abstract

Background

The prevalence of obesity-induced type 2 diabetes mellitus is increasing worldwide. The objective of this review and meta-analysis is to determine the impact of bariatric surgery on type 2 diabetes in association with the procedure performed and the weight reduction achieved.

Methods

The review includes all articles published in English from January 1, 1990, to April 30, 2006.

Results

The dataset includes 621 studies with 888 treatment arms and 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes, that is, the resolution of the clinical and laboratory manifestations of type 2 diabetes. Nineteen studies with 43 treatment arms and 11,175 patients reported both weight loss and diabetes resolution separately for the 4070 diabetic patients in these studies. At baseline, the mean age was 40.2 years, body mass index was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more.

Conclusion

The clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for 2 years or more.

Section snippets

Search Strategy for Identification of Studies

We conducted a comprehensive review of all studies published in the English literature containing data on weight loss and type 2 diabetes-related outcomes for patients treated with any form of bariatric surgery. We performed an electronic search in MEDLINE, Current Contents, and the Cochrane Library for interventional or observational studies published from January 1, 1990, to April 30, 2006. Search terms used were as follows: obesity/surgery (MeSH) OR gastric bypass OR gastroplasty OR

Search Yields

Initially, a total of 4402 citations were screened and 1817 full publications were retrieved, yielding 621 primary studies that met criteria for inclusion in the extractable and analyzable dataset (Figure 1). These primary studies were associated with an additional 558 kin studies, which occasionally contributed additional data of interest, such as data on subgroups.

Study Characteristics

The dataset consists of 621 studies with 888 treatment arms and 135,246 patients; 103 arms with 3188 patients reported on the

Discussion

The prevalence of type 2 diabetes has markedly increased in the last decade in the United States8, 9, 10 and globally.11, 12, 13 These data are correlated with a comparably steep increase in the prevalence of obesity.14, 15, 16, 17 The primary risk factor for type 2 diabetes is obesity, and 90% of all patients with type 2 diabetes are overweight or obese.18, 19 The National Health and Nutrition Examination Survey III (1988-1994) data showed that the risk for chemical diabetes is approximately

Conclusions

This systematic review and meta-analysis demonstrates that bariatric surgery has a powerful treatment effect in morbidly obese persons with type 2 diabetes. In the studies reporting only diabetic patients, 82% of patients had resolution of the clinical and laboratory manifestations of diabetes in the first 2 years after surgery, and 62% remained free of diabetes more than 2 years after surgery (80% and 75% for the total group). Randomized clinical trials comparing surgery and medical therapies

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    Funding: This work was supported by Ethicon Endo-Surgery, Inc, a Johnson & Johnson Company, Cincinnati, Ohio.

    Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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