Original article
The effects of metabolic surgery on microvascular complications in obese patients with type 2 diabetes: a meta-analysis

https://doi.org/10.1016/j.soard.2020.09.013Get rights and content

Highlights

  • The effects of metabolic surgery on the rate of microvascular complications have not been revealed. In this study, we carried out a meta-analysis and found that metabolic surgery was superior to medical treatment in reducing the incidence of microvascular complications.

Abstract

Background

Metabolic surgery is a standard treatment for obesity with type 2 diabetes (T2D), although the effects of metabolic surgery on the incidence rate of microvascular complications remain controversial.

Objectives

We aimed to evaluate the effect of metabolic surgery versus nonsurgical treatments on the incidence rate of microvascular complications in obesity with T2D.

Setting

A meta-analysis of published studies.

Methods

We searched PubMed, Web of Science, and the Cochrane Library to identify clinical studies assessing the effect of metabolic surgery on the incidence rate of microvascular diabetic complications compared with that of nonsurgical treatments. We extracted the primary outcomes, including the incidence rate of microvascular complications after metabolic surgery.

Results

A total of 32,756 participants from 12 studies were identified. Metabolic surgery reduced the incidence rate of microvascular complications (odds ratios [OR], .34; 95% confidence intervals [CI], .30–.39; P < .001) compared with that of nonsurgical treatments in obesity with T2D. Moreover, metabolic surgery also reduced the incidence of diabetic nephropathy (OR, .39; 95% CI, .30–.50; P < .001), diabetic retinopathy (OR, .52; 95% CI, .42–.65; P < .001) and diabetic neuropathy (OR, .27; 95% CI, .22–.34; P < .001) compared with nonsurgical treatments in obesity with T2D.

Conclusion

Metabolic surgery was superior to nonsurgical treatments in reducing the incidence of microvascular complications in obesity with T2D. Prospective studies, preferably randomized controlled trials, with evaluations of different types of metabolic surgery are warranted to provide guidelines for treatment preferences in obesity with T2D.

Section snippets

Methods

This meta-analysis was performed on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [17]. All stages of the literature search, study selection, data extraction, and quality assessment processes were performed independently by 2 authors (X. C. and J. Z.). Disagreements were resolved by discussion or consensus with a third reviewer (Z. Z.).

Characteristics of the included studies

The details of the literature search process are presented in Fig. 1. The initial literature search yielded 9738 articles after duplicates were removed. Two reviewers then excluded 9684 articles after they independently screened the titles and abstracts, and 54 articles were assessed for eligibility. Ultimately, 12 studies [12,[23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33]] were selected for inclusion. Fig. 2 shows the risk of bias of the included RCTs. The 9 cohort studies

Discussion

Currently, diabetes is a major public health concern [1]. This meta-analysis shows that metabolic surgery was superior to nonsurgical treatments in reducing the overall incidence of microvascular complications in patients with T2D. The incidence rates of nephropathy, retinopathy, and neuropathy were lower after metabolic surgery than after medical therapy. Our findings support the central role of metabolic surgery in the prevention of microvascular complications.

Our research shows that

Conclusions

We now have evidence that metabolic surgery is superior to nonsurgical treatments in reducing the incidence rate of microvascular complications in obese patients with T2D. Prospective studies, preferably RCTs, with evaluations of different types of metabolic surgery are warranted to provide guidelines for treatment preferences in obese patients with T2D.

Disclosures

All the authors have no commercial associations that might be a conflict of interest in relation to this article.

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    Supported by the National Key R&D Program of China (2016 YFC1305000, 2016 YFC1305001), the National Natural Science Foundation of China (91749118, 81770775), the Science and Technology Major Project of Hunan Province (2017 SK1020) and the Planned Science and Technology Project of Hunan Province (2017 RS3015).

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