School of Health, Dongguan Polytechnic, Dongguan, 523808, China.
Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Obes Surg. 2023 Aug;33(8):2493-2508. doi: 10.1007/s11695-023-06713-0. Epub 2023 Jul 5.
This study aimed to perform a meta-analysis regarding the mid-long-term effect (≥ 2-year follow-up) of metabolic surgery on T2DM in non-obese patients.
PubMed, EMBASE and CENTRAL databases were searched for clinical studies from inception to March 2023. Stata 12.0 was used for data aggregation. Sensitivity, subgroup, and meta-regression analyses were performed when feasible.
This meta-analysis included 18 articles involving 548 patients. A pooled rate of 47.5% of T2DM remission was found after metabolic surgery. To be more specific, 83.5% was obtained for hemoglobin A1c (HbA1c) < 7.0%, 45.1% for HbA1c < 6.5%, and 40.4% for HbA1c < 6.0%. Subgroup analysis showed that one-anastomosis gastric bypass (OAGB) had a higher remission rate (93.9%) than other surgeries. Studies conducted in America had a higher remission rate (61.4%) than in Asia (43.6%). Meta-regression analysis displayed that publication year, number of patients, study design, preoperative age, BMI, and quality assessment score were not significantly associated with T2DM remission rate. Additionally, metabolic surgery could result in significant reductions in BMI (-4.133 kg/m2), weight (-9.874 kg), HbA1c (-1.939%), fasting blood glucose, fasting C-peptide, and fasting insulin. However, metabolic surgery seemed to have poorer glycemic control in non-obese than obese T2DM patients.
A moderate mid-long-term effect of T2DM remission was observed after metabolic surgery in non-obese patients. However, we still need more prospective multi-institutional studies using the same definitions for diabetes and the same surgical technique for the surgery. Without this, the exact role of bariatric surgery in non-obese patients is unanswered.
本研究旨在对代谢手术治疗非肥胖 2 型糖尿病患者的中-长期效果（≥2 年随访）进行荟萃分析。
检索从建库至 2023 年 3 月的 PubMed、EMBASE 和 CENTRAL 数据库中关于临床研究的相关文献，使用 Stata 12.0 进行数据合并。在可行的情况下进行敏感性分析、亚组分析和荟萃回归分析。
本荟萃分析共纳入 18 项研究，涉及 548 例患者。代谢手术后，2 型糖尿病缓解率的汇总率为 47.5%。具体而言，糖化血红蛋白（HbA1c）<7.0%的缓解率为 83.5%，HbA1c<6.5%的缓解率为 45.1%，HbA1c<6.0%的缓解率为 40.4%。亚组分析显示，单吻合口胃旁路术（OAGB）的缓解率（93.9%）高于其他术式。美国开展的研究的缓解率（61.4%）高于亚洲（43.6%）。荟萃回归分析显示，发表年份、患者数量、研究设计、术前年龄、BMI 和质量评估评分与 2 型糖尿病缓解率无显著相关性。此外，代谢手术可使 BMI（-4.133kg/m2）、体重（-9.874kg）、HbA1c（-1.939%）、空腹血糖、空腹 C 肽和空腹胰岛素显著降低。然而，代谢手术对非肥胖 2 型糖尿病患者的血糖控制效果较差。
在非肥胖患者中，代谢手术后 2 型糖尿病的缓解效果为中等程度的中-长期效果。然而，我们仍然需要更多使用相同的糖尿病定义和相同的手术技术的前瞻性多机构研究。如果没有这些研究，那么减重手术在非肥胖患者中的确切作用仍无法确定。
