Outcomes of Metabolic Surgery

Age (mean) (years)

BMI (mean) (kg/m²)

T2DM duration (mean)

Follow-up (years)

Surgical intervention

Enrollment

Mingrone et al.

6 years

RYGB/BPD

Dixon et al.

≤2 years

LAGB

Schauer et al.

8.5 years

RYGB/SG

150

	T2DM remission^a (%)	HbA1c change (%)	EWL (%)	Systolic BP change (%)	Diastolic BP change (%)	LDL change (%)	HDL change (%)	Triglyceride change (%)	Total cholesterol change (%)
Mingrone et al.
RYGB	75	−25 (21)	68 (13)	−9 (8)	−7 (9)	−17 (36)	30 (18)	−21 (41)	−7 (27)
BPD	95	−43 (10)	69 (18)	−15 (13)	−13 (9)	−65 (16)	13 (21)	−57 (17)	−49 (12)
MED	0	−8 (10)	9 (13)	−11 (13)	−7 (12)	−20 (15)	6 (6)	−18 (8)	−17 (12)
Dixon et al.
LAGB	73	−23	63	−4	−1	N/A	27	−38	2
MED	13	−5	4	−1	−1	N/A	5	−1	0
Schauer et al.
RYGB	42	−31	88	−2	−4	12 (49)	29 (23)	−44	1 (27)
SG	27	−31	81	−4	−4	17 (53)	28 (22)	−42	4 (24)
MED	0	−16	13	−3	−5	3 (38)	11 (26)	−14	−0.3 (24)

BMI body mass index, T2DM type 2 diabetes mellitus, HbA1c glycated hemoglobin, EWL excess weight loss, BP blood pressure, LDL low-density lipoprotein, HDL high-density lipoprotein, RYGB Roux-en-Y gastric bypass, LAGB laparoscopic adjustable gastric banding, MED medical management, SG sleeve gastrectomy, BPD biliopancreatic diversion

^aRemission of T2DM criteria without the use of glycemic medications: Mingrone et al., HbA1c < 6.5 % and fasting glucose < 100 mg/dl; Dixon et al., HbA1c < 6.2 % and fasting glucose < 126 mg/dl; Schauer et al., HbA1c ≤ 6.0 %

The first published RCT by Dixon et al. [27] compared conventional diabetes therapy with a focus on weight loss by lifestyle change versus laparoscopic adjustable gastric banding with conventional diabetes care in 60 obese patients (BMI 30–40 kg/m²) with recently diagnosed T2DM (<2 years). At the end of the 2-year follow-up period, 73 % in the surgical group and 13 % in the conventional group achieved remission of diabetes (defined as fasting glucose level <126 mg/dl and glycated hemoglobin [HbA1c] value <6.2 % while taking no glycemic therapy). Remission of type 2 diabetes was related to weight loss and lower baseline HbA1c levels. In addition to glycemic benefits, the surgical group had a significantly greater improvement in insulin resistance and in levels of triglycerides and HDL cholesterol. Although there was no significant blood pressure difference between study participants in the surgical and conventional-therapy groups, there was a significant reduction in use of antihypertensive agents in the surgical group. There also was a reduction in the use of lipid-lowering medications in the surgical group (12/29 at baseline and 4/29 at 2 years, P = .02) but no significant change in the conventional-therapy group (8/26 at baseline and 7/26 at 2 years).

Mingrone et al. [28

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