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
This is a preview of subscription content, log in to check access.
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.
This article does not contain any studies with human participants or animals performed by any of the authors.
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
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
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMedGoogle Scholar
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
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
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
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
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
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
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
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
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
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
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
Ahima RS, Lazar MA. Physiology. The health risk of obesity—better metrics imperative. Science. 2013;341(6148):856–8.CrossRefPubMedGoogle Scholar
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