Systematic Reviews: Comorbidities
{"Image DocumentName": "Systematic Reviews: Comorbidities", "Image ImageDescription": "Buchwald et al. JAMA. 2004;292: meta-analysis of all types of bariatric surgery. Average 61% EWL (n=10,172)  Improvements in T2DM, hypertension, sleep apnea, and hyperlipidemia in most patients. Buchwald et al. Am J Med. 2009;122: meta-analysis of bariatric surgeries and diabetes. Includes all English articles studying biliopancreatic diversion/duodenal switch, gastric bypass, and gastric banding from 1/1/1990-4/30/ % EWL (n=34,329), weight loss overall was 38.5 kg  78.1% patients had complete resolution of type 2 diabetes. 86.6% improvement or resolution of type 2 diabetes in patients.  The LAP-BAND\u00ae System was approved in the United States on the basis of a nonrandomized, single-arm study (N=299). Significant improvement in percent of excess weight loss vs baseline was achieved at 12 months (34.5%), 24 months (37.8%), and 36 months (36.2%). With respect to Buchwald et al., JAMA, 2004, the following may be noted: Review was based on 136 fully extracted studies with a total of 22,094 patients\u2014the majority of whom were female (72.6%) with a mean age of 39 years and a baseline BMI of The review used a random effects model for the meta-analysis. More specifically, the review noted a 47.5% EWL, with respect to gastric banding; a 61.6% EWL, with respect to gastric bypass; a 68.2% EWL, with respect to gastroplasty; and a 70.1% EWL, with respect to BDP/DS. The review also reported an operative mortality rate of 0.1% for purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for BDP/DS. With Respect to Buchwald et al. Am J Med. Published in 2009: This paper is the largest, current, comprehensive meta-analysis of this subject and includes all articles published in English from Jan 1, 1990 to April 30, The authors expanded the database from the 2004 meta-analysis to 621 studies with 888 treatment arms and 135,246 patients. At baseline, the mean age was 40.2 years, body mass index (BMI) was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. For diabetic patients only, the total weight loss (all procedures) at the time point for which data are available for at least 50% of study patients was 40.6 kg or 64.4% of excess body weight loss. The weight loss results again appear to last more than 2 years, with a weight loss of 38.2 kg or 67.1% excess body weight at less than 2 years and 42.9 kg or 58.0% excess body weight at 2 years or more. The proportion of patients with diabetes resolution or improvement was fairly constant at time points less than 2 years and 2 years or more. (Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more. (The definition of diabetes at times varied among authors; as a rule, however, overt diabetes was defined as a fasting blood glucose greater than 125 mg/dL or an HgA1c greater than 7%) With respect to Maggard et al., Am. Coll of Phys., 2005, the following may be noted: Review was based on 147 studies and concluded that surgery is more effective than non-surgical treatment for weight loss and control of some comorbid conditions in patients with a BMI of 40 or greater. Bariatric procedures studies reviewed included RYGBP, LAGB, VBG, and BDP/DS. With respect to Sjostrom et al., NEJM, 2007, the following may be noted: See additional notes included on slide 39. The prospective, controlled study involved 4047 obese patients with 2010 undergoing bariatric surgery and 2037 receiving conventional treatment and reported mortality during an average of 10.9 years of follow-up. Mean weight loss was maximal after one (1) to two (2) years (gastric bypass, 32\u00b18%; VBG, 25\u00b19%; and banding 20\u00b110%). After ten (10) years, the EWLs were 25\u00b111%; 16\u00b111%; and 14\u00b114%, respectively, and after 15 years were 27\u00b112%; 18\u00b111%; and 13\u00b114%, respectively. Unable to confirm some findings (i.e. dealing with comorbidities) based on the materials available. References: 1. Buchwald, et al. Bariatric surgery: a systematic review and meta-analysis JAMA 2004;292: Buckwald, et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. The American. Journal of Medicine (2009) 122, Maggard, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142: Sjostrom, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. NEJM 2007;357: Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA ;292: Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122: e5. 47.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}