Diabetes remission and diabetic complications of bariatric surgery vs. medical management in patients with type 2 diabetes: A meta-analysis of randomized controlled trials.
{"title":"Diabetes remission and diabetic complications of bariatric surgery vs. medical management in patients with type 2 diabetes: A meta-analysis of randomized controlled trials.","authors":"Jiayu Cheng, Hengchi Yu, Yulin Gu, Chifa Ma, Chenfei Li, Zimo Pan, Mingxia Yuan","doi":"10.1111/dom.70152","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>Most randomized controlled trials (RCTs) of bariatric surgery have a small size, a limited type of surgical procedure, and follow-up duration. Our aim was to compare bariatric surgery with medical management in patients with type 2 diabetes mellitus (T2DM) based on a meta-analysis of RCTs.</p><p><strong>Materials and methods: </strong>PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published before February 28, 2025. We included RCTs comparing bariatric surgery with medical management in T2DM patients with follow-up ≥1 year. The outcomes of interest were diabetes remission, diabetic microvascular complications, and diabetic macrovascular complications. The criterion of diabetes remission was prespecified in clinical trials' protocols or defined as HbA1c <6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy.</p><p><strong>Results: </strong>At 1 year follow-up, 53.1% of patients in the bariatric surgery group achieved diabetes remission, compared to only 5.4% in the medical management group (risk ratio [RR] = 8.26; 95% confidence intervals [CI], 4.69-14.56; p < 0.001). The superiority of bariatric surgery in diabetes remission remained significant at 2 years (RR = 7.42), 3 years (RR = 16.97), and even ≥5 years (RR = 4.26). Bariatric surgery was associated with a significantly reduced risk of diabetic microvascular events compared to medical management (RR = 0.42, 95% CI 0.18-0.97, p = 0.04), while its association with macrovascular events was not statistically significant (RR = 1.09; 95% CI, 0.70-1.70; p = 0.71). Considering the specific microvascular events, bariatric surgery was significantly associated with the reduced incidence of albuminuria (RR = 0.37, 95% CI 0.16-0.81, p = 0.01), but not with diabetic retinopathy.</p><p><strong>Conclusion: </strong>Bariatric surgery seems to be superior to medical management for diabetes remission and improving diabetic microvascular complications in patients with T2DM. However, bariatric surgery and medical management show similar effects on diabetic macrovascular complications.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes, Obesity & Metabolism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/dom.70152","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Aim: Most randomized controlled trials (RCTs) of bariatric surgery have a small size, a limited type of surgical procedure, and follow-up duration. Our aim was to compare bariatric surgery with medical management in patients with type 2 diabetes mellitus (T2DM) based on a meta-analysis of RCTs.
Materials and methods: PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published before February 28, 2025. We included RCTs comparing bariatric surgery with medical management in T2DM patients with follow-up ≥1 year. The outcomes of interest were diabetes remission, diabetic microvascular complications, and diabetic macrovascular complications. The criterion of diabetes remission was prespecified in clinical trials' protocols or defined as HbA1c <6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy.
Results: At 1 year follow-up, 53.1% of patients in the bariatric surgery group achieved diabetes remission, compared to only 5.4% in the medical management group (risk ratio [RR] = 8.26; 95% confidence intervals [CI], 4.69-14.56; p < 0.001). The superiority of bariatric surgery in diabetes remission remained significant at 2 years (RR = 7.42), 3 years (RR = 16.97), and even ≥5 years (RR = 4.26). Bariatric surgery was associated with a significantly reduced risk of diabetic microvascular events compared to medical management (RR = 0.42, 95% CI 0.18-0.97, p = 0.04), while its association with macrovascular events was not statistically significant (RR = 1.09; 95% CI, 0.70-1.70; p = 0.71). Considering the specific microvascular events, bariatric surgery was significantly associated with the reduced incidence of albuminuria (RR = 0.37, 95% CI 0.16-0.81, p = 0.01), but not with diabetic retinopathy.
Conclusion: Bariatric surgery seems to be superior to medical management for diabetes remission and improving diabetic microvascular complications in patients with T2DM. However, bariatric surgery and medical management show similar effects on diabetic macrovascular complications.
目的：大多数关于减肥手术的随机对照试验（RCTs）规模小，手术类型有限，随访时间短。我们的目的是基于随机对照试验的荟萃分析，比较2型糖尿病（T2DM）患者的减肥手术与内科治疗。材料和方法：检索PubMed/Medline、Embase和Cochrane Central Register of Controlled Trials，检索2025年2月28日之前发表的研究。我们纳入了随访≥1年的T2DM患者中比较减肥手术与内科治疗的随机对照试验。研究结果为糖尿病缓解、糖尿病微血管并发症和糖尿病大血管并发症。糖尿病缓解的标准在临床试验方案中预先指定或定义为HbA1c。结果：1年随访时，减肥手术组53.1%的患者达到糖尿病缓解，而内科治疗组只有5.4%(风险比[RR] = 8.26； 95%可信区间[CI]， 4.69-14.56；结论：减肥手术在缓解糖尿病和改善T2DM患者糖尿病微血管并发症方面似乎优于内科治疗。然而，减肥手术和医疗管理对糖尿病大血管并发症的影响相似。
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
