Metabolic Surgery for the Treatment of Type 2 Diabetes: A Network Metanalysis of Randomized Controlled Trials.

AIM: Aim of this network-meta-analysis (NMA) was to compare different types of metabolic surgery (MS) with medical therapy (MT) for the treatment of type 2 diabetes (T2D). MATERIALS AND METHODS: This NMA includes randomized clinical trials comparing different MS techniques versus MT inT2D, with a duration of >/= 24 weeks. Primary endpoints were HbA1c, fasting plasma glucose (FPG) and diabetes remission. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% Confidence Intervals for continuous variables, and Mantel-Haenzel Odds Ratio [MH-OR] for categorial variables were calculated, using random effect models. Types of MS included Laparoscopic Adjustable Gastric Banding (LABG), Roux-en-Y Gastric By-Pass (RYGB), Sleeve Gastrectomy (SG) and Bilio-Pancreatic Diversion (BPD); Greater Curvature Plication (GCP); One-Anastomosis Gastric Bypass (OAGB); Duodenojejunal Bypass (DJB). RESULTS: The 24 retrieved trials included 1.351 patients (1017 with surgery and 337 with MT). The mean baseline BMI was 36.8 kg/m2. MS was associated with a significantly greater reduction of HbA1c, FPG and diabetes remission when compared to MT. In the NMA, a significant reduction of HbA1c was observed with OAGB and SG. All surgical procedures were associated with a significant increase of diabetes remission, except GCP and LAGB. All procedures were associated with a reduction of BMI. CONCLUSIONS: MS is an interesting option for the treatment of T2D, although further data are needed to demonstrate its long-term efficacy and safety. Present data are not sufficient to modify current recommendations, which consider MS a possible treatment for T2D with a BMI above 35 kg/m2. This article is protected by copyright. All rights reserved.