Cresci Barbara, Cosentino Claudia, Monami Matteo, Mannucci Edoardo
Diabetology, Careggi Hospital, Florence, Italy.
University of Florence, Florence, Italy.
Diabetes Obes Metab. 2020 Aug;22(8):1378-1387. doi: 10.1111/dom.14045. Epub 2020 May 4.
To compare different types of metabolic surgery (MS) with medical therapy (MT) for the treatment of type 2 diabetes (T2D).
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.
The 24 retrieved trials included 1351 patients (1014 with MS and 337 with MT). The mean baseline BMI was 36.8 kg/m . 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).
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 .
比较不同类型的代谢手术（MS）与药物治疗（MT）对2型糖尿病（T2D）的治疗效果。
我们进行了一项网状Meta分析（NMA），纳入了比较不同MS技术与MT治疗T2D患者且疗程≥24周的随机临床试验。主要终点为糖化血红蛋白（HbA1c）、空腹血糖（FPG）和糖尿病缓解情况。通过NMA对不同类型手术进行间接比较。连续变量的均值和95%置信区间，以及分类变量的Mantel-Haenzel优势比，均使用随机效应模型计算。MS的类型包括：腹腔镜可调节胃束带术（LAGB）、Roux-en-Y胃旁路术、袖状胃切除术（SG）、胆胰转流术（BPD）；大弯折叠术（GCP）；单吻合口胃旁路术（OAGB）；以及十二指肠空肠旁路术。
检索到的24项试验共纳入1351例患者（1014例接受MS，337例接受MT）。平均基线体重指数为36.8kg/m²。与MT相比，MS与HbA1c和FPG的显著降低以及更高的糖尿病缓解率相关。在NMA中，观察到OAGB和SG可使HbA1c显著降低。除GCP和LAGB外，所有手术均与糖尿病缓解率的显著提高相关。所有手术均与体重指数（BMI）降低相关。
代谢手术是治疗T2D的一个有吸引力的选择，尽管需要更多数据来证明其长期疗效和安全性。目前的数据不足以改变当前的推荐意见，即BMI>35kg/m²的T2D患者可考虑将MS作为一种治疗选择。
