Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Diabetes Obes Metab. 2012 Mar;14(3):262-70. doi: 10.1111/j.1463-1326.2011.01524.x. Epub 2011 Dec 27.
The aim of this meta-analysis is to assess the metabolic effects of bariatric surgery in type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) < 35 kg/m(2) .
We performed an electronic literature search of published articles to identify relevant evidence since inception to June 2011. Primary outcome measures were metabolic improvement and resolution diabetes after bariatric surgery. The weighted mean difference (WMD) and its 95% confidence interval (CI) were calculated from the raw data extracted from the original literature. The software Review Manager (version 4.3.1) was applied for meta-analysis.
Thirteen trials involving 357 patients were included in the meta-analysis. The follow-up interval ranged from 6 months to 18 years. According to WMD calculation, bariatric surgery led to 5.18 kg/m(2) of BMI lowering (95% CI, 3.79-6.57, p < 0.00001), 4.8 mmol/l of fasting plasma glucose (FPG) decrement (95% CI, 3.88-5.71 mmol/l, p < 0.00001), 2.59% of HbA1c decreasing (95% CI, 2.12-3.07%, p < 0.00001), 56.67 mg/dl of triglyceride decrement (95% CI 11.53-101.82, p = 0.01) and 48.38 mg/dl of total cholesterol reduction (95% CI 21.08-75.68, p = 0.0005). Moreover, the procedures produced an increased high-density lipoprotein cholesterol by 5.37 mg/dl (95% CI -11.37-0.63, p = 0.08). However, this effect was not statistically significant. Overall, 80.0% of the patients achieved adequate glycaemic control (HbA1c < 7%) without antidiabetic medication. The surgeries produced a low incidence of major complications (3.2%) with no mortality.
Bariatric surgery is effectual and safe in the treatment of non-severely obese (BMI < 35 kg/m(2) ) T2DM patients. Moreover, the metabolic benefits acquired from the procedures can be long sustained after the surgery.
本荟萃分析旨在评估体重指数（BMI）<35kg/m2的 2 型糖尿病（T2DM）患者行减肥手术后的代谢变化。
我们对已发表的相关文献进行电子检索，时间限定为建库至 2011 年 6 月。主要观察指标为减肥手术后代谢改善及糖尿病缓解。从原始文献中提取原始数据，计算加权均数差值（WMD）及其 95%可信区间（CI）。采用 Review Manager（版本 4.3.1）软件进行荟萃分析。
13 项临床试验共纳入 357 例患者，随访时间 6 个月至 18 年。根据 WMD 计算，减肥手术后 BMI 降低 5.18kg/m2（95%CI，3.79-6.57，p<0.00001），空腹血糖（FPG）降低 4.8mmol/L（95%CI，3.88-5.71mmol/L，p<0.00001），糖化血红蛋白（HbA1c）降低 2.59%（95%CI，2.12-3.07%，p<0.00001），三酰甘油降低 56.67mg/dl（95%CI，11.53-101.82mg/dl，p=0.01），总胆固醇降低 48.38mg/dl（95%CI，21.08-75.68mg/dl，p=0.0005）。此外，高密度脂蛋白胆固醇升高 5.37mg/dl（95%CI，-11.37-0.63mg/dl，p=0.08）。但差异无统计学意义。总体而言，80.0%的患者无需降糖药物即可达到血糖控制目标（HbA1c<7%）。手术并发症发生率低（3.2%），无死亡病例。
减肥手术对非重度肥胖（BMI<35kg/m2）T2DM 患者的治疗效果确切且安全，术后代谢获益可持续较长时间。
