Obesity Surgery

, Volume 27, Issue 10, pp 2733–2739 | Cite as

Roux-En-Y Gastric Bypass in Type 2 Diabetes Patients with Mild Obesity: a Systematic Review and Meta-analysis

  • Ricardo Cohen
  • Carel W. Le Roux
  • Silvio Junqueira
  • Rodrigo Antonini Ribeiro
  • Alexandre Luque
Review Article

Abstract

This study aimed to evaluate the effectiveness of only Roux-en-Y gastric bypass (RYGB) in patients with type 2 diabetes (T2D) and body mass index (BMI) of 30–40 kg/m2. A literature search was performed on MEDLINE, Embase, and Cochrane CENTRAL. The searches were performed in February 2017. English was the target language of the publications. The PICO question was used to determine eligibility for studies to be included: population, patient with BMI 30–40 kg/m2; intervention, RYGB; comparison, control group with medical care alone; and outcome, metabolic outcomes. Only randomized clinical trials (RCT) were selected. The main outcome was T2D remission. Secondary outcomes were metabolic effect of RYGB, such as hypertension and dyslipidemia. A total of five RCTs were included. The studies included a larger proportion of women, and the average time of T2D duration ranged between 6 and 10 years with 43.3% of the patients having a BMI below 35 kg/m2. Despite randomization, the baseline demographics such as age, HbA1c, and duration of diabetes were often less favorable in the surgical group. At the longest follow-up, RYGB significantly improves total and partial type 2 remission, OR 17.48 (95% CI 4.28–71.35) and OR 20.71 (95% CI 5.16–83.12), respectively. HbA1c also reduces at longest follow-up in the surgery group (− 1.83 (95% CI − 2.14; − 1.51)). All these three outcomes revealed high level of evidence according to GRADE evaluation. There is already strong evidence that RYGB improves metabolic outcomes for at least 5 years in patients with class I obesity.

Keywords

Roux-en-Y gastric bypass Mild obesity Diabetes Meta-analysis Metabolic surgery 

Supplementary material

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Table S1(DOCX 16 kb)
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Table S2(DOCX 29 kb)
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Figure S1(DOCX 37 kb)
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ESM 1(PDF 90 kb)

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Ricardo Cohen
    • 1
  • Carel W. Le Roux
    • 2
  • Silvio Junqueira
    • 3
  • Rodrigo Antonini Ribeiro
    • 4
  • Alexandre Luque
    • 3
  1. 1.Center for Diabetes and ObesityOswaldo Cruz HospitalSão PauloBrazil
  2. 2.Diabetes Complication Research Centre, UCD Conway Institute, School of Medicine and Medical ScienceUniversity College, DublinDublinIreland
  3. 3.Health Economy Department of Johnson & Johnson Medical DevicesSão PauloBrazil
  4. 4.HTAnalyze consulting; Faculdade Meridional-IMEDPorto AlegreBrazil

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