MedWire News: Results from a systematic review suggest that bariatric surgery resolves symptoms of Type 2 diabetes in most patients with a body mass index (BMI) below 35 kg/m2, without excessive weight loss.
Bariatric surgery carried out primarily to initiate weight reduction in morbidly obese (BMI above 35 kg/m2) individuals, many of whom also have Type 2 diabetes, has been found to dramatically reduce or resolve diabetic symptoms, as previously reported by MedWire News.
It has been suggested that bariatric surgery may also improve or resolve symptoms of Type 2 diabetes in those with lower BMIs. Martin Fried (Charles University, Prague, Czech Republic) and colleagues therefore carried out a systematic review of the literature published between 1979 and 2009 to assess whether this was the case.
In total, 16 studies involving 343 patients were included in the review. Patient follow-up ranged from 6 to 216 months. Baseline mean BMI of the pooled cohort was 29.4 kg/m2 (overweight) and was reduced to 24.2 kg/m2 (normal weight) after follow-up.
Types of bariatric surgery included: biliopancreatic diversion (BPD; three studies); stomach- and pylorus-preserving BPD (one study); Roux-en-Y gastric bypass (two studies); laparoscopic adjustable gastric banding (three studies); duodenal-jejunal bypass (four studies); mini-gastric bypass (one study); ileal interposition with sleeve gastrectomy (one study); and ileal interposition with diverted sleeve gastrectomy (two studies).
Writing in the journal Obesity Surgery, the team reports that 85.3% of the patients had stopped taking antidiabetic medication at study completion. In addition, the participants had achieved an almost normal fasting plasma glucose, of 105.2 mg/dl (reduction of 93.3 mg/dl) on average, and a normal mean glycated hemoglobin concentration of 6% (reduction of 2.7%) by the end of follow-up.
When different surgical techniques were compared, weight reduction and resolution of Type 2 diabetes symptoms was greatest in patients who had malabsorptive or restrictive procedures.
Individuals with a baseline BMI between 30.0 and 35.0 kg/m2 (moderately obese) also had greater reduction in BMI and diabetes symptoms than those with a BMI between 25.0 and 29.9 kg/m2 (overweight).
Of note, few complications were recorded and operative mortality was low at 0.29%.
The results of this study provide “preliminary evidence to support continued investigation of surgery as a possible means of achieving lasting resolution of Type 2 diabetes in a vast non-morbidly obese population,” conclude the authors.
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