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. 2020 Aug;22(8):1378-1387.
doi: 10.1111/dom.14045. Epub 2020 May 4.

Metabolic surgery for the treatment of type 2 diabetes: A network meta-analysis of randomized controlled trials

Barbara Cresci  1 , Claudia Cosentino  2 , Matteo Monami  1 , Edoardo Mannucci  1   2
Affiliations

Metabolic surgery for the treatment of type 2 diabetes: A network meta-analysis of randomized controlled trials

Barbara Cresci et al. Diabetes Obes Metab. 2020 Aug.

Abstract

Aim: To compare different types of metabolic surgery (MS) with medical therapy (MT) for the treatment of type 2 diabetes (T2D).

Materials and methods: We conducted a network-meta-analysis (NMA) including randomized clinical trials comparing different MS techniques versus MT in people with T2D, with a duration of ≥24 weeks. Primary endpoints were glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and diabetes remission. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and Mantel-Haenzel odds ratios for categorial variables, were calculated using random effect models. Types of MS included: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass, sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD); greater curvature plication (GCP); one-anastomosis gastric bypass (OAGB); and duodenojejunal bypass.

Results: The 24 retrieved trials included 1351 patients (1014 with MS and 337 with MT). The mean baseline BMI was 36.8 kg/m2 . MS was associated with significantly greater reductions in HbA1c and FPG and greater diabetes remission when compared to MT. In the NMA, a significant reduction in HbA1c was observed with OAGB and SG. All surgical procedures were associated with a significant increase in diabetes remission, except GCP and LAGB. All procedures were associated with a reduction of body mass index (BMI).

Conclusions: Metabolic surgery is an interesting option for the treatment of T2D, although further data are needed to demonstrate its long-term efficacy and safety. Present data are not sufficient to modify current recommendations, which consider MS a possible treatment for T2D in those with a BMI >35 kg/m2 .

Keywords: diabetes; obesity metabolic or bariatric surgery.

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References

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