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Bariatric surgery more effective than medical therapy

Paper calls for more randomised controlled trials to increase the evidence base

A retrospective literature review has reported that bariatric procedures were more likely to help obese patients with type 2 diabetes to achieve benefits, than medical therapy alone. The study, which was published online in the BioMed Research International journal, concluded that in order to provide additional evidence further intensive high-quality randomised controlled trials at multiple centres with long-term follow-up should be performed.

The study researchers from the Department of General Surgery and the Hepatic-Biliary-Pancreatic Institute, Lanzhou University Second Hospital, Lanzhou, China, wanted to assess the effects of bariatric surgery versus medical therapy for type 2 diabetes mellitus.

Following a literature search, they identified three randomised controlled trials from 269 publications. These three studies included 170 patients in the bariatric surgery group and 100 patients in the medical therapy group.

They reported that compared with medical therapy, bariatric surgery for type 2 diabetes can significantly decrease the levels of HbA1c, FBG, weight, triglycerides, and the dose of hypoglycaemic, antihypertensive, and lipid-lowering medicine, while increasing the rate of diabetes remission (RR=9.74, 95%CI, (1.36, 69.66)) and the levels of high-density lipoprotein.

However, they noted are no statistical differences in serious adverse events between the surgical and medical groups (RR=1.23, 95%CI, (0.80, 1.87)).

Only two of the studies reported the diabetes remission rates, with significant heterogeneity between surgical and medical groups (I2 = 53%, p=0.03). Bariatric surgery was associated with significantly increasing the diabetes remission (RR=9.74, 95% CI, (1.36, 69.66)). Schauer et al. reported that proportion of patients with HbA1c ≤ 6% was 39.39% in surgical group and 12% in medical group, 12 months after surgery. Overall, they noted that the results suggested that bariatric surgery could effectively improve patients' glycaemic control after two years after undergoing operations.

“This meta-analysis showed that bariatric procedures could significantly induce and maintain well-glycaemic control, which was confirmed by the results of several other studies,” they write. “The gastric bypass, gastric banding, gastrectomy, and biliopancreatic diversion decreased HbA1c by 0.79%, 1.13%, 0.89%, and 3.46%, respectively, when compared with medical therapy; the gastric bypass, gastric banding, and biliopancreatic diversion decreased FBG by 23.44%, 32.8mg/dL, and 27.14% at baseline, respectively.”

The investigators also highlighted significant differences in the change in the number of patients without hypoglycaemia between all surgical groups and medical groups. Patients in the gastric bypass group, gastric banding group and sleeve gastrectomy group all significantly increased the number of subjects without hypoglycaemia compared with medical group.

With regard to weight loss, bariatric procedures significantly decreased the patients' weight, compared with medial therapy alone.

“The results of our meta-analysis showed that bariatric surgery could not only significantly decrease the levels of HbA1c, FBG, the amount of medicines (including hypoglycaemic, antihypertensive, and lipid-lowering ones), weight, and triglycerides,” the authors note, “but also increase the rate of diabetes remission and the levels of high-density lipoprotein. Meanwhile, there were no statistical differences in the serious adverse events between surgical and medical groups.”

The researchers acknowledge that their meta-analysis is limited by the scarcity of research, the different operative methods and procedures performed by different surgeons, and the small follow-up period (12-24 months). To overcome this shortfall of empirical data, they call for the creation of additional randomised controlled trials to confirm their findings.

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