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August 20, 2026Cochrane library

Metabolic and bariatric surgery in adults with obesity and diabetes mellitus: a network meta-analysis

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Authors

EKEva KiesswetterUniversity of FreiburgLGLea GorenfloUniversity Medical Center FreiburgGSGuido SchwarzerUniversity of Freiburg

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Overview

Network meta-analysis shows bariatric surgery improves long-term weight and glycemia in adults with diabetes, indicating surgical benefits over medical therapy.

Key Points

  • To assess the medium- and long-term benefits and harms of various metabolic and bariatric surgery (MBS) procedures compared with each other and non-surgical treatment in adults with obesity and type 2 diabetes.
  • Systematic search across multiple databases up to June 25, 2024, including RCTs and cohort studies with ≥3 years of follow-up comparing MBS procedures or non-surgical therapy (lifestyle intervention/medical treatment [LI/MT]).
  • Analyzed 18 studies (13 RCTs, n = 911; 5 cohort studies, n = 14,371) evaluating Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), laparoscopic adjustable gastric banding (LAGB), and gastric plication (GCP).
  • Performed random-effects frequentist network meta-analyses and evaluated certainty of evidence using the GRADE approach for long-term (≥5 years) outcomes.
  • RYGB achieved greater long-term weight loss compared to LI/MT (MD -16.95%, 95% CI -24.19 to -9.71; 8 RCTs, n = 491), along with greater reductions via OAGB (MD -12.10%, 95% CI -22.85 to -1.34) and SG (MD -9.40%, 95% CI -17.45 to -1.34), though evidence for OAGB and SG was very uncertain.
  • RYGB likely reduced long-term waist circumference compared to LI/MT (MD -12.34 cm, 95% CI -17.88 to -6.81; 6 RCTs, n = 348) and lowered HbA1c (MD -1.44%, 95% CI -2.26 to -0.63; 10 RCTs, n = 612).
  • Evidence was very uncertain regarding the comparative effects of MBS on complete type 2 diabetes remission, serious adverse events, all-cause mortality, and long-term diabetes complications (RYGB vs LI/MT Rate Ratio 0.17, 95% CI 0.03 to 0.89; 5 RCTs, n = 356).

Cite This Study

Kiesswetter et al. (2026) studied this question.

synapsesocial.com/papers/6a86b56c8a91293e6a1cccb5https://doi.org/10.1002/14651858.cd015622.pub2
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparative Mid- to Long-Term Effects of Bariatric Surgery Versus Medical/Lifestyle Management in Type 2 Diabetes Mellitus: A Network Meta-Analysis of Randomized Controlled Trials2026 · 1 citations
  2. 2Efficacy and Safety of Pharmacological, Endoscopic, and Surgical Treatments for Obesity: A <scp>GRADE</scp> ‐Based Network Meta‐Analysis2026 · 3 citations
  3. 3Outcomes and Adverse Events After Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2013–20232023 · 56 citations
  4. 4IBC Oxford Oral Abstract 63 - Impact of metabolic and bariatric surgery on the paediatric &amp; adolescent metabolome: a systematic review and meta-analysis2026
  5. 5Single-Center Metabolic Bariatric Surgery Experience Study: Outcomes from 21,205 Cases over 12 Years2024