Department of Surgery, College of Medicine, University of Oklahoma, 4502 E 41st Street, Tulsa, OK, 74135, USA.
Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Bariatric and Metabolic Institute, Brooklyn, NY, USA.
Obes Surg. 2019 Mar;29(3):964-974. doi: 10.1007/s11695-018-3552-x.
Bariatric surgery improves type 2 diabetes (T2D) in obese patients. The sustainability of these effects and the long-term results have been under question.
To compare bariatric surgery versus medical management (MM) for T2D based on a meta-analysis of randomized controlled trials (RCTs) with 2 years of follow-up.
Seven RCTs with at least 2-year follow-up were identified. The primary endpoint was remission of T2D (full or partial). Four hundred sixty-three patients with T2D and body mass index > 25 kg/m were evaluated.
After 2 years, T2D remission was observed in 138 of 263 patients (52.5%) with bariatric surgery compared to seven of 200 patients (3.5%) with MM (risk ratio (RR) = 10, 95% CI 5.5-17.9, p < 0.001). Subgroup analysis of the Roux-en-Y gastric bypass (RYGB) showed a significant effect size at 2 years in favor of RYGB over MM for a higher decrease of HbA1C (0.9 percentage points, 95% CI 0.6-1.1, p < 0.001), decrease of fasting blood glucose (35.3 mg/dl, 95% CI 13.3-57.3, p = 0.002), increase of high-density lipoprotein (HDL) (12.2 mg/dl, 95% CI 7.6-16.8, p < 0.001), and decrease of triglycerides (32.4 mg/dl, 95% CI 4.5-60.3, p = 0.02). Four studies followed patients up to 5 years and showed 62 of 225 patients (27.5%) with remission after surgery, compared to six of 156 patients (3.8%) with MM (RR = 6, 95% CI 2.7-13, p < 0.001).
This meta-analysis shows a superior and persistent effect of bariatric surgery versus MM for inducement of remission of T2D. This benefit of bariatric surgery was significant at 2 years and superior to MM even after 5 years. Compared with MM, patients with RYGB had better glycemic control and improved levels of HDL and triglycerides.
减重手术可改善肥胖患者的 2 型糖尿病（T2D）。这些效果的可持续性和长期结果一直存在争议。
通过对至少随访 2 年的随机对照试验（RCT）进行荟萃分析，比较减重手术与药物治疗（MM）对 T2D 的疗效。
共纳入 7 项至少随访 2 年的 RCT。主要终点是 T2D 的缓解（完全或部分）。共评估了 463 名 T2D 合并 BMI＞25kg/m²的患者。
在 2 年时，与 MM 组的 7 例患者（3.5%）相比，减重手术组的 263 例患者中有 138 例（52.5%）T2D 缓解（风险比（RR）=10，95%CI 5.5-17.9，p＜0.001）。Roux-en-Y 胃旁路术（RYGB）的亚组分析显示，在 2 年时，与 MM 相比，RYGB 对 T2D 的缓解具有显著的治疗效果，可使糖化血红蛋白（HbA1C）降低 0.9%（95%CI 0.6-1.1，p＜0.001），空腹血糖（35.3mg/dl，95%CI 13.3-57.3，p=0.002）降低，高密度脂蛋白（HDL）升高（12.2mg/dl，95%CI 7.6-16.8，p＜0.001），三酰甘油（TG）降低（32.4mg/dl，95%CI 4.5-60.3，p=0.02）。4 项研究随访患者至 5 年，发现手术组有 225 例患者中的 62 例（27.5%）缓解，而 MM 组有 156 例患者中的 6 例（3.8%）缓解（RR=6，95%CI 2.7-13，p＜0.001）。
本荟萃分析表明，与 MM 相比，减重手术对 T2D 的缓解具有更好的效果，且具有持久性。该获益在 2 年时显著，即使在 5 年后仍优于 MM。与 MM 相比，RYGB 患者的血糖控制更好，HDL 和 TG 水平改善。
