Bariatric Surgery versus Conventional Medical Therapy for Obese Patients with Type 2 Diabetes: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XIE Xiaofeng ¹ , ZHANG Wenliang ² , LI Qian ² , LI Na ³ ,  WANG Chen ²

1. The School of Basic Medicine of Lanzhou University, Lanzhou 730000, China;2. The Second Hospital of Lanzhou University, Lanzhou 730000, China;3. The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

WANG Chen, Email: wcdfjack@163.com

Keywords：

Bariatric surgery; Type 2 diabetes; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130129

Video：

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Objective 　To systematically evaluate the effectiveness of frequently-used bariatric surgery versus conventional medical therapy for obese patients with type 2 diabetes.
Methods 　Such databases as The Cochrane Library (Issue 12, 2012), PubMed, CNKI, CBM, VIP and WanFang Data were searched to collect the randomized controlled trails (RCTs) about frequently-used bariatric surgery vs. conventional therapy for obese patients with type 2 diabetes. The retrieval time was from inception to May, 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality. Then the meta-analysis was performed using RevMan 5.1.2 software.
Results 　A total of three RCTs involving 340 patients were included finally. The results of meta-analysis showed that, compared with conventional medical therapy, bariatric surgery could improve the diabetes remission, decrease both glycated hemoglobin level and patient’s weight. At the same time, the postoperative complications were fairly mild.
Conclusion 　Frequently-used bariatric surgery is superior to conventional medical therapy when treating obese patients with type 2 diabetes, and it deserves to be recommended in clinic. However more studies are required to further confirm this conclusion because of the quality and quantity limitation of the included studies.

Citation： XIE Xiaofeng,ZHANG Wenliang,LI Qian,LI Na,WANG Chen. Bariatric Surgery versus Conventional Medical Therapy for Obese Patients with Type 2 Diabetes: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(6): 728-734. doi: 10.7507/1672-2531.20130129 Copy

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2.	Yang W, Lu J, Weng J, et al. Prewalence of diabetes among men and women in China. N Engl J Med, 2010(12), 362: 1090-1101.
3.	Zimmer P, Albefti KG, Shaw J. G1obal and societal implications of the diabetes epidemic. Nature, 2001, 414(6865): 782-787.
4.	郑成竹, 张鼎宇. 2型糖尿病的外科治疗. 中华胃肠外科杂志, 2009, 12(6): 545-548.
5.	中华医学会糖尿病学分会, 中华医学会外科学分会. 手术治疗糖尿病专家共识. 中华糖尿病杂志, 2011, 3(3): 205-208.
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7.	Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it, An operati on proves to be the most effective therapy for adult onset diabetes mellitus. Ann Surg, 1995, 222(3): 339-350.
8.	Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. N Engl J Med, 2004, 351(26): 2683-2693.
9.	Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index < 35 kg/m2. Diabetes, Obes Metab, 2012, 14(3): 262-270.
10.	Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care, 2002, 25(2): 358-363.
11.	Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg, 2004, 14(10): 1335-1342.
12.	Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg, 2003, 238(4): 467-485.
13.	Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass induced weight loss. Ann Surg, 2003, 237(6): 751-758.
14.	Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care, 2009, 32(11): 2133-2135.
15.	Higgins JPT, Green SJ (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. Available from: www.cochranehandbook.org.
16.	Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery vs. conventional medical therapy for type 2 diabetes. N Engl J Med, 2012, 366(17): 1577-1585.
17.	Schauer PR, Kashyap SR, Wolski K, et al. Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med, 2012, 366(17):1567-1576.
18.	Dixon JB, O’Brien PE, Playfair J, et al. Adjust able gastric banding and conventional the rapy for type 2 diabetes: a randomized controlled trial. JAMA, 2008, 299(3): 616-323.
19.	肖竹, 程中, 田浩明. 从减肥手术谈2型糖尿病的外科治疗. 实用医院临床杂志, 2012, 7(4): 22-24.
20.	王平, 李成林, 崔谚. 减重手术治疗2型糖尿病的进展. 中国现代普通外科, 2011, 14(17): 875-879.
21.	Salinari S, Bertuzzi A, Asnaghi S, et al. Firstphase insulin secretion restoration and differential response to glucose load depending on the route of administration in type 2 diabetic subjects after bariatric surgery. Diabetes Care, 2009, 32(3): 375-380.
22.	古应超, 于健春. 胃肠手术治疗2型糖尿病的机制研究进展. 中国医学科学院院报, 2011, 33(3): 262-264.
23.	Iaconelli A, Panunzi S, De Gaetano A, et al. Effects of biliopancreatic diversion on diabetic complications: a 10-year follow up. Diabetes Care, 2011, 34(3): 561-567.
24.	Hoerger Tj, Zhang P, Segel JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care, 2010, 33(9): 1933-1939.
25.	Keating CL, Dixon JB, Moodie ML, et al. Cost efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care, 2009, 32(4): 580-584.
26.	Sovik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med, 2011, 155(9): 281-291.
27.	The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. N Engl J Med, 2009, 361(5): 445-454.

1. 李威杰. 全球手术治疗糖尿病最新进展. 中国实用外科杂志, 2010, 30(7): 571-573.
2. Yang W, Lu J, Weng J, et al. Prewalence of diabetes among men and women in China. N Engl J Med, 2010(12), 362: 1090-1101.
3. Zimmer P, Albefti KG, Shaw J. G1obal and societal implications of the diabetes epidemic. Nature, 2001, 414(6865): 782-787.
4. 郑成竹, 张鼎宇. 2型糖尿病的外科治疗. 中华胃肠外科杂志, 2009, 12(6): 545-548.
5. 中华医学会糖尿病学分会, 中华医学会外科学分会. 手术治疗糖尿病专家共识. 中华糖尿病杂志, 2011, 3(3): 205-208.
6. Tuner RC, Cull CA, Frighi V. Glycemic control with diet, sulphonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UK-PDS49). UK Prospective Diabetes Study (UKPDS) Group. JAMA, 1999, 281 (21): 2005-2012.
7. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it, An operati on proves to be the most effective therapy for adult onset diabetes mellitus. Ann Surg, 1995, 222(3): 339-350.
8. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. N Engl J Med, 2004, 351(26): 2683-2693.
9. Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index < 35 kg/m2. Diabetes, Obes Metab, 2012, 14(3): 262-270.
10. Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care, 2002, 25(2): 358-363.
11. Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg, 2004, 14(10): 1335-1342.
12. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg, 2003, 238(4): 467-485.
13. Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass induced weight loss. Ann Surg, 2003, 237(6): 751-758.
14. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care, 2009, 32(11): 2133-2135.
15. Higgins JPT, Green SJ (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. Available from: www.cochranehandbook.org.
16. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery vs. conventional medical therapy for type 2 diabetes. N Engl J Med, 2012, 366(17): 1577-1585.
17. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med, 2012, 366(17):1567-1576.
18. Dixon JB, O’Brien PE, Playfair J, et al. Adjust able gastric banding and conventional the rapy for type 2 diabetes: a randomized controlled trial. JAMA, 2008, 299(3): 616-323.
19. 肖竹, 程中, 田浩明. 从减肥手术谈2型糖尿病的外科治疗. 实用医院临床杂志, 2012, 7(4): 22-24.
20. 王平, 李成林, 崔谚. 减重手术治疗2型糖尿病的进展. 中国现代普通外科, 2011, 14(17): 875-879.
21. Salinari S, Bertuzzi A, Asnaghi S, et al. Firstphase insulin secretion restoration and differential response to glucose load depending on the route of administration in type 2 diabetic subjects after bariatric surgery. Diabetes Care, 2009, 32(3): 375-380.
22. 古应超, 于健春. 胃肠手术治疗2型糖尿病的机制研究进展. 中国医学科学院院报, 2011, 33(3): 262-264.
23. Iaconelli A, Panunzi S, De Gaetano A, et al. Effects of biliopancreatic diversion on diabetic complications: a 10-year follow up. Diabetes Care, 2011, 34(3): 561-567.
24. Hoerger Tj, Zhang P, Segel JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care, 2010, 33(9): 1933-1939.
25. Keating CL, Dixon JB, Moodie ML, et al. Cost efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care, 2009, 32(4): 580-584.
26. Sovik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med, 2011, 155(9): 281-291.
27. The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. N Engl J Med, 2009, 361(5): 445-454.

Chinese Journal of Evidence-Based Medicine

Bariatric Surgery versus Conventional Medical Therapy for Obese Patients with Type 2 Diabetes: A Meta-Analysis

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