Running Header: SURGERY VS DIET IN DIABETES REMISSION

Bariatric Surgery Vs Dietary Approaches in Diabetes Remission a Review

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SURGERY VS DIET IN DIABETES REMISSION 1

Table of Contents

Introduction......................................................................................................................................1

Methodology....................................................................................................................................2

PICOT..........................................................................................................................................2

Relevant Literature Search Strategy.............................................................................................2

Study Type....................................................................................................................................4

Scientific Literature Databases Used for the Study......................................................................4

Results from the Literature Search...............................................................................................4

Results and Findings........................................................................................................................4

Discussion........................................................................................................................................4

Recommendations............................................................................................................................4

Identification................................................................................................................................5

Eligibility......................................................................................................................................5

Included........................................................................................................................................5

Screening......................................................................................................................................5

REFERENCES................................................................................................................................6

APPENDIX......................................................................................................................................8
SURGERY VS DIET IN DIABETES REMISSION 2

Introduction

Obesity and diabetes have long been known to be comorbidities that have fatal consequences

(Smyth & Heron, 2006). Alleviation of obesity is a known viable route that can lead to remission

of type 2 diabetes mellitus. As such, it has been widely utilized. Two ways of obesity reduction

exist. One of them involves undertaking lifestyle changes where there is incorporation of low

calorie diet and introduction of an exercise regime (Wadden et al., 2005). The other involves

bariatric surgery which is aimed at reducing the abdominal size and as such reducing the number

of calories absorbed by the body (Dixon, Zimmet, Alberti, & Rubino, 2011). Reports and studies

indicate that bariatric surgery is effective in the overseeing weight reduction among obese

subjects. It has also been shown to produce better results when compared to patient subjection to

intensive medical therapy (Mingrone et al., 2012; Schauer et al., 2012). Further, bariatric surgery

has been shown to produce impressive results when compared to lifestyle interventions

(Cummings et al., 2016; Ludwig, Ebbeling, & Livingston, 2012). Still some of the studies that

make this generalisation possess a faulty subject recruitment, are non-randomized and are not

controlled. The validity of such results therefore is subject to debate. Due to this, a literature

analysis aimed at identifying and utilizing high quality studies to answer the question of whether

bariatric surgery or lifestyle intervention in isolation can lead to diabetes type 2 remission was

undertaken.
SURGERY VS DIET IN DIABETES REMISSION 3

Methodology
Question being reviewed: In adult obese patients with type II diabetes does bariatric surgery

or dietary approaches alone cause greater likelihood of diabetic remission?

PICOT
Table 1: PICOT Analysis for The Clinical Scenario

Population Adult obese patients with type II diabetes

Intervention Bariatric surgery or dietary intervention
Control Dietary intervention
Outcome Diabetic remission?

Relevant Literature Search Strategy

Key words for Database search

Tips for key words identification as well as essential general databases were sought from

(Fonseca, 2013). This made sure that no relevant literature was left out.

1. Diabetes 7. Weight loss surgery

2. Diabetes type 2 8. Gastric banding surgery

3. Diabetes mellitus type II 9. Gastric bypass surgery

4. Diabetes mellitus type 2 10. Metabolic surgery

5. Hyperglycemia 11. Multidisciplinary bariatric program

6. Bariatric surgery 12. Vertical banded gastroplasty

13. Roux-en-Y Gastric Bypass surgery 14. Obesity

15. Adult obese patients 19. Diabetes cure

16. Obes* 20. Diabetes remission

17. Adult obesity 21. Diabetes management

18. Diabetes treatment 22. Diet

SURGERY VS DIET IN DIABETES REMISSION 4

23. Dietary approaches 27. 14 OR 15 OR 16 OR 17

24. Nutrition 28. 18 OR 19 OR 20 OR 21

25. 1 OR 2 OR 3 OR 4 OR 5 29. 22 OR 23 OR 24

26. 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 30. 29 OR 2

OR 13

The studies were also excluded based on their language (only English accepted), relevance to the

topic in question and whether they utilized a randomized control trial methodology (those which

didn’t were excluded). This advanced exclusion criteria involved scanning the abstracts and titles

of the paper hits that were generated from the search

this literature analysis. Outside of that,

Inclusion Criteria.

Studies which were experimental or were randomized controlled trials (RCT’s), were written in

the English language and met the PICOT criteria were deemed eligible.

Exclusion Criteria.

Exclusion was conducted if the Literature source 1) was Non-English, 2) failed to satisfy any of

the PICOT criteria outlined and, 3) was conducted outside the clinical setting.

Study Type.

In evidence hierarchy, randomized controlled trials are considered the “gold standard” and

provided the most reliable inferential information (Greenhalgh, 2014). As such, they were the

most preferred for this review. An exception was made, with experimental studies that were

relevant being considered also. Any other paper that employed a different methodological

approach other than the ones listed above were disregarded.

Scientific Literature Databases Used for the Study.

SURGERY VS DIET IN DIABETES REMISSION 5

Information about the best databases for nursing literature was sourced from (Raszewski, 2016),

with accessibility being a factor in the choice made

1. Medline via PubMed

Results from the Literature Search

Results are contained in the appendix as well as the analysis

Results and Findings

Discussion

Recommendations
SURGERY VS DIET IN DIABETES REMISSION 6

Search Progression
SURGERY VS DIET IN DIABETES REMISSION 7

Records identified through Additional records identified

n database searching through other sources(n = 3)
MEDLINE via PubMed (n= 17)
io
cat
ifi
ent
Id

Results after duplicate sources were

removed(n = (16)

ng
ni n = 8 records were excluded
ree Records screened(n =16) based on the criteria that is
Sc outlined in the appendix below

Full-text articles assessed

for eligibility(n = 8) Full-text articles excluded, with
ity reasons were as follows
bil n = 1 were inadequately
gi controlled
Eli

Studies included in
qualitative synthesis(n =
0)

d
de
clu
In Studies included in
quantitative synthesis
(meta-analysis)(n = 6 )

REFERENCES
SURGERY VS DIET IN DIABETES REMISSION 8

Cummings, D. E., Arterburn, D. E., Westbrook, E. O., Kuzma, J. N., Stewart, S. D., Chan, C. P.,

… Flum, D. R. (2016). Gastric bypass surgery vs intensive lifestyle and medical

intervention for type 2 diabetes: the CROSSROADS randomised controlled trial.

Diabetologia, 59(5), 945–953. https://doi.org/10.1007/s00125-016-3903-x

Dixon, J. B., Zimmet, P., Alberti, K. G., & Rubino, F. (2011). Bariatric surgery: an IDF statement

for obese Type 2 diabetes. Diabetic Medicine, 28(6), 628–642.

Fonseca, M. (2013). Tips for effective literature searching and keeping up with new publications.

Retrieved December 8, 2017, from https://www.editage.com/insights/tips-for-effective-

literature-searching-and-keeping-up-with-new-publications

Greenhalgh, T. (2014). How to read a paper: the basics of evidence-based medicine. John Wiley

& Sons.

Ludwig, D. S., Ebbeling, C. B., & Livingston, E. H. (2012). Surgical vs Lifestyle Treatment for

Type 2 Diabetes. JAMA, 308(10), 981. https://doi.org/10.1001/2012.jama.10156

Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Leccesi, L., … Ghirlanda,

G. (2012). Bariatric surgery versus conventional medical therapy for type 2 diabetes. New

England Journal of Medicine, 366(17), 1577–1585.

Raszewski, R. (2016). Nursing: Databases for Articles, etc. Retrieved December 8, 2017, from

https://researchguides.uic.edu/c.php?g=252186&p=1684967

Schauer, P. R., Kashyap, S. R., Wolski, K., Brethauer, S. A., Kirwan, J. P., Pothier, C. E., …

Bhatt, D. L. (2012). Bariatric surgery versus intensive medical therapy in obese patients

with diabetes. New England Journal of Medicine, 366(17), 1567–1576.

Smyth, S., & Heron, A. (2006). Diabetes and obesity: the twin epidemics. Nature Medicine,

12(1), 75–80.
SURGERY VS DIET IN DIABETES REMISSION 9

Wadden, T. A., Berkowitz, R. I., Womble, L. G., Sarwer, D. B., Phelan, S., Cato, R. K., …

Stunkard, A. J. (2005). Randomized trial of lifestyle modification and pharmacotherapy for

obesity. New England Journal of Medicine, 353(20), 2111–2120.

SURGERY VS DIET IN DIABETES REMISSION
10

APPENDIX
Search Results
 Filters activated: Controlled Clinical Trial, Humans, English, Adult: 19+ years. Clear
all to show 457 items.
Select item 23666972 1.
Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms.
Astiarraga B, Gastaldelli A, Muscelli E, Baldi S, Camastra S, Mari A, Papadia F, Camerini G,
Adami G, Scopinaro N, Ferrannini E.
J Clin Endocrinol Metab. 2013 Jul;98(7):2765-73. doi: 10.1210/jc.2013-1476. Epub 2013 May
10.
PMID:23666972
Select item 26114120 2.
Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese
Patients with Type 2 Diabetes.
Mottalib A, Sakr M, Shehabeldin M, Hamdy O.
J Diabetes Res. 2015;2015:468704. doi: 10.1155/2015/468704. Epub 2015 May 31. Erratum
in: J Diabetes Res. 2016;2016:8708047.
PMID:26114120

Select item 24112375 3.
Weight change upon once-daily initiation of insulin detemir with or without dietary
intervention in overweight or obese insulin-naïve individuals with type 2 diabetes: results from
the DIET trial.
Niswender K, Piletic M, Andersen H, Conradsen Hiort L, Hollander P.
Diabetes Obes Metab. 2014 Feb;16(2):186-92. doi: 10.1111/dom.12218. Epub 2013 Oct 29.
PMID:24112375
Select item 22449317 4.
Bariatric surgery versus conventional medical therapy for type 2 diabetes.
Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A,
Castagneto M, Ghirlanda G, Rubino F.
N Engl J Med. 2012 Apr 26;366(17):1577-85. doi: 10.1056/NEJMoa1200111. Epub 2012 Mar
26.
PMID:22449317
Select item 25132119 5.
Attenuated improvements in adiponectin and fat loss characterize type 2 diabetes non-
remission status after bariatric surgery.
Malin SK, Bena J, Abood B, Pothier CE, Bhatt DL, Nissen S, Brethauer SA, Schauer PR,
Kirwan JP, Kashyap SR.
Diabetes Obes Metab. 2014 Dec;16(12):1230-8. doi: 10.1111/dom.12376. Epub 2014 Sep 14.
PMID:25132119
Select item 26983924 6.
SURGERY VS DIET IN DIABETES REMISSION
11

Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the

CROSSROADS randomised controlled trial.
Cummings DE, Arterburn DE, Westbrook EO, Kuzma JN, Stewart SD, Chan CP, Bock SN,
Landers JT, Kratz M, Foster-Schubert KE, Flum DR.
Diabetologia. 2016 May;59(5):945-53. doi: 10.1007/s00125-016-3903-x. Epub 2016 Mar 17.
PMID:26983924
Select item 26369473 7.
Bariatric-metabolic surgery versus conventional medical treatment in obese
patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised
controlled trial.
Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M,
Bornstein S, Rubino F.
Lancet. 2015 Sep 5;386(9997):964-73. doi: 10.1016/S0140-6736(15)00075-6.
PMID:26369473
Select item 25628424 8.
Immediate enhancement of first-phase insulin secretion and unchanged glucose effectiveness in
patients with type 2 diabetes after Roux-en-Y gastric bypass.
Martinussen C, Bojsen-Møller KN, Dirksen C, Jacobsen SH, Jørgensen NB, Kristiansen VB,
Holst JJ, Madsbad S.
Am J Physiol Endocrinol Metab. 2015 Mar 15;308(6):E535-44.
doi: 10.1152/ajpendo.00506.2014. Epub 2015 Jan 27.
PMID:25628424