The long-term effect of bariatric/metabolic surgery versus pharmacologic therapy in type 2 diabetes mellitus patients: A systematic review and meta-analysis

Abstract

AbstractBackgroundMetabolic/bariatric surgery as a treatment for obesity and related diseases, such as type 2 diabetes mellitus (T2DM), has been increasingly recognized. However, the long-term effect (≥ five years) of metabolic surgery in T2D patients is still unclear compared with conventional pharmacologic therapy. This study aims to evaluate the diabetes remission rate, diabetic microvascular complications incidence, macrovascular complications incidence, and mortality in T2D patients who received metabolic surgery versus pharmacologic therapy more than five years after the surgery.MethodsSearching the database, including PubMed, Embase, Web of Science, and Cochrane Library from the inception to recent (2022), for randomized clinical trials (RCTs) or cohort studies comparing T2D patients treated with metabolic surgery versus pharmacologic therapy reporting on the outcomes of the diabetes remission rate, diabetic microvascular complications, macrovascular complications, or mortality over five years or more.ResultsA total of 13 articles with a total of 68,280 patients with T2D were eligible for review and meta-analysis in this study. There is a significant long-term increase in diabetes remission for metabolic surgery compared with conventional medical therapy in the overall pooled estimation and RCT studies or cohort studies separately (overall: OR = 8.39, 95%CI: 3.58-19.67, P<0.001). Significant long-term decreases showed in the pooled results of microvascular complications incidence (HR = 0.43, 95%CI: 0.37-0.49, P<0.001), macrovascular complications incidence (HR = 0.60, 95%CI: 0.48-0.75, P<0.001) and mortality (HR = 0.44, 95%CI: 0.37-0.49, P<0.001).ConclusionMetabolic surgery showed more significant long-term effects than pharmacologic therapy on diabetes remission, macrovascular complications, microvascular complications incidence, and all-cause mortality in patients with T2D using currently available evidence. More high-quality evidence is needed to validate the long-term effects of metabolic surgery versus conventional treatment in the management of diabetes.