Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis

被引:27
作者
Madadi, Ferdous [1 ,2 ]
Jawad, Rami [1 ]
Mousati, Ismail [1 ]
Plaeke, Philip [3 ]
Hubens, Guy [4 ,5 ]
机构
[1] Univ Antwerp, Fac Med & Hlth Care, Univ Pl 1, B-2610 Antwerp, Belgium
[2] Antwerp Univ Hosp, Wilrijkstr 10, B-2650 Edegem, Belgium
[3] Univ Antwerp, LEMP, Univ Pl 1, B-2610 Antwerp, Belgium
[4] Antwerp Univ Hosp, Dept Abdominal Surg, Wilrijkstr 10, B-2650 Edegem, Belgium
[5] Univ Antwerp, ASTARC, Univ Pl 1, B-2610 Antwerp, Belgium
关键词
Sleeve gastrectomy; Roux-en-Y gastric bypass; Gastric banding; Diabetes remission; T2DM; Y-GASTRIC BYPASS; LAPAROSCOPIC BARIATRIC SURGERY; LONG-TERM OUTCOMES; WEIGHT-LOSS; METABOLIC SYNDROME; INSULIN-RESISTANCE; IMPROVEMENT; MELLITUS; GHRELIN; IMPACT;
D O I
10.1007/s11695-019-04199-3
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background The sleeve gastrectomy (SG) has gained popularity which has resulted in a rising number of patients with T2DM to undergo this procedure. This systematic review and meta-analysis aimed to compare the long-term effects of SG on T2DM remission with remission seen after Roux-en-Y gastric bypass (RYGB) or gastric banding (GB). Methods A literature search was performed in PubMed and Cochrane Library using the following search terms: 'sleeve gastrectomy', 'diabetes', 'gastric bypass' and 'gastric banding'. Studies published between January 2000 and April 2018, and with following inclusion criteria were selected for this review: BMI >= 35 kg/m2, age >= 18 years, follow-up >= 1 year, T2DM. Data was statistically analysed using a random-effects model and results were expressed as odds ratio with 95% confidence interval. Results After exclusion, 35 out of an initial 748 studies, consisting of 18 138 T2DM patients, remained for inclusion. Of these patients, 2480 underwent a SG. The remaining patients underwent a RYGB (n = 10,597) or GB (n = 5061). One year postoperatively, SG patients reached significantly (OR 0.71, p = 0.003) less T2DM remission than RYGB. After stratifying for different criteria for remission, RYGB still tended to result in higher remission rates, but the difference was not statistically significant. Beyond 1 year of follow-up, the difference between RYGB and SG in terms of T2DM remission decreased. SG was superior to the GB (OR 2.17, p = 0.001) after 1 year of follow-up. Conclusion This review demonstrates important remission of T2DM following SG. Nevertheless, as remission was significantly more often observed following RYGB surgery, the latter procedure remains the gold standard for reaching T2DM remission in patients with concurrent obesity.
引用
收藏
页码:4066 / 4076
页数:11
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