Full text of Buchwald Meta-analysis
Pre-ops, look closely at the differences in long-term results between the various surgeries. And keep in mind that because of (now changing, unfounded and illogical) insurance restrictions and limitations on access to the DS, DS patients on average tend to be heavier and sicker before surgery. The results are striking.
See in particular Table 8:
| Table 8.
Overview of Weight Loss, Surgical Procedure, and Diabetes Resolution |
 |
Total | Gastric Banding | Gastroplasty | Gastric Bypass | BPD/DS | |
|
|---|---|---|---|---|---|---|---|
|
% EBWL | 55.9 | 46.2 | 55.5 | 59.7 | 63.6 | |
|
% Resolved overall | 78.1 | 56.7 | 79.7 | 80.3 | 95.1 | |
|
% Resolved <2 y |
80.3 | 55.0 | 81.4 | 81.6 | 94.0 | |
|
% Resolved≥2 y |
74.6 | 58.3 | 77.5 | 70.9 | 95.9 | |
|
%EBWL = percent excess body weight loss; BPD/DS |
Diabetes Resolution for Pure Diabetic Populations
Overall, there were 12 treatment groups reporting categoric outcomes for diabetes with 79.3% of diabetic patients having resolution of their clinical and laboratory manifestations of diabetes and 98.9% having resolution or improvement (Table 9, online). Again, the observation of greater resolution for biliopancreatic diversion/duodenal switch procedures followed by bypass and then banding held true. Results were fairly homogeneous with I2 values of 0%, 49%, and 21% for the biliopancreatic diversion/duodenal switch, gastric bypass, and banding groups, respectively. Meta-regression revealed evidence of an impact of mean change in BMI on diabetes resolution (P<.01). Substantively, the same association held true at the time points of less than 2 years and 2 years or more. The laboratory parameters of diabetes declined significantly (P<.001): insulin levels 97.9 mU/L, HbA1c 2.1%, and fasting glucose 44.4 mmol/L.
