Network meta‐analysis of the relative efficacy of bariatric surgeries for diabetes remission
Abstract
Summary: Background: Bariatric surgery leads to a higher remission rate for type 2 diabetes mellitus than non‐surgical treatment. However, it remains unsolved which surgical procedure is the most efficacious. This network meta‐analysis aimed to rank surgical procedures in terms of diabetes remission. Methods and findings: We electronically searched for randomized controlled trials in which at least one surgical treatment was included among multiple arms and the diabetes remission rate was included in study outcomes. A random‐effects network meta‐analysis was performed within a frequentist framework. The hierarchy of treatments was expressed as the surface under the cumulative ranking curve value. Results of the analysis of 25 eligible randomized controlled trials that covered non‐surgical treatments and eight surgical procedures (biliopancreatic diversion [BPD], BPD with duodenal switch, Roux‐en Y gastric bypass, mini gastric bypass [mini‐GBP], laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, greater curvature plication and duodenal‐jejunal bypass) showed that BPD and mini‐GBP had the highest surface under the cumulative ranking curve values among the eight surgical treatments. Conclusion: Current network meta‐analysis indicated that BPD or mini‐GBP achieved higher diabetes remission rates than the other procedures. However, the result needs to be interpreted with caution considering that these procedures were in the minority of bariatric surgeries.
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There was a marginal difference in major operative morbidity between RYGB and sleeve gastrectomy (OR 2.04, 95% CI 1.00 to 4.16).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
There was no significant difference in excess weight loss between RYGB and sleeve gastrectomy (WMD -4%, 95% CI -14% to 8%).
“There was no significant difference in EWL (WMD − 4%, 95% CI − 14% to 8%) or diabetes remission (RR 0.89, 95% CI 0.73 to 1.06), findings supported by moderate certainty of evidence.”
Sleeve gastrectomy was associated with 57% higher odds of diabetes remission compared with adjustable gastric banding (OR 0.43, 95% CI 0.19 to 0.98).
“Sleeve gastrectomy was associated with a weighted mean difference of 25% EWL (95% CI 6.4% to 41%) and 57% higher odds of diabetes remission (OR 0.43, 95% CI 0.19 to 0.98).”
Mixed direct and indirect effect estimates were in favor of RYGB compared with adjustable gastric banding for diabetes remission (RR 2.65, 95% CI 1.16 to 6.07).
“Nevertheless, mixed (direct and indirect) effect estimates were in favor of RYGB (RR 2.65, 95% CI 1.16 to 6.07) [91].”
Sleeve gastrectomy was associated with a weighted mean difference of 25% excess weight loss (95% CI 6.4% to 41%) compared with adjustable gastric banding.
“Sleeve gastrectomy was associated with a weighted mean difference of 25% EWL (95% CI 6.4% to 41%) and 57% higher odds of diabetes remission (OR 0.43, 95% CI 0.19 to 0.98).”
There was no difference in diabetes remission between RYGB and adjustable gastric banding (RR 1.96, 95% CI 0.47 to 8.33).
“There was no difference in diabetes remission (RR 1.96, 95% CI 0.47 to 8.33), although certainty of the evidence was low (Supplementary Table S17).”
The weighted mean difference of excess weight loss was 22% (95% CI 6.5% to 34%) in favor of RYGB compared with adjustable gastric banding.
“The WMD of EWL was 22% (95% CI 6.5% to 34%) in favor of RYGB, which was associated with high certainty evidence.”
A network meta-analysis found RYGB to be associated with higher odds for diabetes remission compared with gastric plication (RR 4.00, 95% CI 1.40 to 11.11).
“A network meta-analysis found RYGB to be associated with higher odds for remission compared to gastric plication (RR 4.00, 95% CI 1.40 to 11.11), albeit certainty was low due to imprecision and risk of bias (Supplementary Table S18).”
There was no significant difference in diabetes remission between RYGB and sleeve gastrectomy (RR 0.89, 95% CI 0.73 to 1.06).
“There was no significant difference in EWL (WMD − 4%, 95% CI − 14% to 8%) or diabetes remission (RR 0.89, 95% CI 0.73 to 1.06), findings supported by moderate certainty of evidence.”
Remission of dyslipidemia and hypertension were in favor of sleeve gastrectomy compared with RYGB, but certainty of the evidence was very low.
“Remission of dyslipidemia and hypertension were in favor of sleeve gastrectomy, but certainty of the evidence was very low due to observational study design, risk of bias, inconsistency and indirectness (Supplementary Table S19).”
OAGB was associated with marginally reduced odds for in-hospital morbidity compared with RYGB (OR 0.38, 95% CI 0.13 to 1.14).
“OAGB was associated with marginally reduced odds for in-hospital morbidity (OR 0.38, 95% CI 0.13 to 1.14) and late complications (0.76, 95% CI 0.33 to 1.77) at the expense of less pronounced EWL (WMD 13%, 95% CI 2% to 29%; very low certainty) (Supplementary Table S22).”
Quality of life and resolution of comorbidities were similar between OAGB and RYGB.
“Quality of life and resolution of comorbidities was similar.”
There were no differences in long-term major complications between RYGB and sleeve gastrectomy (OR 0.64, 95% CI 0.21 to 1.96).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
OAGB was associated with marginally reduced odds for late complications compared with RYGB (OR 0.76, 95% CI 0.33 to 1.77).
“OAGB was associated with marginally reduced odds for in-hospital morbidity (OR 0.38, 95% CI 0.13 to 1.14) and late complications (0.76, 95% CI 0.33 to 1.77) at the expense of less pronounced EWL (WMD 13%, 95% CI 2% to 29%; very low certainty) (Supplementary Table S22).”
OAGB was associated with less pronounced excess weight loss compared with RYGB (WMD 13%, 95% CI 2% to 29%; very low certainty).
“OAGB was associated with marginally reduced odds for in-hospital morbidity (OR 0.38, 95% CI 0.13 to 1.14) and late complications (0.76, 95% CI 0.33 to 1.77) at the expense of less pronounced EWL (WMD 13%, 95% CI 2% to 29%; very low certainty) (Supplementary Table S22).”
There were no differences in minor perioperative complications between RYGB and sleeve gastrectomy (OR 1.43, 95% CI 0.60 to 3.23).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
There were no differences in long-term minor complications between RYGB and sleeve gastrectomy (OR 0.64, 95% CI 0.28 to 1.47).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
The present guidelines identified several gaps, particularly in the long-term reporting of outcomes.
“Despite the advances in the field, we have identified several gaps, particularly in the long-term reporting of outcomes [90, 91].”
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- Authors
- Kodama, S., Fujihara, K., Horikawa, C., Harada, M., Ishiguro, H., Kaneko, M., Furukawa, K., Matsubayashi, Y., Matsunaga, S., Shimano, H., Tanaka, S., Kato, K., & Sone, H.
- Affiliations
- Niigata University (JP)
- University of Niigata Prefecture (JP)
- University of Tsukuba (JP)
- Kyoto University Hospital (JP)
- Corresponding author
- Kodama, S.
- ORCID
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2018-09-30
- Volume
- 19
- Issue
- 12
- Pages
- 1621-1629
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W2895571792
- Cited by
- 42
- References
- 49
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 12 · 2019: 5
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (16671647, 17900899, ID16671647, ID17900899)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- bariatric surgery, type 2 diabetes, diabetes remission, biliopancreatic diversion, duodenal switch, Roux-en-Y gastric bypass, one anastomosis gastric bypass, laparoscopic adjustable gastric banding, sleeve gastrectomy, duodenal-jejunal bypass, treatment ranking
- MeSH terms
- Diabetes Mellitus, Type 2, Humans, Remission Induction, Treatment Outcome, Bariatric Surgery
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