Diabetes remission: sleeve gastrectomy vs Roux-en-Y gastric bypass

  • Madadi F & al.
  • Obes Surg
  • 27 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that type 2 diabetes mellitus (T2DM) remission is less frequently achieved following sleeve gastrectomy (SG) compared with Roux-en-Y gastric bypass (RYGB).

Why this matters

  • Further research is needed to determine the definite role of SG in patients suffering from obesity and T2DM.

Study design

  • 35 studies (5 randomised controlled trials, 8 prospective and 22 retrospective studies) including 18,138 patients with T2DM met eligibility criteria after a search on PubMed and Cochrane Library.
  • T2DM remission rates were compared between patients undergoing SG (n=2480), RYGB (n=10,597) and gastric banding (GB; n=5061).
  • Funding: None disclosed.

Key results

  • At 1-year follow-up, T2DM remission occurred significantly less often after SG vs RYGB (OR, 0.71; 95% CI, 0.56-0.89).
  • After stratifying for different criteria for remission, RYGB appeared superior to SG in terms of T2DM remission, but the difference was not statistically significant.
  • Cessation of antidiabetic drugs was significantly more frequent after RYGB vs SG (OR, 0.73; 95% CI, 0.55-0.96; P=.03).
  • Beyond 1 year of follow-up, T2DM remission rates were lower after SG vs RYGB (OR, 0.76; 95% CI, 0.62-0.94; P=.01).
  • At 1-year follow-up, secondary analysis demonstrated a significant difference of T2DM remission in favour of SG vs GB (OR, 2.17; 95% CI, 1.36-3.47; P=.001).

Limitations

  • Heterogeneity among included studies.