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Outcomes of Bariatric Surgery Versus Medical Management for Type 2 Diabetes Mellitus: a Meta-Analysis of Randomized Controlled Trials

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Abstract

Introduction

Bariatric surgery improves type 2 diabetes (T2D) in obese patients. The sustainability of these effects and the long-term results have been under question.

Objective

To compare bariatric surgery versus medical management (MM) for T2D based on a meta-analysis of randomized controlled trials (RCTs) with 2 years of follow-up.

Material and Methods

Seven RCTs with at least 2-year follow-up were identified. The primary endpoint was remission of T2D (full or partial). Four hundred sixty-three patients with T2D and body mass index > 25 kg/m2 were evaluated.

Results

After 2 years, T2D remission was observed in 138 of 263 patients (52.5%) with bariatric surgery compared to seven of 200 patients (3.5%) with MM (risk ratio (RR) = 10, 95% CI 5.5–17.9, p < 0.001). Subgroup analysis of the Roux-en-Y gastric bypass (RYGB) showed a significant effect size at 2 years in favor of RYGB over MM for a higher decrease of HbA1C (0.9 percentage points, 95% CI 0.6–1.1, p < 0.001), decrease of fasting blood glucose (35.3 mg/dl, 95% CI 13.3–57.3, p = 0.002), increase of high-density lipoprotein (HDL) (12.2 mg/dl, 95% CI 7.6–16.8, p < 0.001), and decrease of triglycerides (32.4 mg/dl, 95% CI 4.5–60.3, p = 0.02). Four studies followed patients up to 5 years and showed 62 of 225 patients (27.5%) with remission after surgery, compared to six of 156 patients (3.8%) with MM (RR = 6, 95% CI 2.7–13, p < 0.001).

Conclusion

This meta-analysis shows a superior and persistent effect of bariatric surgery versus MM for inducement of remission of T2D. This benefit of bariatric surgery was significant at 2 years and superior to MM even after 5 years. Compared with MM, patients with RYGB had better glycemic control and improved levels of HDL and triglycerides.

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Acknowledgments

The authors gratefully acknowledge the thoughtful guidance and critical comments of Michael G. Sarr, MD (Department of Gastroenterology and General Surgery, Mayo Clinic, Rochester, MN).

Registration

This study has been registered in the international prospective register of systematic reviews (PROSPERO, registration number CRD42016037105).

Author information

Authors and Affiliations

  1. Department of Surgery, College of Medicine, University of Oklahoma, 4502 E 41st Street, Tulsa, OK, 74135, USA

    Zhamak Khorgami, C. Anthony Howard & Guido M. Sclabas

  2. Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Bariatric and Metabolic Institute, Brooklyn, NY, USA

    Saeed Shoar

  3. Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA

    Alan A. Saber

  4. Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA

    Goodarz Danaei

  5. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

    Goodarz Danaei

Authors
  1. Zhamak Khorgami
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  2. Saeed Shoar
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Corresponding author

Correspondence to Zhamak Khorgami.

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The authors declare that they have no conflict of interest.

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

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Supplementary Figure 1

Comparison of T2D remission (full or partial) between bariatric surgery and medical management after 5 years (PNG 427 kb)

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Khorgami, Z., Shoar, S., Saber, A.A. et al. Outcomes of Bariatric Surgery Versus Medical Management for Type 2 Diabetes Mellitus: a Meta-Analysis of Randomized Controlled Trials. OBES SURG 29, 964–974 (2019). https://doi.org/10.1007/s11695-018-3552-x

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  • DOI: https://doi.org/10.1007/s11695-018-3552-x

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