Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta-analysis of randomized controlled trials.
Li DingYuxin FanHui LiYalan ZhangDongwang QiShaofang TangJingqiu CuiQing HeChuanjun ZhuoMing LiuPublished in: Obesity reviews : an official journal of the International Association for the Study of Obesity (2020)
A network meta-analysis of randomized controlled trials (RCTs) was performed to determine the hierarchies of different bariatric surgeries in patients with obesity and type 2 diabetes mellitus (T2DM), in terms of diabetes remission and cardiometabolic outcomes. Seventeen RCTs and six bariatric surgeries, including single anastomosis (mini) gastric bypass (mini-GBP), biliopancreatic diversion without duodenal switch (BPD), laparoscopic-adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGBP), greater curvature plication (GCP) and nonsurgical treatments (NST) were included. Mini-GBP, BPD, LSG, RYGBP and LAGB (from best to worst), as compared with NST, were all significantly associated with the remission of T2DM. For the follow-up period > 3 years, BPD, mini-GBP, RYGBP and LSG (from best to worst) were significantly superior to NST in achieving the remission of T2DM. For secondary outcomes, the overall ranking for bariatric surgeries was RYGBP > BPD > LSG > LAGB after comprehensively weighting glucose, weight, systolic and diastolic pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Mini-GBP has the greatest probability of achieving diabetes remission in adults with obesity and T2DM, yet BPD was the most effective in long-term diabetes remission. RYGBP appears to be the most favourable alternative treatment to manage patients with cardiometabolic conditions.
Keyphrases
- weight loss
- glycemic control
- roux en y gastric bypass
- gastric bypass
- bariatric surgery
- blood glucose
- disease activity
- ulcerative colitis
- type diabetes
- obese patients
- systematic review
- blood pressure
- left ventricular
- weight gain
- heart failure
- rheumatoid arthritis
- insulin resistance
- cardiovascular disease
- metabolic syndrome
- combination therapy
- systemic lupus erythematosus
- skeletal muscle
- atrial fibrillation
- high density
- cardiovascular risk factors