Bariatric Surgery Versus Conventional Therapy for Type 2 Diabetes Remission and Metabolic Outcomes in Obese Children: A Systematic Review
DOI:
https://doi.org/10.64149/J.Ver.8.20s.158-165Abstract
Background: Over the past two decades, the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has risen sharply, largely paralleling the global surge in pediatric obesity. Youth-onset T2DM is marked by greater insulin resistance, rapid β-cell decline, early complications, and poor response to conventional therapies such as lifestyle medication and pharmacotherapy. These limitations made bariatric surgery superior to conventional therapies because it shows substantial and sustained weight loss, improved glycemic control, and high remission rates in adolescents.
Methods: A systematic search of PubMed, Web of Science, and other databases was conducted to identify studies to differentiate bariatric surgery from conventional therapies in pediatric patients diagnosed with T2DM. Moreover, included studies contained randomized controlled trials and retrospective cohorts. Data were extracted based on glycemic control (HbA1c), BMI change, and diabetes remission
Results: Three studies, conducted in China and the United States, were included. Participants’ mean ages ranged from 15.3 to 17.81 years, with female representation between 44% and 70%. Follow-up durations varied from short- to long-term. Pooled analysis showed that bariatric surgery resulted in greater HbA1c reduction compared with medical therapy, despite significant heterogeneity (I² = 91%). Surgery also led to a significantly larger decrease in BMI [MD: -14.61, 95% CI: -18.67 to -10.55] and fasting glucose [MD: -57.06 mg/dL, 95% CI: -81.63 to -32.48] (P < 0.00001).
Conclusion: Our study shows that bariatric surgery provides better outcomes compared with conventional treatment in obese adolescents with type 2 diabetes, especially in terms of glycemic control, weight loss, and diabetes remission. However, the generalizability of these ndings is limited, highlighting the need for further high-quality, long-term studies.
