Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes: a meta-analysis of randomized controlled trials

Abstract

We aimed to evaluate the efficacy and safety of laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes. We searched the Cochrane Library, PubMed, EMBASE, Google Scholar, and the Chinese Wan fang database up to October 2013. Randomized controlled trials regarding the efficacy and safety of laparoscopic gastric bypass versus sleeve gastrectomy for obese diabetic patients were included. Two review authors independently abstracted data and assessed the risk of bias. The mean difference and relative risk were estimated with 95 per cent confidence intervals. Four randomized controlled trials met inclusion criteria. There was no significant difference between gastric bypass and sleeve gastrectomy groups with regard to glycosylated hemoglobin (mean difference [MD], 0.41%; 95% confidence interval [CI], -0.09 to 0.91), fasting plasma glucose (standardized MD, 0.61 mg/mL; 95% CI, -0.10 to 1.32), the numbers of subjects using oral antihyperglycemic medications and insulin (relative rate [RR], 1.53; 95% CI, 0.45 to 5.24; RR, 1.44; 95% CI, 0.47 to 4.39, respectively), body weight (MD, 0.42 kg; 95% CI, -5.01 to 5.85), body mass index (MD, 0.85 kg/m(2); 95% CI, 0.13 to 1.58), or waist circumference (MD, 1.59 cm; 95% CI, -3.02 to 6.19). However, cardiovascular risk was more significantly lessened in the gastric bypass group. Our meta-analysis demonstrated that compared with laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass offers equal efficacy for treatment of diabetes in obese patients but is associated with a significantly decreased cardiovascular risk.