Gastric Bypass and Sleeve Gastrectomy for Type 2 Diabetes: A Systematic Review and Meta-analysis of Outcomes
- 2.1k Downloads
Bariatric surgery is effective in the management of type 2 diabetes (T2D) and obesity; however, it is not clear whether Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) is the most effective procedure. This review compared T2D remission and weight loss in patients with T2D after GBP or SG. All human SG or GBP studies published in English between 1 Jan 2007 and 30 April 2012 reporting on BMI and T2D outcomes were included. Analyses were performed separately for the most frequent distinct time points reported after surgery. A total of 21 prospective (three randomised control trials) and 12 retrospective studies, involving 1375 patients met eligibility criteria. T2D remission defined by hemoglobin A1c of <6.5 % for GBP and SG respectively was 67 and 56 % at 3 months, 76 and 68 % at 12 months, and 81 and 80 % at 36 months. Greater percent excess BMI loss occurred at 12 months (72.5 % after GBP and 66.7 % after SG) compared with 3 months (45.9 % after GBP and 25.9 % after SG). There was no significant difference in either T2D remission or weight loss with GBP compared with SG. Both GBP and SG result in similar early remission of T2D in 67 and 56 % of patients at 3 months respectively with modest additional T2D remission with time, although weight loss with both procedures increase substantially between 3 and 12 months post-operatively. Further randomised controlled trials comparing SG and GBP in patients with T2D using comparable definitions of diabetes remission with long-term follow-up are needed to evaluate relative benefits.
KeywordsType 2 diabetes Gastric bypass Sleeve gastrectomy Bariatric surgery Obesity
Conflict of Interest
The authors Shelley Yip, Lindsay Plank, and Rinki Murphy declare that they have no conflict of interest.
- 24.Anonymous. Morbid obesity II and selected papers in bariatric surgery. Gastroenterol Clin North Am 1987; 16:389–544.Google Scholar
- 28.Shah S, Shah P, Todkar J, et al. Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus. Surg Obes Relat Dis Off J Am Soc Bariatric Sur. 2010;6:152–7.CrossRefGoogle Scholar
- 39.ZK C, Krause KR, Chengelis DL, et al. Determinants of the resolution of type 2 diabetes after bariatric surgery. Vasc Dis Prev. 2008;5:75–80.Google Scholar
- 40.Zalesin KC, Krause KR, Chengelis DL, et al. Determinants of the resolution of type 2 diabetes after bariatric surgery. Vasc Dis Prev. 2008;5:75–80.Google Scholar
- 43.Nosso G, Angrisani L, Saldalamachia P, et al. Impact of sleeve gastrectomy onweight loss, glucose homeostasis, and comorbidities in severely obese type 2 diabetic subjects. Journal of Obesity 2011; 2011: Article ID 340867.Google Scholar
- 47.Dorman RB, Serrot FJ, Miller CJ et al. Case-matched outcomes in bariatric surgery for treatment of type 2 diabetes in the morbidly obese patient. Ann Surge 2012;255:287–93.Google Scholar
- 60.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;21:738–43.PubMedCrossRefGoogle Scholar
- 61.Shah B, Sucher K, Hollenbeck CB. Comparison of ideal body weight equations and published height–weight tables with body mass index tables for healthy adults in the United States. Nutr Clin Prac Off publ Am Soc Parenter Enter Nutr. 2006;21:312–9.Google Scholar