1073 Roux-en-Y Gastric Bypass or Sleeve Gastrectomy Versus Medical Therapy in the Management of Obesity in Patients with Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis

Abstract

Abstract Aim Bariatric Surgery has proven to be effective in achieving diabetic control in morbidly obese patients. Advances in Roux-En-Y Gastric Bypass (RYGB) and Sleeve gastrectomy procedures have influenced this majorly. This review aims to analyse the clinical outcomes by comparing the two procedures and medical therapy, in morbidly obese patients with Type 2 Diabetes Mellitus (T2DM). Method A systematic literature review was conducted in accordance to the PRISMA guidelines to identify relevant articles that compared RYGB, sleeve gastrectomy and medical therapy for obesity in diabetic patients. Primary outcomes included BMI and HbA1c. Results Seven studies were identified enrolling 900 patients. Participants were predominantly female (61.31%) with a mean follow up of 2.71 years. A greater reduction in BMI and HbA1c was noted with both procedures compared to medical therapy. Sleeve gastrectomy was better in reducing BMI than RYGB (SMD = 19.23 [15.61 – 22.84], p<0.01). HbA1c (SMD = -2.37 [-2.72 – -2.02], p<0.01) and Triglycerides (SMD = -0.87 [-1.65 – -0.08], p = 0.03) were statistically significantly in favour of RYGB. No differences were noted between the two procedures in other outcomes including fasting glucose, weight and Blood pressure. Both procedures compared to medical therapy were considered to be superior statistically across all outcomes measured. Conclusions Overall, the study shows the superiority of Bariatric surgery to medical therapy in managing T2DM in obese patients. No significant differences were noted between the types of bariatric surgery, however, there exists a need to perform studies with longer follow up and compare the feasibility of these procedures.