Skip to main content

Advertisement

SpringerLink
Log in

Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis

  • Review
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The sleeve gastrectomy (SG) has gained popularity which has resulted in a rising number of patients with T2DM to undergo this procedure. This systematic review and meta-analysis aimed to compare the long-term effects of SG on T2DM remission with remission seen after Roux-en-Y gastric bypass (RYGB) or gastric banding (GB).

Methods

A literature search was performed in PubMed and Cochrane Library using the following search terms: ‘sleeve gastrectomy’, ‘diabetes’, ‘gastric bypass’ and ‘gastric banding’. Studies published between January 2000 and April 2018, and with following inclusion criteria were selected for this review: BMI ≥ 35 kg/m2, age ≥ 18 years, follow-up ≥ 1 year, T2DM. Data was statistically analysed using a random-effects model and results were expressed as odds ratio with 95% confidence interval.

Results

After exclusion, 35 out of an initial 748 studies, consisting of 18 138 T2DM patients, remained for inclusion. Of these patients, 2480 underwent a SG. The remaining patients underwent a RYGB (n = 10,597) or GB (n = 5061). One year postoperatively, SG patients reached significantly (OR 0.71, p = 0.003) less T2DM remission than RYGB. After stratifying for different criteria for remission, RYGB still tended to result in higher remission rates, but the difference was not statistically significant. Beyond 1 year of follow-up, the difference between RYGB and SG in terms of T2DM remission decreased. SG was superior to the GB (OR 2.17, p = 0.001) after 1 year of follow-up.

Conclusion

This review demonstrates important remission of T2DM following SG. Nevertheless, as remission was significantly more often observed following RYGB surgery, the latter procedure remains the gold standard for reaching T2DM remission in patients with concurrent obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

EWL:

Excess weight loss

GB:

Gastric banding

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

T2DM:

Type 2 diabetes mellitus

References

  1. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. 2000;894:i-xii, 1-253.

  2. Kasama K, Tagaya N, Kanahira E, et al. Has laparoscopic bariatric surgery been accepted in Japan? The experience of a single surgeon. Obes Surg. 2008;18(11):1473–8.

    PubMed  Google Scholar 

  3. Ding D, Chen DL, Hu XG, et al. Outcomes after laparoscopic surgery for 219 patients with obesity. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(2):128–31.

    PubMed  Google Scholar 

  4. Mazzone T, Chait A, Plutzky J. Cardiovascular disease risk in type 2 diabetes mellitus: insights from mechanistic studies. Lancet. 2008;371(9626):1800–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523–9.

    CAS  PubMed  Google Scholar 

  6. National Task Force on the P, Treatment of O. Overweight, obesity, and health risk. Arch Intern Med. 2000;160(7):898–904.

    Google Scholar 

  7. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.

    CAS  PubMed  Google Scholar 

  8. Franco JV, Ruiz PA, Palermo M, et al. A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding. Obes Surg. 2011;21(9):1458–68.

    PubMed  Google Scholar 

  9. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24.

    PubMed  Google Scholar 

  10. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 50-2

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84. discussion 84-5

    PubMed  PubMed Central  Google Scholar 

  12. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8(8):CD003641.

    Google Scholar 

  13. Sjostrom L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.

    PubMed  Google Scholar 

  14. Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.

    CAS  PubMed  Google Scholar 

  15. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    CAS  PubMed  Google Scholar 

  16. Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy-a “food limiting” operation. Obes Surg. 2008;18(10):1251–6.

    PubMed  Google Scholar 

  17. Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.

    PubMed  Google Scholar 

  18. Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg. 2011;21(6):738–43.

    PubMed  Google Scholar 

  19. Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24(5):1005–10.

    CAS  PubMed  Google Scholar 

  20. Rosenthal RJ, International Sleeve Gastrectomy Expert P, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    PubMed  Google Scholar 

  21. Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.

    PubMed  PubMed Central  Google Scholar 

  22. le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.

    PubMed  Google Scholar 

  23. Williams DL, Cummings DE. Regulation of ghrelin in physiologic and pathophysiologic states. J Nutr. 2005;135(5):1320–5.

    CAS  PubMed  Google Scholar 

  24. Garcia-Fuentes E, Garrido-Sanchez L, Garcia-Almeida JM, et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels. Obes Surg. 2008;18(11):1424–9.

    CAS  PubMed  Google Scholar 

  25. Stanley S, Wynne K, McGowan B, et al. Hormonal regulation of food intake. Physiol Rev. 2005;85(4):1131–58.

    CAS  PubMed  Google Scholar 

  26. Davenport AP, Bonner TI, Foord SM, et al. International Union of Pharmacology. LVI. Ghrelin receptor nomenclature, distribution, and function. Pharmacol Rev. 2005;57(4):541–6.

    CAS  PubMed  Google Scholar 

  27. Murphy KG, Dhillo WS, Bloom SR. Gut peptides in the regulation of food intake and energy homeostasis. Endocr Rev. 2006;27(7):719–27.

    CAS  PubMed  Google Scholar 

  28. Benaiges D, Flores Le-Roux JA, Pedro-Botet J, Chillaron JJ, Renard M, Parri A, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance. Int J Surg. 2013;11(4):309-13.

    PubMed  Google Scholar 

  29. Casajoana A, Pujol J, Garcia A, Elvira J, Virgili N, de Oca FJ, et al. Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication. Obesity surgery. 2017;27(9):2235-45.

    PubMed  Google Scholar 

  30. Cutolo PP, Nosso G, Vitolo G, et al. Clinical efficacy of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass in obese type 2 diabetic patients: a retrospective comparison. Obes Surg. 2012;22(10):1535–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. de Gordejuela AG, Pujol Gebelli J, Garcia NV, et al. Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients? Surg Obes Relat Dis. 2011;7(4):506–9.

    PubMed  Google Scholar 

  32. Dicker D, Yahalom R, Comaneshter DS, Vinker S. Long-Term Outcomes of Three Types of Bariatric Surgery on Obesity and Type 2 Diabetes Control and Remission. Obes Surg. 2016;26(8):1814-20.

    Google Scholar 

  33. Gan SS, Talbot ML, Jorgensen JO. Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus. ANZ journal of surgery. 2007;77(11):958-62.

    PubMed  Google Scholar 

  34. Gray KD, Moore MD, Bellorin O, et al. Increased metabolic benefit for obese, elderly patients undergoing Roux-en-Y gastric bypass vs sleeve gastrectomy. Obes Surg. 2018;28(3):636–42.

    Google Scholar 

  35. Hariri K, Guevara D, Jayaram A, Kini SU, Herron DM, Fernandez-Ranvier G. Preoperative insulin therapy as a marker for type 2 diabetes remission in obese patients after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2018;14(3):332-7.

    PubMed  Google Scholar 

  36. Haruta H, Kasama K, Ohta M, et al. Long-term outcomes of bariatric and metabolic surgery in Japan: results of a multi-institutional survey. Obes Surg. 2017;27(3):754–62.

    Google Scholar 

  37. Hong J, Park S, Menzo EL, et al. Midterm outcomes of laparoscopic sleeve gastrectomy as a stand-alone procedure in super-obese patients. Surg Obes Relat Dis. 2018;14(3):297–303.

    PubMed  Google Scholar 

  38. Inabnet WB, 3rd, Winegar DA, Sherif B, Sarr MG. Early outcomes of bariatric surgery in patients with metabolic syndrome: an analysis of the bariatric outcomes longitudinal database. Journal of the American College of Surgeons. 2012;214(4):550-6; discussion 6-7.

    PubMed  Google Scholar 

  39. Jimenez A, Casamitjana R, Flores L, Viaplana J, Corcelles R, Lacy A, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023-9.

    PubMed  Google Scholar 

  40. Jimenez A, Ceriello A, Casamitjana R, Flores L, Viaplana-Masclans J, Vidal J. Remission of type 2 diabetes after Roux-en-Y gastric bypass or sleeve gastrectomy is associated with a distinct glycemic profile. Ann Surg. 2015;261(2):316-22.

    PubMed  Google Scholar 

  41. Keidar A, Hershkop KJ, Marko L, Schweiger C, Hecht L, Bartov N, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia. 2013;56(9):1914-8.

    PubMed  Google Scholar 

  42. Lemus R, Karni D, Hong D, Gmora S, Breau R, Anvari M. The impact of bariatric surgery on insulin-treated type 2 diabetes patients. Surgical endoscopy. 2018;32(2):990-1001.

    PubMed  Google Scholar 

  43. Mas-Lorenzo A, Benaiges D, Flores-Le-Roux JA, Pedro-Botet J, Ramon JM, Parri A, et al. Impact of different criteria on type 2 diabetes remission rate after bariatric surgery. Obesity surgery. 2014;24(11):1881-7.

    CAS  PubMed  Google Scholar 

  44. Menguer RK, Weston AC, Schmid H. Evaluation of metabolic syndrome in morbidly obese patients submitted to laparoscopic bariatric surgery: comparison of the results between Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2017;27(7):1719–23.

    PubMed  Google Scholar 

  45. Mohos E, Schmaldienst E, Prager M. Quality of life parameters, weight change and improvement of co-morbidities after laparoscopic Roux Y gastric bypass and laparoscopic gastric sleeve resection--comparative study. Obes Surg. 2011;21(3):288-94.

    Google Scholar 

  46. Murphy R, Clarke MG, Evennett NJ, et al. Laparoscopic sleeve gastrectomy versus banded Roux-en-Y gastric bypass for diabetes and obesity: a prospective randomised double-blind trial. Obes Surg. 2018;28(2):293–302.

    Google Scholar 

  47. Nosso G, Griffo E, Cotugno M, et al. Comparative effects of Roux-en-Y gastric bypass and sleeve gastrectomy on glucose homeostasis and incretin hormones in obese type 2 diabetic patients: a one-year prospective study. Hormone Metab Res. 2016;48(5):312–7.

    CAS  PubMed  Google Scholar 

  48. Peterli R, Wolnerhanssen BK, Vetter D, Nett P, Gass M, BorbÈly Y, et al. Laparoscopic Sleeve Gastrectomy Versus Roux-Y-Gastric Bypass for Morbid Obesity-3-Year Outcomes of the Prospective Randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS). Annals of surgery [Internet]. 2017; 265(3):466-73.

    PubMed  Google Scholar 

  49. Pournaras DJ, Aasheim ET, Sovik TT, Andrews R, Mahon D, Welbourn R, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. The British journal of surgery. 2012;99(1):100-3.

    Google Scholar 

  50. Robert M, Ferrand-Gaillard C, Disse E, et al. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg. 2013;23(6):770–5.

    CAS  PubMed  Google Scholar 

  51. Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA. 2018;319(3):241–54.

    PubMed  PubMed Central  Google Scholar 

  52. Stallard R, Sahai V, Drover JW, Chun S, Keresztes C. Defining and Using Preoperative Predictors of Diabetic Remission Following Bariatric Surgery. JPEN Journal of parenteral and enteral nutrition. 2017 Mar 1:148607117697934.

  53. Thereaux J, Corigliano N, Poitou C, et al. Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI >/= 50 kg/m(2). Surg Obes Relat Dis. 2015;11(4):785–90.

  54. Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18(9):1077–82.

    CAS  PubMed  Google Scholar 

  55. Vitello DJ, Beach-Bachmann J, Vitello JM. Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution. Obes Surg. 2016;26(8):1906-11.

    Google Scholar 

  56. Wallenius V, Dirinck E, Fandriks L, Maleckas A, le Roux CW, Thorell A. Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus. Obesity surgery. 2017. https://doi.org/10.1007/s11695-017-3061-3.

    PubMed Central  Google Scholar 

  57. Yaghoubian A, Tolan A, Stabile BE, Kaji AH, Belzberg G, Mun E, et al. Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year. The American surgeon. 2012;78(12):1325-8.

  58. Zenti MG, Rubbo I, Ceradini G, Rinaldi E, Nadalini L, Battistoni M, et al. Clinical factors that predict remission of diabetes after different bariatric surgical procedures: interdisciplinary group of bariatric surgery of Verona (G.I.C.O.V.). Acta diabetologica. 2015;52(5):937-42.

    CAS  PubMed  Google Scholar 

  59. Zhang N, Maffei A, Cerabona T, et al. Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy? Surg Endosc. 2013;27(4):1273–80.

    PubMed  Google Scholar 

  60. Omana JJ, Nguyen SQ, Herron D, et al. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surg Endosc. 2010 Oct;24(10):2513–7.

    PubMed  Google Scholar 

  61. Vitiello A, Pilone V, Ferraro L, et al. Is the sleeve gastrectomy always a better procedure? Five-year results from a retrospective matched case- control study. Obes Surg. 2018 Mar;16

  62. Fruhbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015 Aug;11(8):465–77.

    PubMed  Google Scholar 

  63. Boido A, Ceriani V, Cetta F, et al. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2015 May;25(5):437–43.

    CAS  PubMed  Google Scholar 

  64. Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. Jama. 2018 Jan 16;319(3):255–65.

    PubMed  PubMed Central  Google Scholar 

  65. Li J, Lai D, Wu D. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2016 Feb;26(2):429–42.

    PubMed  Google Scholar 

  66. Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015 Jan;25(1):19–26.

    PubMed  Google Scholar 

  67. Li JF, Lai DD, Ni B, et al. Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Canadian journal of surgery Journal canadien de chirurgie. 2013 Dec;56(6):E158–64.

    PubMed  PubMed Central  Google Scholar 

  68. Melissas J, Stavroulakis K, Tzikoulis V, et al. Sleeve gastrectomy vs Roux-en-Y gastric bypass. Data from IFSO-European chapter Center of Excellence Program. Obes Surg. 2017 Apr;27(4):847–55.

    PubMed  Google Scholar 

  69. Zhu Y, Sun Z, Du Y, et al. Evaluation of insulin resistance improvement after laparoscopic sleeve gastrectomy or gastric bypass surgery with HOMA-IR. Biosci Trends. 2017;11(6):675–81.

    CAS  PubMed  Google Scholar 

  70. Peterli R, Wolnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009 Aug;250(2):234–41.

    PubMed  Google Scholar 

  71. Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008 Feb;31(Suppl 2):S290–6.

    PubMed  Google Scholar 

  72. Santiago-Fernandez C, Garcia-Serrano S, Tome M, et al. Ghrelin levels could be involved in the improvement of insulin resistance after bariatric surgery. Endocrinol Diabetes Nutr. 2017 Aug – Sep;64(7):355–62.

    PubMed  Google Scholar 

  73. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide- YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008 Mar;247(3):401–7.

    PubMed  Google Scholar 

  74. Aminian A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017 Oct;266(4):650–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Ferdous Madadi, Rami Jawad & Ismail Mousati

  2. Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Ferdous Madadi

  3. Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Philip Plaeke

  4. Department of Abdominal Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Guy Hubens

  5. Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Guy Hubens

Authors
  1. Ferdous Madadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rami Jawad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ismail Mousati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philip Plaeke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guy Hubens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ferdous Madadi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madadi, F., Jawad, R., Mousati, I. et al. Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis. OBES SURG 29, 4066–4076 (2019). https://doi.org/10.1007/s11695-019-04199-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04199-3

Keywords

Search

Navigation