Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta‐analysis and network meta‐analysis of randomized controlled trials

Luca, Maurizio De; Zese, Monica; Bandini, Giulia; Chiappetta, Sonja; Iossa, Angelo; Merola, Giovanni; Piatto, Giacomo; Tolone, Salvatore; Vitiello, Antonio; Silverii, Giovanni Antonio; Ragghianti, Benedetta; Mannucci, Edoardo; Monami, Matteo

doi:10.1111/dom.15117

Cited by 18 publications

(5 citation statements)

References 111 publications

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“…The meta-analysis showed that MBS was associated with a significantly higher reduction of HbA1c, T2DM remission, and BMI compared with medical therapy and a significant reduction of HbA1c was observed with OAGB and SG and in addition, RYGB and OAGB were associated with a significant reduction of BMI. The group concluded therefore, that MBS is an effective option for the treatment of T2DM in patients with obesity, but pointed out that further long-term trials of appropriate quality are needed for assessing the risk–benefit ratio in some patient cohorts, such as those with a BMI of less than 35 kg/m 2 23 .…”

Section: Discussionmentioning

confidence: 99%

Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Kermansaravi,

Chiappetta,

Parmar

et al. 2024

Sci Rep

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Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.

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Section: Discussionmentioning

confidence: 99%

Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Kermansaravi,

Chiappetta,

Parmar

et al. 2024

Sci Rep

Self Cite

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“…The SCD2023 recommends that metabolic surgery should be considered to treat T2DM in adult patients with class III obesity (categorized according to body mass index (BMI) and ethnicity) or class II obesity who receive nonsurgical treatment but do not achieve durable weight reduction and improvement in comorbidities [ 24 ]. Compared with nonsurgical treatment, metabolic surgery was associated with a greater reduction in HbA1c (MD = − 3.1% at endpoint) and rates of T2DM remission (odds ratio (OR) = 4.23) [ 41 ].…”

Section: Metabolic Surgerymentioning

confidence: 99%

Body Fat Depletion: the Yin Paradigm for Treating Type 2 Diabetes

Zhu,

Wilding

2023

Curr Atheroscler Rep

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Purpose of Review To highlight that body fat depletion (the Yin paradigm) with glucose-lowering treatments (the Yang paradigm) are associated with metabolic benefits for patients with type 2 diabetes mellitus (T2DM). Recent Findings The sodium-glucose cotransporter-2 inhibitor-mediated sodium/glucose deprivation can directly improve glycemic control and kidney outcome in patients with T2DM. The glucose deprivation might also promote systemic fatty acid β-oxidation to deplete ectopic/visceral fat and thereby contribute to the prevention of cardiovascular diseases. As with metabolic surgery, bioengineered incretin-based medications with potent anorexigenic and insulinotropic efficacy can significantly reduce blood glucose as well as body weight (especially in the ectopic/visceral fat depots). The latter effects could be a key contributor to their cardiovascular-renal protective effects. Summary In addition to a healthy diet, the newer glucose-lowering medications, with body fat reduction effects, should be prioritized when treating patients with T2DM, especially for those with established cardiovascular/renal risks or diseases.

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“…LSG is primarily utilized in early surgical interventions for severely patients with obesity; it is a relatively simple procedure with few complications. A substantial body of clinical evidence has indicated that LSG yields favorable outcomes in terms of weight loss and metabolic improvement (Balasubaramaniam & Pouwels, 2023;Cosentino et al, 2021;De Luca et al, 2023). On the other hand, LSG + JJB involves preserving the excised portion of the greater curvature while incorporating a 200 cm long jejunum into the procedure based on the principles of LSG.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic sleeve gastrectomy and laparoscopic sleeve gastrectomy with jejunojejunal bypass surgery in patients with obesity: a correlation analysis between body weight, inflammation, glucose metabolism, and sex

Feng,

Gao,

Zhang

et al. 2024

Preprint

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Background Bariatric surgery, which can be performed via laparoscopic sleeve gastrectomy (LSG) or laparoscopic sleeve gastrectomy with jejunojejunal bypass (LSG + JJB), is a promising treatment for patients with obesity. However, the influencing factors in LSG and LSG + JJB surgery remain unclear. Methods This study included 60 patients with obesity, divided randomly into LSG group and LSG + JJB group based on the surgical type. The weight loss and diabetes remission were compared at 3 months after surgery. Blood glucose metabolism indices including fasting blood glucose (FBG), homeostatic model assessment of insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), as well as inflammatory factors were measured. Results We found that the hypoglycemic effect in the LSG + JJB group was significantly superior to that in the LSG group. In the LSG + JJB group, weight was associated with inflammatory factors, including IL-8 (r = 0.431, P = 0.017), TNF-α (r = 0.381, P = 0.038), IL-10 (r = 0.410, P = 0.024), and glucose metabolism indicators FBG (r = 0.360, P = 0.050) and HOMA-IR (r = 0.374, P = 0.042). In addition, we observed a correlation between inflammatory factors and glucose metabolism in this group. The operative effect was also found to correlate with sex; males showed a more optimal effect in decreasing glucose metabolism and reducing inflammatory factors than females who underwent LSG + JJB surgery. Conclusion LSG + JJB surgery was related to inflammation, glucose metabolism, and sex, providing valuable insights for effective treatment approaches targeting individuals with obesity.

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Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta‐analysis and network meta‐analysis of randomized controlled trials

Cited by 18 publications

References 111 publications

Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Body Fat Depletion: the Yin Paradigm for Treating Type 2 Diabetes

Laparoscopic sleeve gastrectomy and laparoscopic sleeve gastrectomy with jejunojejunal bypass surgery in patients with obesity: a correlation analysis between body weight, inflammation, glucose metabolism, and sex

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