• Beat P Müller-Stich, Jonas D Senft, René Warschkow, Hannes G Kenngott, Adrian T Billeter, Gianmatteo Vit, Stefanie Helfert, Markus K Diener, Lars Fischer, Markus W Büchler, and Peter P Nawroth.
• *Department of General, Visceral and Transplantation Surgery †Institute of Medical Biometry and Informatics ‡Study Center of the German Surgical Society (SDGC) §Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany ¶Department of Surgery, Kantonsspital St Gallen, Rorschacher Strasse 95, CH-9007 St Gallen, Switzerland.
• Ann. Surg.. 2015 Mar 1;261(3):421-9.

ObjectiveTo compare surgical versus medical treatment of type 2 diabetes mellitus (T2DM) remission and comorbidities in patients with a body mass index (BMI) less than 35 kg/m2.BackgroundObesity surgery can achieve remission of T2DM and its comorbidities. Metabolic surgery has been proposed as a treatment option for diabetic patients with BMI less than 35 kg/m2 but the efficacy of metabolic surgery has not been conclusively determined.MethodsA systematic literature search identified randomized (RCT) and nonrandomized comparative observational clinical studies (OCS) evaluating surgical versus medical T2DM treatment in patients with BMI less than 35 kg/m2. The primary outcome was T2DM remission. Additional analyses comprised glycemic control, BMI, HbA1c level, remission of comorbidities, and safety. Random effects meta-analyses were calculated and presented as weighted odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CI).ResultsFive RCTs and 6 OCSs (706 total T2DM patients) were included. Follow-up ranged from 12 to 36 months. Metabolic surgery was associated with a higher T2DM remission rate (OR: 14.1, 95% CI: 6.7-29.9, P < 0.001), higher rate of glycemic control (OR: 8.0, 95% CI: 4.2-15.2, P < 0.001) and lower HbA1c level (MD: -1.4%, 95% CI -1.9% to -0.9%, P < 0.001) than medical treatment.Bmi (Md-5.5 kg/m2, 95% CI: -6.7 to -4.3 kg/m2, P < 0.001), rate of arterial hypertension (OR: 0.25, 95% CI: 0.12-0.50, P < 0.001) and dyslipidemia (OR: 0.21, 95% CI: 0.10-0.44, P < 0.001) were lower after surgery.ConclusionMetabolic surgery is superior to medical treatment for short-term remission of T2DM and comorbidities. Further RCTs should address the long-term effects on T2DM complications and mortality.

13 keywords...

hide…