Ribaric G, Buchwald J N, McGlennon T W
European Surgical Institute, Ethicon Endo-Surgery (Europe) GmbH, Hamburg, Germany,
Obes Surg. 2014 Mar;24(3):437-55. doi: 10.1007/s11695-013-1160-3.
We performed a meta-analysis of weight loss and remission of type 2 diabetes mellitus (T2DM) evaluated in randomized controlled trials (RCTs) and observational studies of bariatric surgery vs conventional medical therapy. English articles published through June 10, 2013 that compared bariatric surgery with conventional therapy and included T2DM endpoints with ≥12-month follow-up were systematically reviewed. Body mass index (BMI, in kilogram per square meter), glycated hemoglobin (HbA1C, in degree), and fasting plasma glucose (FPG, in milligram per deciliter) were analyzed by calculating weighted mean differences (WMDs) and pooled standardized mean differences and associated 95 % confidence intervals (95 % CI). Aggregated T2DM remission event data were analyzed by calculating the pooled odds ratio (POR) and 95 % CI. Random effects assumptions were applied throughout; I(2) ≥ 75.0 % was considered indicative of significant heterogeneity. Systematic review identified 512 articles: 47 duplicates were removed, 446 failed inclusion criteria (i.e., n < 10 per arm, animal studies, reviews, case reports, abstracts, and kin studies). Of 19 eligible articles, two not focused on diagnosed T2DM and one with insufficient T2DM data were excluded. In the final 16 included papers, 3,076 patients (mean BMI, 40.9; age, 47.0; 72.0 % female) underwent bariatric surgery; 3,055 (39.4; 48.6, 69.0 %) received conventional or no weight-loss therapy. In bariatric surgery vs conventional therapy groups, the mean 17.3 ± 5.7 month BMI WMD was 8.3 (7.0, 9.6; p < 0.001; I(2) = 91.8), HbA(1C) was 1.1 (0.6, 1.6; p < 0.001; I(2) = 91.9), and FPG, 24.9 (15.9, 33.9; p < 0.001; I(2) = 84.8), with significant differences favoring surgery. The overall T2DM remission rate for surgery vs conventional group was 63.5 vs 15.6 % (p < 0.001). The Peto summary POR was 9.8 (6.1, 15.9); inverse variance summary POR was 15.8 (7.9, 31.4). Of the included studies, 94.0 % demonstrated a significant statistical advantage favoring surgery. In a meta-analysis of 16 studies (5 RCTs) with 6,131 patients and mean 17.3-month follow-up, bariatric surgery was significantly more effective than conventional medical therapy in achieving weight loss, HbA(1C) and FPG reduction, and diabetes remission. The odds of bariatric surgery patients reaching T2DM remission ranged from 9.8 to 15.8 times the odds of patients treated with conventional therapy.
我们对肥胖症手术与传统药物治疗在随机对照试验（RCT）和观察性研究中评估的2型糖尿病（T2DM）体重减轻和缓解情况进行了荟萃分析。对截至2013年6月10日发表的英文文章进行了系统回顾，这些文章比较了肥胖症手术与传统治疗，并纳入了随访时间≥12个月的T2DM终点指标。通过计算加权平均差（WMD）、合并标准化平均差及相关的95%置信区间（95%CI），对体重指数（BMI，千克/平方米）、糖化血红蛋白（HbA1C，%）和空腹血糖（FPG，毫克/分升）进行分析。通过计算合并比值比（POR）和95%CI，对汇总的T2DM缓解事件数据进行分析。整个过程采用随机效应假设；I(2)≥75.0%被认为表明存在显著异质性。系统回顾共识别出512篇文章：去除47篇重复文章，446篇不符合纳入标准（即每组n<10、动物研究、综述、病例报告、摘要和亲属研究）。在19篇符合条件的文章中，排除2篇未聚焦于已诊断T2DM的文章和1篇T2DM数据不足的文章。在最终纳入的16篇论文中，3076例患者（平均BMI 40.9、年龄47.0、72.0%为女性）接受了肥胖症手术；3055例（BMI 39.4、年龄48.6、69.0%为女性）接受了传统或非减重治疗。在肥胖症手术组与传统治疗组中，平均17.3±5.7个月的BMI WMD为8.3（7.0，9.6；p<0.001；I(2)=91.8），HbA(1C)为1.1（0.6，1.6；p<0.001；I(2)=91.9），FPG为24.9（15.9，33.9；p<0.001；I(2)=84.8），手术组有显著差异。手术组与传统治疗组的总体T2DM缓解率分别为63.5%和15.6%（p<0.001）。Peto汇总POR为9.8（6.1，15.9）；逆方差汇总POR为15.8（7.9，31.4）。在纳入的研究中，94.0%显示手术具有显著的统计学优势。在一项对16项研究（5项RCT）、6131例患者且平均随访17.3个月的荟萃分析中，肥胖症手术在实现体重减轻、降低HbA(1C)和FPG以及糖尿病缓解方面显著优于传统药物治疗。肥胖症手术患者达到T2DM缓解的几率是接受传统治疗患者的9.8至15.8倍。
