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Study finds bariatric surgery resolves T2DM

Study supports previous meta-analyses that surgery resolves type II diabetes mellitus symptoms

According to the results from a systematic review, bariatric surgery resolves symptoms of type II diabetes mellitus (T2DM) in most patients with a body mass index (BMI) below 35kg/m2, without excessive weight loss. The outcomes from this meta-analysis support the findings of two previous meta-analysis including 133,000 patients (621 studies) reported by Buchwald et al. The paper is featured in the journal, Obesity Surgery.

The literature review, performed by Martin Fried and colleagues from the Charles University, Prague, Czech Republic, who examined research articles in English over the last 30 years (1979–2009) that addressed surgical resolution of T2DM in patients with a mean BMI<35. Weighted and simple means (95% CI) were calculated to analsze study outcomes. Sixteen studies met inclusion criteria; 343 patients underwent one of eight procedures with 6–216 months follow-up. Patients lost a clinically meaningful, not excessive, amount of weight. The baseline mean BMI of the pooled cohort was 29.4kg/m2 (overweight) and was reduced to 24.2kg/m2 (normal weight) after follow-up.


Study design


Types of bariatric surgery performed on the patients included: biliopancreatic diversion (BPD; three studies); stomach- and pylorus-preserving BPD (one study); Roux-en-Y gastric bypass (two studies); laparoscopic adjustable gastric banding (three studies); duodenal-jejunal bypass (four studies); mini-gastric bypass (one study); ileal interposition with sleeve gastrectomy (one study); and ileal interposi tion with diverted sleeve gastrectomy (two studies).


Outcomes


By the end of follow-up, the outcomes revealed that 85.3% of patients who were off T2DM medications had fasting plasma glucose approaching normal (105.2mg/dL, reduction of 93.3), and normal glycated hemoglobin, 6% (reduction of 2.7). A subgroup comparison examining different surgical techniques found that BMI reduction and T2DM resolution were greatest following malabsorptive/restrictive procedures. Patients with a baseline BMI between 30.0 and 35.0kg/m2 (moderately obese) also had greater reduction in BMI and diabetes symptoms than those with a BMI between 25.0 and 29 kg/m2 (overweight). There were few complications recorded and operative mortality was 0.29%.


The results of this study provide ‘preliminary evidence to support continued investigation of surgery as a possible means of achieving lasting resolution of T2DM in a vast non-morbidly obese population,” the authors conclude. 


The outcomes concur with the previous meta analysis by Buchwald et al, that concluded: “The clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for two years or more.”

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