Abstract A network meta-analysis of randomized controlled trials (RCTs) was conducted to establish the ranking of various bariatric surgeries in mid- and long-term follow-up durations for people with type 2 diabetes mellitus (T2DM), based on T2DM remission, HbA1c levels, and cardiometabolic outcomes. We searched PubMed, Embase, Medline, and Cochrane Central databases. A common comparator was identified between interventions to develop a network. Mean difference (MD) and 95% confidence interval (CI) were estimated between interventions. Direct and indirect evidence were pooled using the random-effect model. Eleven RCTs and four bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic-adjustable gastric banding (LAGB), biliopancreatic diversion without duodenal switch (BPD), sleeve gastrectomy (SG), and medical/lifestyle treatment (MT) as a comparator group, were included. RYGB, LAGB, BPD, SG, as compared with MT, were all significantly associated with the remission of T2DM and HbA1c levels. While BPD is the best one for remission (MD: -5.14 95% CI -7.33 to -2.96), HbA1c (MD: -31.75 95% CI -37.73 to -25.77), the evidence is sparse. RYGB was the most effective surgery type for BMI, TG, and DBP for the mid-term follow-up period. Moderate mid- and long-term effects of T2DM remission and HbA1c levels were observed after all surgical procedures. However, BPD appears to be promising for achieving long-term diabetes remission, HbA1c levels, and cardiometabolic profiles. RYGB is the most favourable option to manage HbA1c levels and BMI. The effects of other surgical types on cardiometabolic profiles are inconclusive and require further research.
Celik et al. (Fri,) studied this question.