Comparison of Benefits and Risks of Metabolic Surgery for Long-Term (5 Years) Weight Loss and Diabetes Remission in Overweight/Obese Patients With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Randomized Trials

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews Pub Date : 2025-03-23 DOI:10.1002/dmrr.70033

Xiaoyu Zang, Tong Lin, Jing Ma, Ying Zhang, Boxun Zhang, Yishan Huang, Danni Zhou, Lu Ding, Lili Zhang, Linhua Zhao

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引用次数: 0

Abstract

Background

While there have been studies comparing the efficiency of several metabolic operations in overweight or obese individuals with type 2 diabetes mellitus (T2DM), there is currently no comprehensive evidence about the complete remission of diabetes and its long-term safety.

Methods

This comprehensive review and network meta-analysis encompassed searches of many databases including PubMed, Web of Science, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ClinicalTrials.gov, and Google Scholar. The search was conducted from the beginning of these databases’ existence until 1 May 2024. The study selected randomized controlled trials (RCTs) with a 5-year follow-up period to compare the clinical benefits and evaluate the occurrence of side events. The network meta-analysis employed a random-effects model. The registration number for PROSPERO is CRD42023412536.

Results

There was a total of 16 RCTs that included 1059 patients. A total of 897 patients, representing 84.7% of the entire sample, successfully completed the 5-year follow-up. Seven metabolic procedures were conducted. All ensuing estimates are to the comparison with a non-surgical treatment (NST). The evidence strongly supports that One-anastomosis gastric bypass (OAGB) is the most effective surgical procedure for achieving long-term complete remission of diabetes (relative risk [RR] 10.28, 95% CI 1.87 to 56.40). Additionally, Biliopancreatic diversion (BPD) is the most effective procedure for achieving long-term partial remission of diabetes (RR 16.74, 95% CI 4.66 to 60.12). The study found that BPD was the most successful method for long-term weight loss, with a mean difference of −11.68 in BMI decrease (95% CI −15.06 to −8.31) and a mean difference of −32.01 in weight change (95% CI −43.27 to −20.74). The evidence supporting this conclusion is of moderate quality. Regarding the occurrence of adverse events and complications related to surgery, gastrointestinal, macrovascular, and microvascular issues are not as frequent in BPD compared with NST (relative risk 0.29, 95% confidence interval 0.06 to 1.37). On the other hand, OAGB may have a higher occurrence of these difficulties, second only to BPD (relative risk 0.08, 95% confidence interval 0.2 to 3.29). Based on the findings on effectiveness and safety, it has been determined that OAGB (One Anastomosis Gastric Bypass) is more effective in obtaining long-term complete remission of diabetes and in assuring overall safety in diabetes management. However, BPD is superior to OAGB in terms of partial remission, weight loss and safety in diabetes management, ranking second in these aspects.

Conclusions

Both BPD and OAGB have been demonstrated superior efficacy in achieving long-term weight loss and diabetes remission in overweight/obese individuals with T2DM. OAGB is particularly advantageous for achieving long-term complete remission of diabetes mellitus and boasts a higher level of safety overall. The study found that BPD was the most efficacious treatment for achieving partial remission and weight loss in patients with long-term diabetes, while also having the lowest number of reported side events.

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2型糖尿病超重/肥胖患者长期（5年）体重减轻和糖尿病缓解的代谢手术的获益和风险比较：随机试验的系统评价和网络荟萃分析

虽然已经有研究比较了超重或肥胖2型糖尿病（T2DM）患者几种代谢手术的效率，但目前还没有关于糖尿病完全缓解及其长期安全性的全面证据。方法本综合综述和网络荟萃分析包括PubMed、Web of Science、Embase、Cochrane Central Register of Controlled Trials （Central）、Scopus、ClinicalTrials.gov和谷歌Scholar等多个数据库的检索。搜索从这些数据库存在之初一直进行到2024年5月1日。该研究选择随机对照试验（RCTs），随访5年，比较临床获益并评估副反应的发生。网络荟萃分析采用随机效应模型。普洛斯彼罗的注册号是CRD42023412536。结果共纳入16项rct，共纳入1059例患者。共897例患者成功完成5年随访，占整个样本的84.7%。进行了7个代谢过程。所有随后的估计是与非手术治疗（NST）的比较。证据有力地支持单吻合术胃旁路术（OAGB）是实现糖尿病长期完全缓解的最有效的手术方法（相对危险度[RR] 10.28, 95% CI 1.87 ~ 56.40）。此外，胆胰分流术（BPD）是实现糖尿病长期部分缓解最有效的手术（RR 16.74, 95% CI 4.66 - 60.12）。研究发现，BPD是最成功的长期减肥方法，BMI下降平均差值为- 11.68 (95% CI为- 15.06 ~ - 8.31)，体重变化平均差值为- 32.01 （95% CI为- 43.27 ~ - 20.74）。支持这一结论的证据质量一般。关于与手术相关的不良事件和并发症的发生，与NST相比，BPD中胃肠道、大血管和微血管问题的发生率较低（相对危险度0.29,95%可信区间0.06 ~ 1.37）。另一方面，OAGB可能有更高的这些困难的发生率，仅次于BPD（相对风险0.08,95%置信区间0.2至3.29）。基于有效性和安全性的研究结果，已经确定OAGB（一次吻合胃旁路术）在获得糖尿病的长期完全缓解和确保糖尿病治疗的总体安全性方面更有效。然而，BPD在部分缓解、体重减轻和糖尿病管理的安全性方面优于OAGB，在这些方面排名第二。结论：BPD和OAGB在超重/肥胖T2DM患者实现长期体重减轻和糖尿病缓解方面均具有卓越的疗效。OAGB对于实现糖尿病的长期完全缓解尤其有利，总体上具有更高的安全性。研究发现，BPD对于长期糖尿病患者实现部分缓解和体重减轻是最有效的治疗方法，同时报告的副作用也最少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

期刊介绍： Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.