Bariatric surgery is more likely to result in diabetes remission and effective blood glucose control than nonsurgical treatments in patients with mild obesity, according to a study published in BMC Endocrine Disorders.
Investigators systematically reviewed literature published between January 2010, and January 2023 after performing a keyword search of the Embase, PubMed/MEDLINE, Scopus, and Cochrane Library databases. The efficacy of surgical and nonsurgical methods for achieving diabetes remission were analyzed in individuals with mild obesity.
The team included a total of 7 articles in the meta-analysis, and participants (n=544) were of White or Asian ethnicity with a BMI between 29 and 35 kg/m2. The studies compared various combinations of nonsurgical treatments, including medical management, GLP-1 analogues, and other antidiabetic drugs, with surgical treatments such as Roux-en-Y gastric bypass surgery, laparoscopic sleeve gastrectomy, and others. A total of 3 were randomized controlled trials, 3 were retrospective cohort studies, and 1 was a prospective study. The main endpoint was diabetes remission, and secondary outcomes were reductions in hemoglobin A1c (HbA1c) levels and fasting plasma glucose (FPG).
Of the 7 studies, 5 reported the number of patients that achieved diabetes remission. Overall, 64% (n=32/50) of participants achieved diabetes remission after surgical intervention, and 2.8% (n=7/250) achieved diabetes remission after nonsurgical treatment (odds ratio [OR], 25.06; 95% CI, 9.58-65.54; P <.00001). A total of 6 studies reported patients’ HbA1clevels. Those treated with bariatric surgery had significantly lower HbA1c levelscompared with those treated with nonsurgical means (mean deviation [MD], -3.81; 95% CI, -4.55 to -3.06; P <.00001). FPG was reported in 4 of the investigations, and participants undergoing bariatric surgery had significantly lower FPG levels than those treated with nonsurgical treatments (MD, -2.61; 95% CI, -3.20 to -2.02; P <.00001).
Study limitations include inconsistencies in type 2 diabetes mellitus remission criteria and follow-up time between studies and a small sample of clinical trials.
“Our finding has revealed that in type 2 diabetes patients with BMI <35 kg/m2, bariatric surgery can achieve better diabetes remission and blood glucose control than nonsurgical treatment,” according to the study authors.
Zhou X, Zeng C. Diabetes remission of bariatric surgery and nonsurgical treatments in type 2 diabetes patients who failure to meet the criteria for surgery: a systematic review and meta-analysis. BMC Endocr Disord. Published online February 22, 2023. doi:10.1186/s12902-023-01283-9