Association between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients with Diabetes and Obesity: A Systematic Review

Document Type : Review Article

Authors

1 Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Department of Trauma and General Surgery, Zahedan University of Medical Science, Zahedan, Iran.

6 Endocrine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: While significant randomized clinical trials have demonstrated the efficacy of bariatric surgery in the treatment of type 2 diabetes, there remains a notable gap in research exploring the potential risks associated with this procedure in patients with both diabetes and obesity. Despite the compelling evidence of its benefits, the associated risks and mortality outcomes specific to this patient population have not been extensively investigated. To better understand the relationship between bariatric surgery and these potential risks, as well as mortality among individuals with type 2 diabetes, comprehensive observational studies are essential. Method: This systematic review was conducted following the PRISMA guidelines for article selection. Relevant articles were identified by searching keywords related to bariatric surgery, metabolic surgery, diabetes, and type 2 diabetes. These keywords were combined and searched across databases including Google Scholar, PubMed, and ScienceDirect, in accordance with the inclusion and exclusion criteria. A total of 4 articles met the criteria and were included in the final analysis. Result: Among the 4 articles related to bariatric surgery and adverse diabetes outcomes in patients with diabetes and obesity, it can be concluded that although bariatric surgery offers many advantages, including a significant reduction in blood glucose levels and the achievement of stable glycemic control, it also has certain disadvantages. Conclusion: Although bariatric surgery offers many benefits, it also presents significant risks for patients with diabetes and a BMI of 35 or higher. These risks may lead to various complications, including worsening of diabetic retinopathy and severe hypoglycemia.

Keywords

Main Subjects


  1. World Health Organization. Obesity: preventing and managing the global epidemic. WHO Obesity Technical Report Series 894. Geneva, Switzerland: World Health Organization, 2000.
  2. Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329-30.
  3. Buchwald H. The future of bariatric surgery. Obes Surg. 2005; 15:598–605.
  4. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93.
  5. Li Z, Bowerman S, Heber D. Health ramifications of the obesity epidemic. Surg Clin North Am 2005;85:681–701.
  6. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289:187-93.
  7. International Diabetes Federation. IDF Diabetes Atlas, 7 ed. Brussels, Belgium: International Diabetes Federation. 2015.
  8. Fetner R, McGinty J, Russell C, Pi-Sunyer FX, Laferre`re B. Incretins, diabetes, and bariatric surgery: a review. Surg Obes Relat Dis. 2005;1:589-97.
  9. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87: 4–14.
  10. Fisher DP, Johnson E, Haneuse S, Arterburn D, Coleman KJ, O'Connor PJ, O'Brien R, Bogart A, Theis MK, Anau J, Schroeder EB, Sidney S. Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity. JAMA. 2018;320(22):2381.
  11. Koliaki C, Liatis S, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017;17(1):50.
  12. Johnson BL, Blackhurst DW, Latham BB, Cull DL, Bour ES, Oliver TL, Williams B, Taylor SM, Scott JD. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. Journal of the American College of Surgeons. 2013 Apr 1;216(4):545-56.
  13. Chen Y, Laybourne JP, Sandinha MT, de Alwis NMW, Avery P, Steel DH, et al. Does bariatric surgery prevent progression of diabetic retinopathy? Eye. 2017; 31:1131–9.
  14. Stenberg E, Szabo E, Ågren G, Näslund E, Boman L, Bylund A, Hedenbro J, Laurenius A, Lundegårdh G, Lönroth H, Möller P. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Annals of surgery. 2014;260(6):1040-7.  
  15. Yong PH, Weinberg L, Torkamani N, Churilov L, Robbins RJ, Ma R, Bellomo R, Lam QT, Burns JD, Hart GK, Lew JF. The presence of diabetes and higher HbA1c are independently associated with adverse outcomes after surgery. Diabetes Care. 2018;41(6):1172-9.
  16. Shah M, Simha V, Garg A. Long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223-31.
  17. Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab.2009;35:544–57.
  18. Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, Ekbom K, Friberg P, Göthberg G, Järvholm K, Karlsson J. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol.2017;5:174–83.
  19. Goldberg I, Yang J, Nie L, Bates AT, Docimo Jr S, Pryor AD, Cohn T, Spaniolas K. Safety of bariatric surgery in patients older than 65 years. Surg Obes Relat Dis. 2019;15(8):1380-7.
  20. Doumouras  AG, Hong D, Lee  Y, Tarride  J-E, Paterson  JM, Anvari  M.  Association between bariatric surgery and all-cause mortality: a population-based matched cohort study in a universal health care system.   Ann Intern Med. 2020;173(9):694-703.
  21. Ghouse J, Isaksen JL, Skov MW, Lind B, Svendsen JH, Kanters JK, Olesen MS, Holst AG, Nielsen JB. Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes. Diabetes, Obesity and Metabolism. 2020;22(2):231-42.
  22. Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861-77.
  23. Austin  PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.   Stat Med. 2009;28(25):3083-107.
  24. Wanjura V, Sandblom G, Österberg J, Enochsson L, Ottosson J, Szabo E. Cholecystectomy after gastric bypass—incidence and complications. Surg Obes Relat Dis.2017;13:979–87.
  25. Gustafsson U, Benthin L, Granström L, Groen AK, Sahlin S, Einarsson C. Changes in gallbladder bile composition and crystal detection time in morbidly obese subjects after bariatric surgery. Hepatology. 2005;41(6):1322-8.
  26. Lu B. Propensity score matching with time-dependent covariates. 2005;61:721–8.