Comparative Effectiveness of Bariatric Surgeries in Patients with Type 2 Diabetes Mellitus and BMI >= 25 kg/m(2): a Systematic Review and Network Meta-Analysis

Autores da FMUP

• Hugo Miguel Teixeira Ferraz Santos Sousa

  Autor

• Bernardo Manuel De Sousa Pinto

  Autor

• Ana Margarida Barbosa Ribeiro Pereira

  Autor

Participantes de fora da FMUP

• Carmona, MN
• Lindeza, L
• Nogueiro, J
• Carneiro, S
• Costa Pinho, A
• Lima da Costa, E
• Preto, J

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Purpose In patients with type 2 diabetes mellitus (T2DM), bariatric surgery appears to be more effective than medical treatment (MT) at improving glycaemic control and decreasing cardiovascular risk. However, long-term effectiveness has not been systematically assessed using randomised controlled trials. In this study, we aimed to systematically assess randomised controlled trials, with at least 5 years of follow-up, on bariatric surgery in patients with T2DM and BMI >= 25 kg/m(2), as well as to compare different bariatric procedures. Material and Methods PubMed, SCOPUS and Web of Science were searched. We performed a network meta-analysis to evaluate the comparative effectiveness of the different procedures and MT in terms of full T2DM remission, weight loss, complications and cardiometabolic biomarkers. The quality of evidence was assessed using the Cochrane Risk of Bias Tool and CINeMA. Results We included 11 primary studies. Laparoscopic one-anastomosis gastric bypass (LOAGB) was found to be one of the most effective treatments for full remission of T2DM (I-2 = 0, inconsistency p value = 0.9223). Biliopancreatic diversion without duodenal switch was found to be more effective than laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding regarding percent total cholesterol and low-density lipoprotein change. Regarding percent high-density lipoprotein and weight change, all analysed surgical treatments were shown to be more effective than MT. The confidence rating in our results was overall moderate, but most studies had high risk of performance and detection bias. Conclusion Bariatric surgery seems to be effective for T2DM remission. LOAGB appears to be a good option in this context, and a possible alternative to laparoscopic duodenal switch, but the included primary studies in our review are not sufficiently powered to establish a more definitive conclusion. More studies with longer follow-up times are needed to comprehensively assess bariatric surgery in T2DM.

Keywords

• Diabetes; Metabolic surgery; Biliopancreatic diversion; Laparoscopic adjustable gastric banding; Laparoscopic one-anastomosis gastric bypass; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic duodenal switch; Laparoscopic sleeve gastrectomy; Vertical banded gastroplasty