Long-term outcomes of macrovascular diseases and metabolic indicators of bariatric surgery for severe obesity type 2 diabetes patients with a meta-analysis

Abstract

There is currently no detailed evidence for the long-term effects of bariatric surgery on severely obese with type 2 diabetes, such as the risk of myocardial infarction and stroke. In order to provide evidence on the risks of macrovascular diseases and metabolic indicators of bariatric surgery follow-up for more than five years, we searched in the Cochrane library, Pubmed, and EMBASE databases from the earliest studies to January 31, 2019. Randomized clinical trials or cohort studies compared bariatric surgery and conventional medical therapy for long-term incidence of macrovascular events and metabolic outcomes in severely obese patients with T2DM. Fixed-effects and random-effects meta-analyses were performed to pool the relative risks (RRs), hazard ratios (HRs) and weighted mean difference (WMD). Publication bias and heterogeneity were examined. Four RCTs and six cohort studies were finally involved in this review. Patients in the bariatric surgery group as compared to the conventional treatment group had lower incidence of macrovascular complications (RR = 0.43, 95%CI = 0.27~0.70), cardiovascular events (CVEs) (HR = 0.52, 95%CI = 0.39~0.71), and myocardial infarction (MI) (RR = 0.40, 95%CI = 0.26~0.61). At the same time, the results demonstrate that bariatric surgery is associated with better weight and better glycemic control over the long-term than non-surgical therapies, and reveal that different surgical methods have different effects on various metabolic indicators. Bariatric surgery significantly decreases macrovascular complications over the long term and is associated with greater weight loss and better intermediate glucose outcomes among T2DM patients with severe obesity as compared to patients receiving only conservative medical measures.

Impact of Bariatric Surgery in A Cohort of Patients with Type 2 Diabetes and Obesity

“…Concerning the lipid profile, as mentioned above and in relation to the improvement in insulin sensitivity, we found an increase in HDL and a decrease in triglycerides and non-HDL cholesterol, the latter also associated with high cardiovascular risk. These changes are similar to those found by different authors [10,13,14]. We also observed a decrease in creatinine levels in the postoperative period, which could be due to the changes in muscle mass that accompany the massive weight loss, as well as due to a decrease in hyper filtration, present in obese patients.…”

“…Such an improvement implies a decrease in the use of oral antidiabetic and insulin, as was also demonstrated by other authors [10,11]. Although we did not find a significant decrease in blood pressure, the decrease in the use of antihypertensive drugs allows us to infer a remission of hypertension (blood pressure <140/90 mmHg without medication) as observed by Puzziferri et al and Yang et al their meta-analysis [12,13]. Concerning the lipid profile, as mentioned above and in relation to the improvement in insulin sensitivity, we found an increase in HDL and a decrease in triglycerides and non-HDL cholesterol, the latter also associated with high cardiovascular risk.…”

The Health Economic Evaluation of Bariatric Surgery Versus a Community Weight Management Intervention Analysis from the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT)

“…Bariatric surgery is known to deliver wide-reaching health benefits, as compared with conservative medical methods for weight loss [ 24 ]. For example, Roux-en-Y gastric bypass surgery is associated with a reduced risk of cardiovascular disease when compared with routine care [ 25 ].…”

Perioperative Sleep Disturbances and Postoperative Delirium in Adult Patients: A Systematic Review and Meta-Analysis of Clinical Trials

“…We used meta-regression to identify the sources of high heterogeneity according to possible risk factors ( 25 ). Meta-regression analyses that produced a risk factor of p < 0.05 were followed by subgroup analysis, while those that produced a risk factor of p ≥ 0.05 were followed by one-by-one article removal ( 26 ).…”