MedWire News: A meta-analysis shows that Type 2 diabetes is resolved in 78% of severely obese patients after bariatric surgery and improved or resolved in 87% of patients.
The prevalence of Type 2 diabetes is rising worldwide due to the increasing occurrence of obesity and sedentary lifestyle. Bariatric surgery is frequently associated with resolution of Type 2 diabetes.
To determine the impact of bariatric surgery on Type 2 diabetes, Henry Buchwald (University of Minnesota, Minneapolis, MN, USA) and colleagues evaluated all studies on banding, gastroplasty, gastric bypass, and biliopancreatic diversion/duodenal switch published between January 1990 and April 2006.
Diabetes-related outcomes were expressed as the percentage of patients with their clinical and laboratory manifestations of diabetes resolved (off diabetes medications with normal fasting blood glucose [less than 100 mg/dl] or glycated hemoglobin), improved (decreased dose of diabetes medications or more normal fasting blood glucose [100-125 mg/dl]), resolved or improved, unchanged, and worsened.
The data set included 621 studies with 135,246 patients.
The authors report in the American Journal of Medicine that, overall, 78.1% of patients with diabetes had complete resolution and 86.6% had their diabetes improved or resolved as a result of the bariatric surgery.
“This systematic review and meta-analysis demonstrates that bariatric surgery has a powerful treatment effect in morbidly obese persons with Type 2 diabetes,” they write.
In the studies reporting only on diabetic patients, 82% of patients had resolution of the clinical and laboratory manifestations of diabetes in the first 2 years after surgery, and 62% remained free of diabetes more than 2 years after surgery.
Weight loss and diabetes resolution varied by the type of bariatric procedure performed and were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures.
The study also showed that the resolution or improvement in Type 2 diabetes is related to the weight loss achieved by morbidly obese people with diabetes.
They authors conclude that randomized clinical trials comparing surgery and medical therapies for Type 2 diabetes are urgently required and should assess the risk/benefit ratio of surgery in both obese and morbidly obese populations.
In an accompanying Editorial, Stuart Chipkin (University of Massachusetts, Amherst, USA) and Robert Goldberg (University of Massachusetts Medical School, Worcester, Massachusetts, USA) cautioned that while surgery may play an important role for short-term changes in glucose control in some patients with Type 2 diabetes, much more research is required before this can be regarded as a long-term cure.
They also note that although the meta-analysis included a large sample of patients with diabetes of varying duration, the study population consisted primarily of obese women and had a mean age of 40 years.
Prospective surgical studies need to enroll more varied patient populations, both in terms of diabetes duration and severity, as well as according to age, gender, and ethnicity to determine the applicability of these findings for broader populations with Type 2 diabetes.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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