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

Autoři: Guoli Yan aff001;  Jinjin Wang aff001;  Jianfeng Zhang aff002;  Kaiping Gao aff003;  Qianqian Zhao aff001;  Xueqin Xu aff001
Působiště autorů: Public Health and Preventive Medicine Teaching and Research Center, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China aff001;  Henan Armed Police Corps Hospital, Zhengzhou, People’s Republic of China aff002;  Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, China aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224828


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.

Klíčová slova:

Cohort studies – Digestive system procedures – Myocardial infarction – Obesity – stroke – Surgical and invasive medical procedures


1. Naidoo V, Naidoo M, Ghai M. Cell- and tissue-specific epigenetic changes associated with chronic inflammation in insulin resistance and type 2 diabetes mellitus. SCAND J IMMUNOL 2018;88:e12723. doi: 10.1111/sji.12723 30589455

2. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR. Bariatric Surgery versus Intensive Medical Therapy for Diabetes—5-Year Outcomes. N Engl J Med 2017;376:641. doi: 10.1056/NEJMoa1600869 28199805

3. Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher AR, Hu J, Li Z, Shekelle PG. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA 2013;309:2250. doi: 10.1001/jama.2013.4851 23736734

4. Wang S, Li P, Sun XF, Ye NY, Xu ZK, Wang D. Comparison between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding for morbid obesity: a meta-analysis. OBES SURG 2013;23:980. doi: 10.1007/s11695-013-0893-3 23604584

5. Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. OBES SURG 2013;23:1994. doi: 10.1007/s11695-013-1030-z 23955521

6. Wu GZ, Cai B, Yu F, Fang Z, Fu XL, Zhou HS, Zhang W, Tian ZQ. Meta-analysis of bariatric surgery versus non-surgical treatment for type 2 diabetes mellitus. Oncotarget 2016;7:87511. doi: 10.18632/oncotarget.11961 27626180

7. Ricci C, Gaeta M, Rausa E, Asti E, Bandera F, Bonavina L. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. OBES SURG 2015;25:397. doi: 10.1007/s11695-014-1442-4 25240392

8. Sheng B, Truong K, Spitler H, Zhang L, Tong X, Chen L. The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis. OBES SURG 2017;27:2724. doi: 10.1007/s11695-017-2866-4 28801703

9. Iaconelli A, Panunzi S, De Gaetano A, Manco M, Guidone C, Leccesi L, Gniuli D, Nanni G, Castagneto M, Ghirlanda G, Et A. Effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up. 2011;34:561.

10. Romeo S, Jacobson P, Maglio C, Svensson P, Burza MA, Peltonen M, Pirazzi C, Sjostrom L, Sjoholm K, Carlsson L. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. 2012;35:2613.

11. Johnson BL, Blackhurst DW, Latham BB, Cull DL, Bour ES, Oliver TL, Williams B, Taylor SM, Scott JD. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J AM COLL SURGEONS 2013;216:545.

12. Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å, Bouchard C, Carlsson B, Karason K, Lönroth H, Näslund I, Sjöström E, Taube M, Wedel H, Svensson PA, Sjöholm K, Carlsson LMS. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA—Journal of the American Medical Association 2014;311:2297.

13. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M, Bornstein S, Rubino F. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. LANCET 2015;386:964. doi: 10.1016/S0140-6736(15)00075-6 26369473

14. Chen Y, Corsino L, Shantavasinkul PC, Grant J, Portenier D, Ding L, Torquati A. Gastric Bypass Surgery Leads to Long-term Remission or Improvement of Type 2 Diabetes and Significant Decrease of Microvascular and Macrovascular Complications. ANN SURG 2016;263:1138. doi: 10.1097/SLA.0000000000001509 26599565

15. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Et A. Bariatric Surgery versus Intensive Medical Therapy for Diabetes—5-Year Outcomes. 2017;376:641.

16. Liakopoulos V, Franzen S, Svensson AM, Zethelius B, Ottosson J, Naslund I, Gudbjornsdottir S, Eliasson B. Changes in risk factors and their contribution to reduction of mortality risk following gastric bypass surgery among obese individuals with type 2 diabetes: a nationwide, matched, observational cohort study. BMJ Open Diabetes Res Care 2017;5:e386.

17. Fisher DP, Johnson E, Haneuse S, Arterburn D, Coleman KJ, O’Connor PJ, O’Brien R, Bogart A, Theis MK, Anau J, Schroeder EB, Sidney S. Association between Bariatric Surgery and Macrovascular Disease Outcomes in Patients with Type 2 Diabetes and Severe Obesity. JAMA—Journal of the American Medical Association 2018;320:1570.


19. Menezes KK, Nascimento LR, Avelino PR, Alvarenga M, Teixeira-Salmela LF. Efficacy of Interventions to Improve Respiratory Function After Stroke. Respir Care 2018;63:920. doi: 10.4187/respcare.06000 29844210

20. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557. doi: 10.1136/bmj.327.7414.557 12958120

21. Baujat B, Mahe C, Pignon JP, Hill C. A graphical method for exploring heterogeneity in meta-analyses: application to a meta-analysis of 65 trials. STAT MED 2002;21:2641. doi: 10.1002/sim.1221 12228882

22. ANTEL N, HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719. 13655060

23. Midgette AS, Wong JB, Beshansky JR, Porath A, Fleming C, Pauker SG. Cost-effectiveness of streptokinase for acute myocardial infarction: A combined meta-analysis and decision analysis of the effects of infarct location and of likelihood of infarction. MED DECIS MAKING 1994;14:108. doi: 10.1177/0272989X9401400203 8028463

24. Mutshinda CM, Sillanpaa MJ. Swift block-updating EM and pseudo-EM procedures for Bayesian shrinkage analysis of quantitative trait loci. THEOR APPL GENET 2012;125:1575. doi: 10.1007/s00122-012-1936-1 22824967

25. Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629. doi: 10.1136/bmj.315.7109.629 9310563

26. Cardiovascular Disease Risk Management: Standards of Medical Care in Diabetes-2018. DIABETES CARE 2018;41:S86. doi: 10.2337/dc18-S009 29222380

27. Low WC, Hess CN, Hiatt WR, Goldfine AB. Clinical Update: Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus—Mechanisms, Management, and Clinical Considerations. CIRCULATION 2016;133:2459. doi: 10.1161/CIRCULATIONAHA.116.022194 27297342

28. Johnston CA, Moreno JP, Foreyt JP. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. CURR ATHEROSCLER REP 2014;16:457. doi: 10.1007/s11883-014-0457-6 25288176

29. Cunningham JW, Wiviott SD. Modern obesity pharmacotherapy: weighing cardiovascular risk and benefit. CLIN CARDIOL 2014;37:693. doi: 10.1002/clc.22304 25223901

30. Arterburn DE, O’Connor PJ. A look ahead at the future of diabetes prevention and treatment. JAMA 2012;308:2517. doi: 10.1001/jama.2012.144749 23287825

31. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311:74. doi: 10.1001/jama.2013.281361 24231879

32. Srivastava G, Apovian CM. Current pharmacotherapy for obesity. NAT REV ENDOCRINOL 2018;14:12. doi: 10.1038/nrendo.2017.122 29027993

33. Courcoulas AP, Belle SH, Neiberg RH, Pierson SK, Eagleton JK, Kalarchian MA, DeLany JP, Lang W, Jakicic JM. Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial. JAMA SURG 2015;150:931. doi: 10.1001/jamasurg.2015.1534 26132586

34. Cummings DE, Arterburn DE, Westbrook EO, Kuzma JN, Stewart SD, Chan CP, Bock SN, Landers JT, Kratz M, Foster-Schubert KE, Flum DR. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. DIABETOLOGIA 2016;59:945. doi: 10.1007/s00125-016-3903-x 26983924

35. Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers. Clin Diabetes 2016;34:3. doi: 10.2337/diaclin.34.1.3 26807004

36. Nakaoka H, Inoue I. Meta-analysis of genetic association studies: methodologies, between-study heterogeneity and winner’s curse. J HUM GENET 2009;54:615. doi: 10.1038/jhg.2009.95 19851339

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden