Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: systemic review and meta-analysis

Abstract Context Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the bariatric procedures most commonly used for the management of obesity. Whether one or the other is associated with a higher chance of remission of type 2 diabetes (T2D) is unclear. Objective This work aims to compare the efficacy of RYGB and SG for T2D remission at 1, 3, and 5 years after surgery. Data Sources Four databases were searched until January 2020. Study Selection Randomized controlled studies with at least 12 months of follow-up of patients with T2D allocated to RYGB or SG were selected. Data Extraction To ensure uniformity, broad and narrow criteria for T2D remission were defined. The number of patients achieving remission of T2D at each assessment was extracted. Data were pooled using a random-effects model. Data Synthesis Ten studies were included, evaluating 778 patients. The overall prevalence of achievement of broad and narrow criteria for T2D remission was 73% and 53% at the 1-year, 60% and 48% at the 3-year, and 51% and 43% at the 5-year assessment. Compared to SG, RYGB was associated with a higher chance of achieving broad and narrow criteria for remission at 1 year after surgery (risk ratio [RR] = 1.34 vs RR = 1.22) and broad criteria for remission at 5 years (RR = 1.18). No other differences were found. Conclusions The present meta-analysis suggests a more favorable effect of RYGB than SG on achieving T2D remission in the short-term only, although the evidence currently available does not clarify whether differences in this outcome are confirmed long term or fade thereafter.

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Gastric Bypass and Sleeve Gastrectomy for Type 2 Diabetes: A Systematic Review and Meta-analysis of Outcomes

Obesity Surgery ◽

10.1007/s11695-013-1030-z ◽

2013 ◽

Vol 23 (12) ◽

pp. 1994-2003 ◽

Cited By ~ 79

Author(s):

Shelley Yip ◽

Lindsay D. Plank ◽

Rinki Murphy

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Meta Analysis

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Laparoscopic Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy for Obese Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

The American Surgeon ◽

10.1177/000313481508100229 ◽

2015 ◽

Vol 81 (2) ◽

pp. 166-171 ◽

Cited By ~ 28

Author(s):

Man Cai Wang ◽

Xiao Hu Guo ◽

Yawu Zhang ◽

Yu Long Zhang ◽

Hui Han Zhang ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Obese Patients ◽

Efficacy And Safety ◽

Randomized Controlled

We aimed to evaluate the efficacy and safety of laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes. We searched the Cochrane Library, PubMed, EMBASE, Google Scholar, and the Chinese Wan fang database up to October 2013. Randomized controlled trials regarding the efficacy and safety of laparoscopic gastric bypass versus sleeve gastrectomy for obese diabetic patients were included. Two review authors independently abstracted data and assessed the risk of bias. The mean difference and relative risk were estimated with 95 per cent confidence intervals. Four randomized controlled trials met inclusion criteria. There was no significant difference between gastric bypass and sleeve gastrectomy groups with regard to glycosylated hemoglobin (mean difference [MD], 0.41%; 95% confidence interval [CI], -0.09 to 0.91), fasting plasma glucose (standardized MD, 0.61 mg/mL; 95% CI, -0.10 to 1.32), the numbers of subjects using oral antihyperglycemic medications and insulin (relative rate [RR], 1.53; 95% CI, 0.45 to 5.24; RR, 1.44; 95% CI, 0.47 to 4.39, respectively), body weight (MD, 0.42 kg; 95% CI, -5.01 to 5.85), body mass index (MD, 0.85 kg/m2; 95% CI, 0.13 to 1.58), or waist circumference (MD, 1.59 cm; 95% CI, -3.02 to 6.19). However, cardiovascular risk was more significantly lessened in the gastric bypass group. Our meta-analysis demonstrated that compared with laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass offers equal efficacy for treatment of diabetes in obese patients but is associated with a significantly decreased cardiovascular risk.

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