A Meta‐Analysis of Short‐Term Outcomes of Patients with Type 2 Diabetes Mellitus and BMI ≤35 kg/m<sup>2</sup> Undergoing Roux‐en‐Y Gastric Bypass

Rao, Wensheng; Shan, Cheng-Xiang; Zhang, Wei; Jiang, Dao-Zhen; Qiu, Ming

doi:10.1007/s00268-014-2751-4

Cited by 46 publications

(18 citation statements)

References 61 publications

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“…In one study that targeted Chinese type 2 diabetes patients with BMI ≤ 35 kg/m 2 , the surgery was associated with greater weight loss, a higher diabetes remission, and lower incidence of death [26]. This finding is consistent with the conclusion from two meta-analyses of relatively short-term studies (≤2 years) in type 2 diabetes patients with BMI between 30 to 35 kg/m 2 [11,42] and < 30 kg/m 2 [43], suggesting that type 2 diabetes patients with BMI lower than 35 kg/m 2 may also benefit from bariatric surgery. It has been suggested that younger patients may benefit more from bariatric surgery, but benefits do not differ by gender [29].…”

Section: Mortalitysupporting

confidence: 67%

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

et al. 2017

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This systematic review aimed to evaluate the long-term (≥ 5 years) outcomes of bariatric surgery on diabetes remission, microvascular and macrovascular events, and mortality among type 2 diabetes (T2D) patients. Ten articles (one randomized controlled trial and nine cohorts) met the inclusion criteria and were included in this review. Pooled estimates of nine cohort studies showed that surgery significantly increased the diabetes remission (relative risk (RR) = 5.90; 95% CI 3.75-9.28), reduced the microvascular (RR = 0.37; 95% CI = 0.30-0.46) and macrovascular events (RR = 0.52; 95% CI 0.44-0.61), and mortality (RR = 0.21; 95% CI 0.20-0.21) as compared to non-surgical treatment. Available evidence suggests better remission and lower risks of microvascular and macrovascular disease and mortality in the surgery group as compared to non-surgical treatment group in T2D patients after at least 5 years of follow-up.

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Section: Mortalitysupporting

confidence: 67%

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

et al. 2017

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“…Previous studies have shown that the choice of glycaemic thresholds in remission definitions markedly affects the estimates of the proportion of people in remission [ 9 , 38 – 42 ]. Despite a variety of strategies to manage heterogeneous definitions of remission, systematic reviews have acknowledged the limitations of summarising data from primary remission studies and interpreting pooled estimates [ 43 – 46 ]. Our findings confirm and quantify the substantial heterogeneity and ambiguity in defining the glycaemic component of remission.…”

Section: Discussionmentioning

confidence: 99%

Defining remission of type 2 diabetes in research studies: A systematic scoping review

et al. 2020

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Background Remission has been identified as a top priority by people with type 2 diabetes. Remission is commonly used as an outcome in research studies; however, a widely accepted definition of remission of type 2 diabetes is lacking. A report on defining remission was published (but not formally endorsed) in Diabetes Care, an American Diabetes Association (ADA) journal. This Diabetes Care report remains widely used. It was the first to suggest 3 components necessary to define the presence of remission: (1) absence of glucose-lowering therapy (GLT); (2) normoglycaemia; and (3) for duration ≥1 year. Our aim is to systematically review how remission of type 2 diabetes has been defined by observational and interventional studies since publication of the 2009 report. Methods and findings Four databases (MEDLINE, EMBASE, Cochrane Library, and CINAHL) were searched for studies published from 1 September 2009 to 18 July 2020 involving at least 100 participants with type 2 diabetes in their remission analysis, which examined an outcome of type 2 diabetes remission in adults ≥18 years and which had been published in English since 2009. Remission definitions were extracted and categorised by glucose-lowering therapy, glycaemic thresholds, and duration. A total of 8,966 titles/abstracts were screened, and 178 studies (165 observational and 13 interventional) from 33 countries were included. These contributed 266 definitions, of which 96 were unique. The 2009 report was referenced in 121 (45%) definitions. In total, 247 (93%) definitions required the absence of GLT, and 232 (87%) definitions specified numeric glycaemic thresholds. The most frequently used threshold was HbA1c<42 mmol/mol (6.0%) in 47 (20%) definitions. Time was frequently omitted. In this study, a total of 104 (39%) definitions defined time as a duration. The main limitations of this systematic review lie in the restriction to published studies written in English with sample sizes of over 100. Grey literature was not included in the search. Conclusions We found that there is substantial heterogeneity in the definition of type 2 diabetes remission in research studies published since 2009, at least partly reflecting ambiguity in the 2009 report. This complicates interpretation of previous research on remission of type 2 diabetes and the implications for people with type 2 diabetes. Any new consensus definition of remission should include unambiguous glycaemic thresholds and emphasise duration. Until an international consensus is reached, studies describing remission should clearly define all 3 components of remission. Systematic review registration PROSPERO CRD42019144619

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“…A smaller systematic review and meta-analysis recently published by Rao et al (34) examined the effects of RYGB on T2DM among studies whose participants exclusively had a baseline BMI <35 kg/m 2 . This encompassed nine publications, describing a total of 343 participants (baseline BMI range 19–35 kg/m 2 , follow-up 1–7 years.)…”

Section: Evidence Regarding the Use Of Bariatric/metabolic Surgery Tomentioning

confidence: 99%

“…Again, there were no deaths, and surgical complication rates were 6–20%, which is similar to published rates for patients with a baseline BMI ≥35 kg/m 2 (9). All nine articles reported significant HbA 1c reductions after surgery, with an average percent HbA 1c lowering of 2.8 points (34). Overall, surgery reduced fasting blood glucose by 60 mg/dL more than did the various nonsurgical comparator interventions.…”

Section: Evidence Regarding the Use Of Bariatric/metabolic Surgery Tomentioning

confidence: 99%

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2

2016

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OBJECTIVEGlobal usage of bariatric surgery has been dictated for the past quarter century by National Institutes of Health recommendations restricting these operations to individuals with a BMI ≥35 kg/m2. Strong evidence now demonstrates that bariatric procedures markedly improve or cause remission of type 2 diabetes mellitus (T2DM), in part through weight-independent mechanisms, and that baseline BMI does not predict surgical benefits on glycemic or cardiovascular outcomes. This impels consideration of such operations as “metabolic surgery,” which is used expressly to treat T2DM, including among patients with a BMI <35 kg/m2 who constitute the majority of people with diabetes worldwide. Here, we review available evidence to inform that consideration.RESULTSA meta-analysis of the 11 published randomized clinical trials (RCTs) directly comparing bariatric/metabolic surgery versus a variety of medical/lifestyle interventions for T2DM provides level 1A evidence that surgery is superior for T2DM remission, glycemic control, and HbA1c lowering. Importantly, this is equally true for patients whose baseline BMI is below or above 35 kg/m2. Similar conclusions derive from meta-analyses of high-quality nonrandomized prospective comparisons. Meta-analysis of all pertinent published studies indicates that T2DM remission rates following bariatric/metabolic surgery are comparable above and below the 35 kg/m2 BMI threshold. The safety, antidiabetes durability, and benefits on other cardiovascular risk factors from bariatric/metabolic surgery appear roughly comparable among patients with a BMI below or above 35 kg/m2. Further studies are needed to extend long-term findings and measure “hard” macrovascular/microvascular outcomes and mortality in RCTs.CONCLUSIONSExtant data, including level 1A evidence from numerous RCTs, support new guidelines from the 2nd Diabetes Surgery Summit that advocate for the consideration of bariatric/metabolic surgery as one option, along with lifestyle and medical therapy, to treat T2DM among patients with a BMI <35 kg/m2.

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A Meta‐Analysis of Short‐Term Outcomes of Patients with Type 2 Diabetes Mellitus and BMI ≤35 kg/m² Undergoing Roux‐en‐Y Gastric Bypass

Abstract: RYGB was effective for T2DM patients with BMI ≤ 35 kg/m(2). Further clinical studies with long-term follow-up data are necessary to clarify this issue.

Cited by 46 publications

References 61 publications

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

Defining remission of type 2 diabetes in research studies: A systematic scoping review

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2

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A Meta‐Analysis of Short‐Term Outcomes of Patients with Type 2 Diabetes Mellitus and BMI ≤35 kg/m2 Undergoing Roux‐en‐Y Gastric Bypass

Abstract: RYGB was effective for T2DM patients with BMI ≤ 35 kg/m(2). Further clinical studies with long-term follow-up data are necessary to clarify this issue.

Cited by 46 publications

References 61 publications

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

Defining remission of type 2 diabetes in research studies: A systematic scoping review

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI &lt;35 kg/m2

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A Meta‐Analysis of Short‐Term Outcomes of Patients with Type 2 Diabetes Mellitus and BMI ≤35 kg/m² Undergoing Roux‐en‐Y Gastric Bypass

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2