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


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.


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


Compliance with Ethical Standards


This study received funding from Johnson&Johnson Medical Devices, Brazil, to contract an external and independent vendor to conduct the systematic review and meta-analysis.

Conflicts of Interest

R. Cohen, C. W. Le Roux, S. Junqueira, and A. Luque declare that they have no conflict of interest. R. A. Ribeiro was contracted to conduct the meta- analysis and systematic review.

Ethical Approval

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

Informed Consent

Informed consent in not applicable in this study.

Supplementary material

11695_2017_2869_MOESM1_ESM.docx (16 kb)
Table S1 (DOCX 16 kb)
11695_2017_2869_MOESM2_ESM.docx (30 kb)
Table S2 (DOCX 29 kb)
11695_2017_2869_MOESM3_ESM.docx (37 kb)
Figure S1 (DOCX 37 kb)
11695_2017_2869_MOESM4_ESM.pdf (90 kb)
ESM 1 (PDF 90 kb)


  1. 1.
    Stark Casagrande S, Fradkin JE, Saydah SH, et al. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;36(8):2271–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Yermilov I, McGory ML, Shekelle PW, et al. Appropriateness criteria for bariatric surgery: beyond the NIH guidelines. Obesity (Silver Spring). 2009;17(8):1521–7.CrossRefGoogle Scholar
  3. 3.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMedGoogle Scholar
  4. 4.
    Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by International Diabetes Organizations. Diabetes Care. 2016;39(6):861–77.CrossRefPubMedGoogle Scholar
  5. 5.
    Muller-Stich BP, Senft JD, Warschkow R, et al. Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis. Ann Surg. 2015;261(3):421–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Rao W-S, Shan C-X, Zhang W, et al. A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI. World J Surg. 2015;39(1):223–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A Meta-Analysis Ann Surg. 2015;261(3):459–67.PubMedGoogle Scholar
  8. 8.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus. JAMA Surg. 2014;149(7):707.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment. JAMA Surg. 2015;150(10):931.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ikramuddin S, Korner J, Lee W-J, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Halperin F, Ding S-A, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7):716–26.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ikramuddin S, Billington CJ, Lee W-J, et al. Roux-en-Y gastric bypass for diabetes (the diabetes surgery study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol. 2015;3(6):413–22.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Singh RP, Gans R, Kashyap SR, et al. Effect of bariatric surgery versus intensive medical management on diabetic ophthalmic outcomes. Diabetes Care. 2015;38(3):e32–3.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fox CS, Golden SH, Anderson C, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2015;38(9):1777–803.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Cummings DE, Cohen RV. Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI. Diabetes Care. 2016;39(6):924–33.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ahima RS, Lazar MA. Physiology. The health risk of obesity—better metrics imperative. Science. 2013;341(6148):856–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kenngott HG, Clemens G, Gondan M, et al. DiaSurg 2 trial—surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial—DRKS00004550. Trials. 2013;14:183.CrossRefPubMedPubMedCentralGoogle Scholar

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

Personalised recommendations