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Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis

Beat P Müller-Stich, Jonas D Senft, Rene Warschkow, Hannes G Kenngott, Adrian T Billeter, Gianmatteo Vit, Stefanie Helfert, Markus K Diener, Lars Fischer, Markus W Büchler & Peter P Nawroth

abstract

OBJECTIVE
To 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.

BACKGROUND
Obesity 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.

METHODS
A 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).

RESULTS
Five 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.

CONCLUSION
Metabolic 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.
   
keywords *Bariatric Surgery
Diabetes Mellitus, Type 2/complications/*surgery/therapy
Humans
Obesity/complications/*surgery/therapy
Obesity, Morbid
   
citation Müller-Stich B P, Senft J D, Warschkow R, Kenngott H G, Billeter A T, Vit G, Helfert S, Diener M K, Fischer L, Büchler M W, Nawroth P P. Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis. Ann Surg 2015; 261:421-429.
   
type journal paper/review (English)
date of publishing 6-3-2015
journal title Ann Surg (261/3)
ISSN electronic 1528-1140
pages 421-429
PubMed 25405560
DOI 10.1097/SLA.0000000000001014
contact Ulrich Beutner