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Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis
Surgery for Obesity and Related Diseases 5 (2009) 409
Announcement For the readers of SOARD, this important meta-analysis on the effects of bariatric surgery for type 2 diabetes mellitus was published in the March 2009 issue of the American Journal of Medicine.
Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis Henry Buchwald, MD, PhD,a Rhonda Estok, RN, BSN,b Kyle Fahrbach, PhD,b Deirdre Banel, BA,b Michael D. Jensen, MD,c Walter J. Pories, MD,d John P. Bantle, MD,e Isabella Sledge, MD, MPHb a
Department of Surgery, University of Minnesota, Minneapolis; bUnited BioSource Corporation, Medford, Mass; cDepartment of Medicine, Mayo Clinic College of Medicine, Rochester, Minn; dDepartment of Surgery, East Carolina University School of Medicine, Greenville, NC; eDepartment of Medicine, University of Minnesota, Minneapolis.
ABSTRACT BACKGROUND: The prevalence of obesity-induced type 2 diabetes mellitus is increasing worldwide. The objective of this review and meta-analysis is to determine the impact of bariatric surgery on type 2 diabetes in association with the procedure performed and the weight reduction achieved. METHODS: The review includes all articles published in English from January 1, 1990, to April 30, 2006. RESULTS: The dataset includes 621 studies with 888 treatment arms and 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes, that is, the resolution of the clinical and laboratory manifestations of type 2 diabetes. Nineteen studies with 43 treatment arms and 11,175 patients reported both weight loss and diabetes resolution separately for the 4070 diabetic patients in these studies. At baseline, the mean age was 40.2 years, body mass index was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more. CONCLUSION: 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 2 years or more. © 2009 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2009) 122, 248-256
Erratum Dr. Roslin has provided the following disclosures related to his Review article in the March/April issue of SOARD, Roslin MS, Oren JH, Shah PC. What should be criteria for adoption of new procedures and devices in bariatric surgery? Surg Obes Relat Dis 2009;5:263-8: Dr. Roslin is a
member of the advisory board of Valentx, and on the advisory board of scientific intake for Covidien. He has licensed patents to CR Bard, Allergan, and Johnson and Johnson, assigned by Cyberonics. He is founder of Ventralfix.
1550-7289/09/$ – see front matter © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2009.04.007
Announcement For the readers of SOARD, this important meta-analysis on the effects of bariatric surgery for type 2 diabetes mellitus was published in the March 2009 issue of the American Journal of Medicine.
Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis Henry Buchwald, MD, PhD,a Rhonda Estok, RN, BSN,b Kyle Fahrbach, PhD,b Deirdre Banel, BA,b Michael D. Jensen, MD,c Walter J. Pories, MD,d John P. Bantle, MD,e Isabella Sledge, MD, MPHb a
Department of Surgery, University of Minnesota, Minneapolis; bUnited BioSource Corporation, Medford, Mass; cDepartment of Medicine, Mayo Clinic College of Medicine, Rochester, Minn; dDepartment of Surgery, East Carolina University School of Medicine, Greenville, NC; eDepartment of Medicine, University of Minnesota, Minneapolis.
ABSTRACT BACKGROUND: The prevalence of obesity-induced type 2 diabetes mellitus is increasing worldwide. The objective of this review and meta-analysis is to determine the impact of bariatric surgery on type 2 diabetes in association with the procedure performed and the weight reduction achieved. METHODS: The review includes all articles published in English from January 1, 1990, to April 30, 2006. RESULTS: The dataset includes 621 studies with 888 treatment arms and 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes, that is, the resolution of the clinical and laboratory manifestations of type 2 diabetes. Nineteen studies with 43 treatment arms and 11,175 patients reported both weight loss and diabetes resolution separately for the 4070 diabetic patients in these studies. At baseline, the mean age was 40.2 years, body mass index was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more. CONCLUSION: 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 2 years or more. © 2009 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2009) 122, 248-256
Erratum Dr. Roslin has provided the following disclosures related to his Review article in the March/April issue of SOARD, Roslin MS, Oren JH, Shah PC. What should be criteria for adoption of new procedures and devices in bariatric surgery? Surg Obes Relat Dis 2009;5:263-8: Dr. Roslin is a
member of the advisory board of Valentx, and on the advisory board of scientific intake for Covidien. He has licensed patents to CR Bard, Allergan, and Johnson and Johnson, assigned by Cyberonics. He is founder of Ventralfix.
1550-7289/09/$ – see front matter © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2009.04.007