Roux-en-Y gastric bypass versus sleeve gastrectomy for remission of type 2 diabetes

CONTEXT: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the bariatric procedures most commonly used for the management of obesity. Whether one or the other is associated with a higher chance of remission of type 2 diabetes (T2D) is unclear.

OBJECTIVE: To compare the efficacy of RYGB and SG for T2D remission at 1, 3 and 5 years after surgery.

DATA SOURCES: Four databases were searched until January 2020.

STUDY SELECTION: Randomized controlled studies with at least 12 months of follow-up of patients with T2D allocated to RYGB or SG were selected.

DATA EXTRACTION: To ensure uniformity, broad and narrow criteria for T2D remission were defined. The number of patients achieving remission of T2D at each assessment was extracted. Data were pooled using a random-effects model.

DATA SYNTHESIS: Ten studies were included, evaluating 778 patients. The overall prevalence of achievement of broad and narrow criteria for T2D remission was 73% and 53% at the 1-year, 60% and 48% at the 3-year, 51% and 43% at the 5-year assessment. Compared to SG, RYBG was associated with a higher chance of achieving broad and narrow criteria for remission at 1 year after surgery (RR=1.34 versus RR=1.22) and broad criteria for remission at 5 years (RR=1.18). No other differences were found.

CONCLUSIONS: The present meta-analysis suggests a more favorable effect of RYGB than SG on achieving T2D remission in the short-term only, although the evidence currently available does not clarify whether differences in this outcome are confirmed long term or fade thereafter.