Abstract
There is currently no detailed evidence for the long-term effects of bariatric surgery on severely obese with type 2 diabetes, such as the risk of myocardial infarction and stroke. In order to provide evidence on the risks of macrovascular diseases and metabolic indicators of bariatric surgery follow-up for more than five years, we searched in the Cochrane library, Pubmed, and EMBASE databases from the earliest studies to January 31, 2019. Randomized clinical trials or cohort studies compared bariatric surgery and conventional medical therapy for long-term incidence of macrovascular events and metabolic outcomes in severely obese patients with T2DM. Fixed-effects and random-effects meta-analyses were performed to pool the relative risks (RRs), hazard ratios (HRs) and weighted mean difference (WMD). Publication bias and heterogeneity were examined. Four RCTs and six cohort studies were finally involved in this review. Patients in the bariatric surgery group as compared to the conventional treatment group had lower incidence of macrovascular complications (RR = 0.43, 95%CI = 0.27~0.70), cardiovascular events (CVEs) (HR = 0.52, 95%CI = 0.39~0.71), and myocardial infarction (MI) (RR = 0.40, 95%CI = 0.26~0.61). At the same time, the results demonstrate that bariatric surgery is associated with better weight and better glycemic control over the long-term than non-surgical therapies, and reveal that different surgical methods have different effects on various metabolic indicators. Bariatric surgery significantly decreases macrovascular complications over the long term and is associated with greater weight loss and better intermediate glucose outcomes among T2DM patients with severe obesity as compared to patients receiving only conservative medical measures.
Highlights
Type 2 diabetes mellitus (T2DM) is a chronic, non-communicable disease caused by the inability of the pancreas to produce enough insulin or the body’s inability to use insulin effectively, which can cause micro- and macrovascular complications [1]
Results of our meta-analysis show that for the severely obese T2DM patient who had their surgery five or more years prior, compared with those who undertook conventional medical therapy, the bariatric surgery group was associated with a lower risk of macrovascular complications especially in cardiovascular events (CVEs) events, whereas there was no difference in all-cause mortality between the two groups
Subgroup analysis based on study design showed that there was no heterogeneity in randomized controlled trials (RCTs) (I2 of 4.8%), and that there is no protective effect on macrovascular disease (RR = 0.75, 95% CI = 0.46~1.22)
Summary
Type 2 diabetes mellitus (T2DM) is a chronic, non-communicable disease caused by the inability of the pancreas to produce enough insulin or the body’s inability to use insulin effectively, which can cause micro- and macrovascular complications [1]. Published randomized controlled trials (RCTs) recommend bariatric surgery as the best treatment for obesity and T2DM [2]. These meta-analyses measured effectiveness outcome indicators including weight loss and blood glucose levelswithin 2 years [3,4,5]. A recent meta-analysis published in 2017 suggested better remission and lower risks of microvascular and macrovascular complications in the bariatric surgery as compared to non-surgical treatment group based on studies reported prior to 2016 [8]. Meta-analyses published to date have not systematized the evidence on the long-term which means followed up for more than five years effects of the various surgical types and specific outcomes such as myocardial infarction (MI) and stroke on T2DM with severe obesity
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