Wang Yao, Pan Yan, Xiao Yibo, Yang Jingxian, Wu Haoming, Chen Yingying
Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China.
Obes Surg. 2025 Mar;35(3):1109-1122. doi: 10.1007/s11695-025-07698-8. Epub 2025 Feb 1.
This meta-analysis aimed to evaluate the effectiveness of Roux-en-Y gastric bypass (RYGB) in people living with type 2 diabetes mellitus (T2DM). A comprehensive search was conducted in the PubMed database up to January 2024. A random-effects model was used to calculate the pooled standard mean differences (SMDs) and odds ratios (ORs). Ten studies were included in our review. The RYGB group demonstrated significantly better outcomes compared to the non-surgical group in multiple measures. These included higher triple criteria compliance rates (OR 9.04, 95% CI 3.22-25.36), complete T2DM remission (OR 15.37, 95% CI 4.42-53.41), and partial T2DM remission (OR 11.49, 95% CI 3.57-37.03). Additionally, improvements were observed in glycated hemoglobin A1c (HbA1c) levels (SMD - 1.41, 95% CI - 2.22 to - 0.61), with HbA1c < 6.0% (OR 8.54, 95% CI 3.38-21.62) and HbA1c < 7.0% (OR 5.62, 95% CI 3.20-9.86). Fasting blood glucose (FBG) levels also showed improvement (SMD - 0.43, 95% CI - 0.71 to - 0.14), with a higher proportion achieving FBG < 100 mg/dl (OR 11.83, 95% CI 4.75-29.43). Other notable outcomes included significant percentage of total weight loss (%TWL: SMD 1.88, 95% CI 1.39-2.37), reductions in body mass index (BMI: SMD - 2.28, 95% CI - 3.52 to - 1.04), and improvements in lipid profiles, including low-density lipoprotein (LDL) levels (SMD - 1.01, 95% CI - 1.91 to - 0.11) and LDL < 2.59 mmol/L (OR 3.65, 95% CI 1.94-6.87). In addition, high-density lipoprotein (HDL) levels increased (SMD 1.30, 95% CI 0.55-2.05), while triglycerides (SMD - 1.11, 95% CI - 1.70 to - 0.52), systolic blood pressure (SBP: SMD - 0.38, 95% CI - 0.70 to - 0.06), and diastolic blood pressure (DBP: SMD - 0.41, 95% CI - 0.63 to - 0.18) decreased. A greater proportion of patients in the RYGB group achieved SBP < 130 mmHg (OR 3.15, 95% CI 1.61-6.13). Moreover, reductions were noted in insulin use (OR 0.25, 95% CI 0.14-0.46), diabetes medication use (SMD - 1.95, 95% CI - 3.32 to - 0.57), and peripheral neuropathy (OR 0.13, 95% CI 0.02-0.79). However, no significant differences were observed in hypertension medication use or retinopathy between the two groups. RYGB was found to be effective in improving glycemic control, promoting weight loss, enhancing lipid profiles, and managing blood pressure. It also significantly reduced the need for postoperative diabetes medications and the incidence of diabetic peripheral neuropathy in people living with T2DM.
本荟萃分析旨在评估Roux-en-Y胃旁路术（RYGB）对2型糖尿病（T2DM）患者的疗效。截至2024年1月，我们在PubMed数据库中进行了全面检索。采用随机效应模型计算合并标准均数差（SMD）和比值比（OR）。我们的综述纳入了10项研究。与非手术组相比，RYGB组在多项指标上显示出显著更好的结果。这些指标包括更高的三联标准依从率（OR 9.04，95%CI 3.22-25.36）、T2DM完全缓解（OR 15.37，95%CI 4.42-53.41）和T2DM部分缓解（OR 11.49，95%CI 3.57-37.03）。此外，糖化血红蛋白A1c（HbA1c）水平也有改善（SMD -1.41，95%CI -2.22至-0.61），HbA1c <6.0%（OR 8.54，95%CI 3.38-21.62）和HbA1c <7.0%（OR 5.62，95%CI 3.20-9.86）。空腹血糖（FBG）水平也有所改善（SMD -0.43，95%CI -0.71至-0.14），达到FBG <100 mg/dl的比例更高（OR 11.83，95%CI 4.75-29.43）。其他显著结果包括显著的总体重减轻百分比（%TWL：SMD 1.88，95%CI 1.39-2.37）、体重指数降低（BMI：SMD -2.28，95%CI -3.52至-1.04）以及血脂谱改善，包括低密度脂蛋白（LDL）水平（SMD -1.01，95%CI -1.91至-0.11）和LDL <2.59 mmol/L（OR 3.65，95%CI 1.94-6.87）。此外，高密度脂蛋白（HDL）水平升高（SMD 1.30，95%CI 0.55-2.05），而甘油三酯（SMD -1.11，95%CI -1.70至-0.52）、收缩压（SBP：SMD -0.38，95%CI -0.70至-0.06）和舒张压（DBP：SMD -0.41，95%CI -0.63至-0.18）降低。RYGB组中更大比例的患者收缩压<130 mmHg（OR 3.15，95%CI 1.61-6.13）更为常见。此外，胰岛素使用（OR 0.25，95%CI 0.14-0.46）、糖尿病药物使用（SMD -1.95，95%CI -3.32至-0.57）和周围神经病变（OR 0.13，95%CI 0.02-0.79）均有所减少。然而，两组在高血压药物使用或视网膜病变方面未观察到显著差异。研究发现，RYGB在改善血糖控制、促进体重减轻、改善血脂谱和控制血压方面有效。它还显著减少了T2DM患者术后糖尿病药物的需求以及糖尿病周围神经病变的发生率。
