Diabetes, obesity & metabolism · 2025
Diabetes remission and diabetic complications of bariatric surgery vs. medical management in patients with type 2 diabetes: A meta-analysis of randomized controlled trials.
СтатьяМетаанализСравнительное исследованиеСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Cheng Jiayu, Yu Hengchi, Gu Yulin, Ma Chifa, Li Chenfei, Pan Zimo, Yuan Mingxia
Аннотация
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.
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.