St. Luke s Medical Center, Philippines
Title: Effects of bariatric surgery on glucose control, weight reduction and disease remission among patients with type 2 diabetes mellitus: A systematic review and meta-analysis
Dr. Dianne Kristine Joy Closa-Bonsol, 30 yo, is a Diplomate in Internal Medicine of the Philippine College of Physicians. At 24 yo, she has finished her MD in the University of the City of Manila, completed specialization training in SLMC by age 29 and subsequently passed the Philippine Specialty Board of Internal Medicine. She has participated in local and international conventions as presenter. One of which is the 4th Diabetes Congress held in Chicago, USA in 2013. She has conducted and authored various studies. Clinical topics such as Cancer Therapy, DM, Metabolic Syndrome, OSA and Immunology were among her research interests.
BACKGROUND: Bariatric procedures aim to reduce weight and appear to have independent metabolic benefits such as blood glucose control. OBJECTIVE: To determine the effectiveness of Bariatric Surgery versus conventional medical therapy on glucose control, weight reduction and disease remission among patients with type 2 diabetes mellitus CONDUCT OF STUDY: Published English-written RCTs from Jan 1, 1990 – June 30, 2012 were included. Participants were type 2 diabetic patients treated with any conventional bariatric procedure, controls were managed medically, and outcomes were quantitatively measured biochemical parameters for blood glucose control. Values of Hba1c, body weight and remission rate were obtained. Heterogeneity was evaluated statistically. Sensitivity and subgroup analyses were performed appropriately. RESULTS: Among 16 articles retrieved, 3 studies met the inclusion criteria. A total of 170 patients underwent bariatric surgery. There is lower HbA1c levels among patients who underwent bariatric surgery compared to those who were given medical therapy alone (p value = 0.03). Likewise, statistically significant lower post-treatment weight is seen among patients who underwent surgery (p value = 0.01). Higher remission rate was also achieved after Bariatric Surgery (p <0.00001), however there is significant heterogeneity (Chi 2 = 3.02; I2 = 0%). CONCLUSION: Among participants, better glycemic control and significantly lower body weight were achieved after Bariatric surgery compared to medical therapy alone. These beneficial effects were seen and sustained for 1 to 2 years following the procedure. A substantial number of patients also achieved disease remission. However, there is high incidence of adverse effects mainly nutrition-related complications and hypoglycemia.