The American Journal of Medicine
Volume 122, Issue 3 , Pages 248-256.e5, March 2009

Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis

  • Henry Buchwald, MD, PhD

      Affiliations

    • Department of Surgery, University of Minnesota, Minneapolis
    • Corresponding Author InformationRequests for reprints should be addressed to Henry Buchwald, MD, PhD, University of Minnesota, 420 Delaware Street SE, MMC 290, Minneapolis, MN 55455
    • ,
  • Rhonda Estok, RN, BSN

      Affiliations

    • United BioSource Corporation, Medford, Mass
    • ,
  • Kyle Fahrbach, PhD

      Affiliations

    • United BioSource Corporation, Medford, Mass
    • ,
  • Deirdre Banel, BA

      Affiliations

    • United BioSource Corporation, Medford, Mass
    • ,
  • Michael D. Jensen, MD

      Affiliations

    • Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn
    • ,
  • Walter J. Pories, MD

      Affiliations

    • Department of Surgery, East Carolina University School of Medicine, Greenville, NC
    • ,
  • John P. Bantle, MD

      Affiliations

    • Department of Medicine, University of Minnesota, Minneapolis
    • ,
  • Isabella Sledge, MD, MPH

      Affiliations

    • United BioSource Corporation, Medford, Mass

Abstract 

Background

The prevalence of obesity-induced type 2 diabetes mellitus is increasing worldwide. The objective of this review and meta-analysis is to determine the impact of bariatric surgery on type 2 diabetes in association with the procedure performed and the weight reduction achieved.

Methods

The review includes all articles published in English from January 1, 1990, to April 30, 2006.

Results

The dataset includes 621 studies with 888 treatment arms and 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes, that is, the resolution of the clinical and laboratory manifestations of type 2 diabetes. Nineteen studies with 43 treatment arms and 11,175 patients reported both weight loss and diabetes resolution separately for the 4070 diabetic patients in these studies. At baseline, the mean age was 40.2 years, body mass index was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more.

Conclusion

The clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for 2 years or more.

Keywords: Bariatric surgery, Biliopancreatic diversion/duodenal switch, Gastric bypass, Gastroplasty, Laparoscopic adjustable gastric banding, Meta-analysis, Type 2 diabetes

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 Funding: This work was supported by Ethicon Endo-Surgery, Inc, a Johnson & Johnson Company, Cincinnati, Ohio.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(08)01064-4

doi:10.1016/j.amjmed.2008.09.041

The American Journal of Medicine
Volume 122, Issue 3 , Pages 248-256.e5, March 2009

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