Effectiveness of surgical weight loss on the remission of type 2 diabetes mellitus: A systematic review.

Abstract

BACKGROUND: Purposeful weight loss resulting in loss of excess body fat contributes to enhanced health outcomes such as lower blood pressure, lower cholesterol, reduced blood glucose levels, and reduced mortality. REVIEW OBJECTIVE: To synthesize the best available evidence regarding the effectiveness of surgical weight loss procedures on the remission of type 2 diabetes mellitus. INCLUSION CRITERIA: Patients 18 years of age and older, females and males with a prior diagnosis of type 2 diabetes mellitus who have undergone a bariatric or surgical weight loss procedure.This review considered surgical weight loss procedures.This review considered as outcome measures: weight loss, body mass index (BMI), hemoglobin A1C values, fasting blood glucose levels, and/or reduction/elimination of antidiabetic medications.This review included randomized controlled trials SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies in English language only from April 2006 through May 2011. The search used multiple databases including MEDLINE, CINAHL, EMBASE, EBSCO, ProQuest, and Science Direct. METHODOLOGICAL QUALITY: The studies were critically appraised using the standardized instruments provided by the Joanna Briggs Institute. DATA COLLECTION: Data was extracted using standardised data extraction form provided by the Joanna Briggs Institute. DATA SYNTHESIS: Due to the heterogeneous nature of the study methods meta-analysis was considered not appropriate. The results are presented in a narrative summary. RESULTS: Five studies compared varying operative techniques, and results substantiate improvement in dynamics directly linked to T2DM: weight loss, BMI, HbA1c values, and utilization of medications for control. CONCLUSIONS: Based on the results of this review surgical weight loss should be considered a best practice recommendation to patients for the treatment and remission of type 2 diabetes mellitus (T2DM) as evidenced by short term effects on weight reduction, change in hemoglobin A1c values, and decrease or elimination of medications to control diabetes IMPLICATIONS FOR PRACTICE: Patients with T2DM should receive counseling from their practitioner to include surgical weight loss as a means to control the untoward effects of this disease with proven short term results when other weight loss attempts fail. IMPLICATIONS FOR RESEARCH: Further studies are warranted to compare the various procedures (LAGB, LRYBG, and LSG) to one another and to conventional therapy with a larger subset of T2DM participants. It would also be important to follow these patients long term in order to adequately assess efficacy on a continuum. Furthermore, researchers need to establish set methods for outcome definition and measurement in order to allow for meta-analysis and better translation into practice.