Short- and long-term remission of obese type 2 diabetes mellitus after gastric bypass surgery or sleeve gastrectomy: a Meta analysis

doi:10.3877/cma.j.issn.1674-0793.2014.04.018

Abstract

Abstract:

Objective

To analyze the evidence-based study of short-term and long-term remission of type 2 diabetes mellitus(T2DM) after sleeve gastrectomy(SG) or gastric bypass surgery(GBP).

Methods

Related articles were systematically retrieved by searching Medline, Embase database, and Cochrane library. Inclusion and exclusion criteria to select literatures were set up. The data were qualitatively evaluated and analyzed by STATA or SPSS software.

Results

Thirty-four articles were involved including 8 randomized controlled trials (RCTs). Among them, 26 studies were on GBP surgeries and 27 on SG. The preoperative BMI of GBP and SG group were (44.8±5.2) kg/m² and (46.68±7.3) kg/m², preoperative glycosylated hemoglobin index were (7.86±0.73)% and (7.91±0.98)%, preoperative fasting plasma glucose were (158.0±18.1) mg/dl and (167.7±41.6)mg/dl, retrospectively. After 1 year of follow-up, the remission rate of T2DM was 77% and 74% in GBP and SG groups, while the remission rate was 74% and 85% in follow-up of 3 years. In follow-up of 5 or more years, the remission rate of SG surgery was 77%, while that of GBP group was 74% according to the Meta analysis. Comparing the remission rate of T2DM in GBP and SG group from the 8 RCTs, the RR was 1.26, 95% CI=1.10-1.44. The difference between the two groups was statistically significant (P<0.01).

Conclusion

Both SG and GBP surgeries are effective treatments for obese T2DM. The remission rate of GBP surgery is higher than SG.

Key words: Sleeve gastrectomy(SG), Gastric bypass surgery(GBP), Type 2 diabetes mellitus, Long-term efficacy, Remission

Cong Tang, Wenfeng Liang, Hong Cen, Qiang Chen. Short- and long-term remission of obese type 2 diabetes mellitus after gastric bypass surgery or sleeve gastrectomy: a Meta analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2014, 08(04): 321-331.

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References 81

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分类	内容	评分
选择偏倚	连续或者有代表性的研究（包括随机非随机临床试验或）	1
失访偏倚	随访率>80%	1
实施偏倚	组间实施及干预相同	1
检出偏倚	随机或者前瞻性临床研究	1
	双盲或者独立临床试验	1
	验证/客观结果	1

分类	内容	评分
选择偏倚	连续或者有代表性的研究（包括随机非随机临床试验或）	1
失访偏倚	随访率>80%	1
实施偏倚	组间实施及干预相同	1
检出偏倚	随机或者前瞻性临床研究	1
	双盲或者独立临床试验	1
	验证/客观结果	1

项目	胃旁路手术（GBP）	袖状胃切除术（SG）
病例数	1 325	1 165
糖尿病患病时间（年）	6.24±1.59	6.56±2.7
年龄（岁）	45.1±4.9	44.1±1.9
基础体重指数（BMI，kg/m²）	44.8±5.2	46.68±7.3
糖化血红蛋白（HbA1c，%）	7.86±0.73	7.91±0.98
空腹血糖（FPG，mg/dl）	158.0±18.1	167.7±41.6

项目	胃旁路手术（GBP）	袖状胃切除术（SG）
病例数	1 325	1 165
糖尿病患病时间（年）	6.24±1.59	6.56±2.7
年龄（岁）	45.1±4.9	44.1±1.9
基础体重指数（BMI，kg/m²）	44.8±5.2	46.68±7.3
糖化血红蛋白（HbA1c，%）	7.86±0.73	7.91±0.98
空腹血糖（FPG，mg/dl）	158.0±18.1	167.7±41.6

文献，出版年	患病时间（年）	血糖水平（mg/dl）	HbA1c（%）	例数	年龄（岁）	BMI（kg/m²）	T2DM术后5年缓解率（%）
Abbatini等，2013^[15]	-	143.2	7.30	13	49.3	52.1	76.9
Brethauer等，2013^[50]	10.5	137	7.8	23	57.7	50.7	74
Zachariah等，2013^[29]	-	-	-	3	34.6	37.42	66.66
Rawlins等，2013^[51]	-	-	-	19	44	65	100
Catheline等，2013^[52]	-	-	-	13	41.8	49.91	61.5
Sieber等，2014^[53]	-	-	-	20	43	46	85

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