1. Weight loss and glycemic control are improved in the short term to a greater extent in nonmorbidly obese diabetic patients who have undergone bariatric surgery relative to nonsurgical intervention.
2. Gastric bypass was more effective than gastric banding for weight loss and glycemic control.
3. Since the literature does not include sufficient follow up beyond 2 years for bariatric surgery outcomes, nonsurgical interventions currently have more evidence to support its efficacy for longitudinal glycemic control.
Evidence Rating Level: 1 (Excellent)
Study Rundown: This systematic review demonstrates that numerous variables, including weight loss, HbA1, fasting blood glucose levels, blood pressure, and hyperlipidemia, are improved to a greater extent with bariatric surgery than with nonsurgical inteventions in nonmorbidly obese diabetic patients. However, the overwhelming majority of studies which were reviewed had a follow up period of two years or less. Therefore, there is not enough data available to conclude that all of the aforementioned variables are improved on a long term basis with surgical intervention. On the other hand, there is a robust literature evaluating the role of nonsurgical interventions such as behavior and medication modifications for improved glycemic control with established long-term efficacy.
Strengths of this systematic review include a selection of studies from reliable sources and categorization of trials by strength (direct versus indirect comparisons). Limitations of this systematic review include: 1) the individual bias of each included study; 2) surgical complications in the included studies were generally reported only by the operating surgeons and open to bias; and 3) the non-randomized studies were generally from single-institution retrospective studies from high-volume academic centers, which may not be an accurate indicator of surgical skill and complication rate in most surgical practices.
Relevant Reading: Bariatric surgery: a systematic review and meta-analysis
In-Depth [systematic review]: The authors conducted a literature search using the databases from PubMed, EMBASE and Cochrane library from January 1985-September 2012. The results provided few randomized controlled trials (RCTs) comparing surgical and nonsurgical interventions. Therefore, 32 surgical studies, 11 systematic reviews on nonsurgical treatments and 11 nonsurgical studies that were ultimately chosen for the study. End points included weight loss; metabolic outcomes including HbA1c and fasting blood glucose levels among others; and postoperative adverse events. The end points were quantified using mean change from baseline to follow up. The authors did not statistically pool the three accepted RCTs comparing surgical intervention vs. medical management only, but each study demonstrated greater weight loss in 1-2 years of follow-up relative to medical management (please see review for more details).
By Anne Marie Walters and Rif Rahman
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