Metabolic surgery for the treatment of type 2 diabetes: A network meta‐analysis of randomized controlled trials. Issue 8 (4th May 2020)

• Record Type: Journal Article
• Authors: Cresci, Barbara; Cosentino, Claudia; Monami, Matteo; Mannucci, Edoardo
• Is Part Of: Diabetes, obesity & metabolism. Volume 22:Issue 8(2020)
• Page Start: 1378
• Page End: 1387
• Publication Date: 2020-05-04
• Subjects: diabetes -- obesity metabolic or bariatric surgery; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14045
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aim: To compare different types of metabolic surgery (MS) with medical therapy (MT) for the treatment of type 2 diabetes (T2D). Materials and methods: We conducted a network‐meta‐analysis (NMA) including randomized clinical trials comparing different MS techniques versus MT in people with T2D, with a duration of ≥24 weeks. Primary endpoints were glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and diabetes remission. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and Mantel−Haenzel odds ratios for categorial variables, were calculated using random effect models. Types of MS included: laparoscopic adjustable gastric banding (LAGB), Roux‐en‐Y gastric bypass, sleeve gastrectomy (SG), bilio‐pancreatic diversion (BPD); greater curvature plication (GCP); one‐anastomosis gastric bypass (OAGB); and duodenojejunal bypass. Results: The 24 retrieved trials included 1351 patients (1014 with MS and 337 with MT). The mean baseline BMI was 36.8 kg/m 2 . MS was associated with significantly greater reductions in HbA1c and FPG and greater diabetes remission when compared to MT. In the NMA, a significant reduction in HbA1c was observed with OAGB and SG. All surgical procedures were associated with a significant increase in diabetes remission, except GCP and LAGB. All procedures were associated with a reduction of body mass index (BMI). Conclusions: Metabolic surgery is an interesting option for the treatment of T2D, although further data are needed to demonstrate its long‐term efficacy and safety. Present data are not sufficient to modify current recommendations, which consider MS a possible treatment for T2D in those with a BMI >35 kg/m 2 .