Bariatric surgery, novel glucose-lowering agents, and insulin for type 2 diabetes and obesity: Bayesian network meta-analysis of randomized controlled trials-Reference-Cited by-同舟云学术

Bariatric surgery, novel glucose-lowering agents, and insulin for type 2 diabetes and obesity: Bayesian network meta-analysis of randomized controlled trials

Published:2023-07-10 Issue:4 Volume:7 Page:
ISSN:2474-9842
Container-title:BJS Open
language:en
Short-container-title:

Author:

Wu Tingting¹^ORCID,Wong Carlos K H¹²³^ORCID,Lui David T W⁴^ORCID,Wong Simon K H⁵⁶,Lam Cindy L K¹^ORCID,Chung Matthew S H²^ORCID,McAllister David A⁷^ORCID,Welbourn Richard⁸^ORCID,Dixon John B⁹^ORCID

Affiliation:

1. Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China

2. Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China

3. Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park , New Territories, Hong Kong SAR , China

4. Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China

5. Division of Surgery, Chinese University of Hong Kong Medical Centre , Hong Kong SAR , China

6. Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR , China

7. Public Health, School of Health and Wellbeing, University of Glasgow , Glasgow , UK

8. Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital , Taunton , UK

9. Iverson Health Innovation Research Institute, Swinburne University of Technology , Melbourne, VIC , Australia

Abstract

Abstract Background This network meta-analysis aimed to compare the effects of bariatric surgery, novel glucose-lowering agents (SGLT2i, GLP1RA, DPP4i), and insulin for patients with type 2 diabetes mellitus (T2DM) and obesity. Methods Four databases were searched from inception to April 2023 to identify randomized controlled trials (RCTs) comparing bariatric surgery, SGLT2i, GLP1RA, DPP4i, insulin, and/or placebo/usual care among patients with T2DM and obesity in the achievement of HbA1c < 7.0 per cent within one year, and 12-month changes in HbA1c and body weight. Results A total of 376 eligible RCTs (149 824 patients) were analysed. Bariatric surgery had significantly higher rates of achieving HbA1c < 7.0 per cent than SGLT2i (RR = 2.46, 95 per cent c.i. = 1.28, 4.92), DPP4i (RR = 2.59, 95 per cent c.i. = 1.36, 5.13), insulin (RR = 2.27, 95 per cent c.i. = 1.18, 4.58) and placebo/usual care (RR = 4.02, 95 per cent c.i. = 2.13, 7.93), but had no statistically significant difference from GLP1RA (RR = 1.73, 95 per cent c.i. = 0.91, 3.44), regardless of oral (RR = 1.33, 95 per cent c.i. = 0.66, 2.79) or injectable (RR = 1.75, 95 per cent c.i. = 0.92, 3.45) administration. Significantly more GLP1RA patients achieved HbA1c < 7.0 per cent than other non-surgical treatments. Bariatric surgery had the greatest reductions in HbA1c (∼1 per cent more) and body weight (∼15 kg more) at 12 months. Among novel glucose-lowering medications, GLP1RA was associated with greater reductions in HbA1c than SGLT2i (−0.39 per cent, 95 per cent c.i. = −0.55, −0.22) and DPP4i (−0.51 per cent, 95 per cent c.i. = −0.64, −0.39) at 12 months, while GLP1RA (−1.74 kg, 95 per cent c.i. = −2.48, −1.01) and SGLT2i (−2.23 kg, 95 per cent c.i. = −3.07, −1.39) showed greater reductions in body weight than DPP4i at 12 months. Conclusion Bariatric surgery showed superiority in glycaemic control and weight management compared to non-surgical approaches. GLP1RA administered by oral or injectable form demonstrated reduced HbA1c and body weight at 12 months, and was preferable over other non-surgical treatments among patients with T2DM and obesity. PROSPERO registration no CRD42020201507

Funder

Health and Medical Research Fund

Food and Health Bureau

Publisher

Oxford University Press (OUP)

Subject

General Medicine

Link

https://academic.oup.com/bjsopen/article-pdf/7/4/zrad077/51043678/zrad077.pdf

Reference64 articles.

1. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013;Ng;Lancet,2014

2. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045;Sun;Diabetes Res Clin Pract,2021

3. Obesity and type 2 diabetes: what can be unified and what needs to be individualized?;Eckel;J Clin Endocrinol Metab,2011

4. Academy of nutrition and dietetics nutrition practice guideline for type 1 and type 2 diabetes in adults: systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process;Franz;J Acad Nutr Diet,2017

5. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control;Chrvala;Patient Educ Couns,2016

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