Effect of Gastric Bypass vs Sleeve Gastrectomy on Remission of Type 2 Diabetes Mellitus Among Patients with Severe Obesity: A Meta-Analysis.

IF 2.9 3区医学 Q1 SURGERY

Obesity Surgery Pub Date : 2025-06-01 Epub Date: 2025-05-16 DOI:10.1007/s11695-025-07858-w

Suelen Queiroz, Júlia Gonçalves Gadelha, Noor Husain, Cristina Sicorschi Gutu

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Abstract

Background: Obesity and type 2 diabetes mellitus (T2DM) are global health crises, with bariatric surgery emerging as a key intervention. However, the comparative efficacy of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) in achieving diabetes remission remains debated.

Methods: This PRISMA-compliant meta-analysis included three randomized controlled trials (RCTs, n = 613 patients) comparing RYGB and SG in adults with severe obesity (BMI ≥30 kg/m²) and T2DM.

Primary outcome: diabetes remission (HbA1c 6.0%). Risk of bias was assessed via Cochrane RoB-2 tool; statistical analysis used fixed-effect models (I²=0%).

Results: RYGB demonstrated superior diabetes remission rates vs. SG (OR 2.77, 95% CI 1.83-4.20, p0.001), with no heterogeneity. Subgroup analyses confirmed consistency across studies. Mean follow-up was ≤5 years; baseline demographics were comparable (mean age 46.2 years, 53.4% male).

Conclusion: RYGB significantly outperforms SG in achieving T2DM remission, likely due to its combined restrictivemalabsorptive mechanisms and metabolic hormonal effects. These findings support RYGB as the preferred surgical option for obese patients with T2DM, though long-term studies are needed to assess durability.

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胃旁路与套管胃切除术对重度肥胖患者2型糖尿病缓解的影响：一项荟萃分析

背景：肥胖和2型糖尿病（T2DM）是全球性的健康危机，减肥手术成为关键的干预措施。然而，Roux-en-Y胃旁路术（RYGB）与袖式胃切除术（SG）在实现糖尿病缓解方面的比较疗效仍存在争议。方法：这项符合prisma标准的荟萃分析包括3项随机对照试验（rct, n = 613例患者），比较RYGB和SG在重度肥胖（BMI≥30 kg/m²）和T2DM患者中的疗效。主要结局：糖尿病缓解（HbA1c 6.0%）。通过Cochrane rob2工具评估偏倚风险；统计分析采用固定效应模型（I²=0%）。结果：RYGB表现出优于SG的糖尿病缓解率（OR 2.77, 95% CI 1.83-4.20, p0.001），无异质性。亚组分析证实了各研究的一致性。平均随访≤5年；基线人口统计学具有可比性（平均年龄46.2岁，53.4%为男性）。结论：RYGB在实现T2DM缓解方面明显优于SG，可能是由于其限制性吸收机制和代谢激素作用的结合。这些发现支持RYGB作为肥胖T2DM患者的首选手术选择，尽管需要长期研究来评估其持久性。

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

Obesity Surgery 医学-外科

CiteScore

5.80

自引率

24.10%

发文量

567

审稿时长

3-6 weeks

期刊介绍： Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.