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Comparative Effectiveness of Bariatric Surgeries in Patients with Type 2 Diabetes Mellitus and BMI ≥ 25 kg/m2: a Systematic Review and Network Meta-Analysis

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A Correction to this article was published on 02 December 2021

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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/m2, 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 (I2 = 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.

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Author notes

  1. Maria Neves Carmona and Hugo Santos-Sousa contributed equally and should be considered first authors.

Authors and Affiliations

  1. Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Maria Neves Carmona, Hugo Santos-Sousa, Luís Lindeza, Jorge Nogueiro, André Pereira, Silvestre Carneiro & André Costa-Pinho

  2. Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Hugo Santos-Sousa, André Costa-Pinho, Eduardo Lima-da-Costa & John Preto

  3. MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal

    Bernardo Sousa-Pinto

  4. CINTESIS - Center for Health Technologies and Services Research, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal

    Bernardo Sousa-Pinto

  5. Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Jorge Nogueiro, André Pereira & Silvestre Carneiro

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  1. Maria Neves Carmona
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CRI-O group

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Correspondence to Hugo Santos-Sousa.

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Key Points

• LOAGB is a good option in terms of T2DM remission.

• Surgical treatments were more effective than medical treatment on HDL control.

• BPD and LRYGB were significantly better than LAGB in lowering DBP.

• No significant differences were found regarding diabetes complications.

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Carmona, M.N., Santos-Sousa, H., Lindeza, L. et al. Comparative Effectiveness of Bariatric Surgeries in Patients with Type 2 Diabetes Mellitus and BMI ≥ 25 kg/m2: a Systematic Review and Network Meta-Analysis. OBES SURG 31, 5312–5321 (2021). https://doi.org/10.1007/s11695-021-05725-y

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