Metabolic Bariatric Surgery Effective for Overweight, Obesity in Type 2 Diabetes

Metabolic bariatric surgery is effective for treatment of type 2 diabetes (T2D) among patients with overweight or obesity, according to study findings published in Diabetes, Obesity and Metabolism.

Patients with a body mass index (BMI) greater than 35 kg/m² with T2D are eligible for bariatric surgery. The main goal of this treatment is to improve gluco-metabolic control, with weight loss as a secondary aim. Researchers conducted a network meta-analysis to assess the efficacy and safety of metabolic bariatric surgery among patients with T2D and overweight or obesity. 

Researchers analyzed randomized controlled trials with a study duration of at least 52 weeks that compared different types of metabolic surgery vs nonsurgical treatments among patients with T2D.

The primary endpoints included partial (hemoglobin A1c [HbA1c] <6.5%) and complete (HbA1c <6%) diabetes remission without pharmacological therapy, HbA1c, and BMI of patients. 

A total of 36 trials were included in the analysis, 19 of which enrolled patients with T2D exclusively and 17 which included a wider patient population.

The treatment discontinuation rate was 3.1% for Roux-en-Y gastric bypass (RYGB), 4.5% for laparoscopic adjustable gastric banding, and 0% for biliopancreatic diversion (BPD).

Of the studies reporting HbA1c (n=11) and fasting plasma glucose (FPG) (n=10), metabolic bariatric surgery was associated with a greater reduction in HbA1c; however, this association was not observed for FPG.

Metabolic bariatric surgery also resulted in partial (32.9% vs 13.8%) and complete (31.1% vs. 7.7%) remission of diabetes when compared with control groups, respectively.

The meta-regression analyses reported an association between higher baseline HbA1c and a higher diabetes remission rate. 

Compared with control groups, patients who underwent bariatric metabolic surgery had greater dyslipidemia remission rates (33.7% vs 52.7%; P <.001).

The network meta-analysis revealed a significant reduction in HbA1c among patients who underwent one-anastomosis gastric bypass (OAGB) vs sleeve gastrectomy (weighted mean difference, -11.0 mmol/mol). Patients who underwent BPD, RYGB, and OAGB experienced a significant reduction in BMI. 

Study limitations included the potential for placebo effect and bias among included trials, the number of patients lost to follow-up, and the lack of patient-level data available. 

“Further long-term trials of appropriate quality are needed for the assessment of risk-benefit ratio in some sub-populations, such as patients with a BMI of less than 30 kg/m² and those aged older than 65 years,” study authors stated.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.