Meta‐analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus
Background This study aimed to examine the effect of metabolic surgery on pre‐existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM...
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| Veröffentlicht in: | British journal of surgery 2018-02, Vol.105 (3), p.168-181 |
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| creator | Billeter, A. T. Scheurlen, K. M. Probst, P. Eichel, S. Nickel, F. Kopf, S. Fischer, L. Diener, M. K. Nawroth, P. P. Müller‐Stich, B. P. |
| description | Background
This study aimed to examine the effect of metabolic surgery on pre‐existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM regarding glycaemic control, it is unclear whether the incidence or severity of microvascular complications is reduced.
Methods
A systematic literature search was performed in MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions, looking for RCTs, case–control trials and cohort studies that assessed the effect of metabolic surgery on the incidence of microvascular diabetic complications compared with medical treatment as control. The study was registered in the International prospective register of systematic reviews (CRD42016042994).
Results
The literature search yielded 1559 articles. Ten studies (3 RCTs, 7 controlled clinical trials) investigating 17 532 patients were included. Metabolic surgery reduced the incidence of microvascular complications (odds ratio 0·26, 95 per cent c.i. 0·16 to 0·42; P |
| doi_str_mv | 10.1002/bjs.10724 |
| format | Article |
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This study aimed to examine the effect of metabolic surgery on pre‐existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM regarding glycaemic control, it is unclear whether the incidence or severity of microvascular complications is reduced.
Methods
A systematic literature search was performed in MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions, looking for RCTs, case–control trials and cohort studies that assessed the effect of metabolic surgery on the incidence of microvascular diabetic complications compared with medical treatment as control. The study was registered in the International prospective register of systematic reviews (CRD42016042994).
Results
The literature search yielded 1559 articles. Ten studies (3 RCTs, 7 controlled clinical trials) investigating 17 532 patients were included. Metabolic surgery reduced the incidence of microvascular complications (odds ratio 0·26, 95 per cent c.i. 0·16 to 0·42; P < 0·001) compared with medical treatment. Pre‐existing diabetic nephropathy was strongly improved by metabolic surgery versus medical treatment (odds ratio 15·41, 1·28 to 185·46; P = 0·03).
Conclusion
In patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment . Metabolic surgery improved pre‐existing diabetic nephropathy compared with medical treatment.
Surgery is better</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.10724</identifier><identifier>PMID: 29405276</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Bariatric Surgery ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - therapy ; Diabetic Angiopathies - epidemiology ; Diabetic Angiopathies - etiology ; Diabetic Angiopathies - prevention & control ; Diabetic nephropathy ; Humans ; Hypoglycemic Agents - therapeutic use ; Incidence ; Medical treatment ; Meta-analysis ; Metabolism ; Microvessels ; Odds Ratio ; Surgery ; Treatment Outcome</subject><ispartof>British journal of surgery, 2018-02, Vol.105 (3), p.168-181</ispartof><rights>2018 BJS Society Ltd Published by John Wiley & Sons Ltd</rights><rights>2018 BJS Society Ltd Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2018 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3194-e9831dd82a59e3938eb1e73179a4d5942aa5ec4398c65f28c25f4d92e21d81603</citedby><orcidid>0000-0002-0895-4015</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.10724$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.10724$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29405276$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Billeter, A. T.</creatorcontrib><creatorcontrib>Scheurlen, K. M.</creatorcontrib><creatorcontrib>Probst, P.</creatorcontrib><creatorcontrib>Eichel, S.</creatorcontrib><creatorcontrib>Nickel, F.</creatorcontrib><creatorcontrib>Kopf, S.</creatorcontrib><creatorcontrib>Fischer, L.</creatorcontrib><creatorcontrib>Diener, M. K.</creatorcontrib><creatorcontrib>Nawroth, P. P.</creatorcontrib><creatorcontrib>Müller‐Stich, B. P.</creatorcontrib><title>Meta‐analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
This study aimed to examine the effect of metabolic surgery on pre‐existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM regarding glycaemic control, it is unclear whether the incidence or severity of microvascular complications is reduced.
Methods
A systematic literature search was performed in MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions, looking for RCTs, case–control trials and cohort studies that assessed the effect of metabolic surgery on the incidence of microvascular diabetic complications compared with medical treatment as control. The study was registered in the International prospective register of systematic reviews (CRD42016042994).
Results
The literature search yielded 1559 articles. Ten studies (3 RCTs, 7 controlled clinical trials) investigating 17 532 patients were included. Metabolic surgery reduced the incidence of microvascular complications (odds ratio 0·26, 95 per cent c.i. 0·16 to 0·42; P < 0·001) compared with medical treatment. Pre‐existing diabetic nephropathy was strongly improved by metabolic surgery versus medical treatment (odds ratio 15·41, 1·28 to 185·46; P = 0·03).
Conclusion
In patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment . Metabolic surgery improved pre‐existing diabetic nephropathy compared with medical treatment.
Surgery is better</description><subject>Bariatric Surgery</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Diabetic Angiopathies - epidemiology</subject><subject>Diabetic Angiopathies - etiology</subject><subject>Diabetic Angiopathies - prevention & control</subject><subject>Diabetic nephropathy</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Incidence</subject><subject>Medical treatment</subject><subject>Meta-analysis</subject><subject>Metabolism</subject><subject>Microvessels</subject><subject>Odds Ratio</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkblOxTAURC0EgsdS8APIEg1NwEucxCUgVoEogDpynBvwUxIH2wGlo6PlG_kSzGMpqDzyPZ5rzSC0Tck-JYQdVHMfRc7SJTSjPBMJo1mxjGaEkDyhnPE1tO79nBDKiWCraI3JNIo8m6G3awjq4_Vd9aqdvPHYNriLV5VtjcZ-dA_gJvwMzo8-DmqjVYuDAxU66ANurMOd0c4-K6_HVjmsbTfEpyoY23tsejxEGVGPX0x4xGEaADNcG1VBgC_LtjVh9JtopVGth62fcwPdn57cHZ8nVzdnF8eHV4nmVKYJyILTui6YEhK45AVUFHJOc6nSWsiUKSVAp1wWOhMNKzQTTVpLBozWBc0I30B7376Ds08j-FB2xuv4CdWDHX1JpRRUREMR0d1_6NyOLua0oOIKKdIiUjs_1FjFfMrBmU65qfyNOAIH38CLaWH6m1NSfnVXxu7KRXfl0eXtQvBPKIKONQ</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Billeter, A. T.</creator><creator>Scheurlen, K. M.</creator><creator>Probst, P.</creator><creator>Eichel, S.</creator><creator>Nickel, F.</creator><creator>Kopf, S.</creator><creator>Fischer, L.</creator><creator>Diener, M. K.</creator><creator>Nawroth, P. P.</creator><creator>Müller‐Stich, B. P.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0895-4015</orcidid></search><sort><creationdate>201802</creationdate><title>Meta‐analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus</title><author>Billeter, A. T. ; Scheurlen, K. M. ; Probst, P. ; Eichel, S. ; Nickel, F. ; Kopf, S. ; Fischer, L. ; Diener, M. K. ; Nawroth, P. P. ; Müller‐Stich, B. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3194-e9831dd82a59e3938eb1e73179a4d5942aa5ec4398c65f28c25f4d92e21d81603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Bariatric Surgery</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Diabetic Angiopathies - epidemiology</topic><topic>Diabetic Angiopathies - etiology</topic><topic>Diabetic Angiopathies - prevention & control</topic><topic>Diabetic nephropathy</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Incidence</topic><topic>Medical treatment</topic><topic>Meta-analysis</topic><topic>Metabolism</topic><topic>Microvessels</topic><topic>Odds Ratio</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Billeter, A. T.</creatorcontrib><creatorcontrib>Scheurlen, K. M.</creatorcontrib><creatorcontrib>Probst, P.</creatorcontrib><creatorcontrib>Eichel, S.</creatorcontrib><creatorcontrib>Nickel, F.</creatorcontrib><creatorcontrib>Kopf, S.</creatorcontrib><creatorcontrib>Fischer, L.</creatorcontrib><creatorcontrib>Diener, M. K.</creatorcontrib><creatorcontrib>Nawroth, P. P.</creatorcontrib><creatorcontrib>Müller‐Stich, B. P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Billeter, A. T.</au><au>Scheurlen, K. M.</au><au>Probst, P.</au><au>Eichel, S.</au><au>Nickel, F.</au><au>Kopf, S.</au><au>Fischer, L.</au><au>Diener, M. K.</au><au>Nawroth, P. P.</au><au>Müller‐Stich, B. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta‐analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2018-02</date><risdate>2018</risdate><volume>105</volume><issue>3</issue><spage>168</spage><epage>181</epage><pages>168-181</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Background
This study aimed to examine the effect of metabolic surgery on pre‐existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM regarding glycaemic control, it is unclear whether the incidence or severity of microvascular complications is reduced.
Methods
A systematic literature search was performed in MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions, looking for RCTs, case–control trials and cohort studies that assessed the effect of metabolic surgery on the incidence of microvascular diabetic complications compared with medical treatment as control. The study was registered in the International prospective register of systematic reviews (CRD42016042994).
Results
The literature search yielded 1559 articles. Ten studies (3 RCTs, 7 controlled clinical trials) investigating 17 532 patients were included. Metabolic surgery reduced the incidence of microvascular complications (odds ratio 0·26, 95 per cent c.i. 0·16 to 0·42; P < 0·001) compared with medical treatment. Pre‐existing diabetic nephropathy was strongly improved by metabolic surgery versus medical treatment (odds ratio 15·41, 1·28 to 185·46; P = 0·03).
Conclusion
In patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment . Metabolic surgery improved pre‐existing diabetic nephropathy compared with medical treatment.
Surgery is better</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>29405276</pmid><doi>10.1002/bjs.10724</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-0895-4015</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | British journal of surgery, 2018-02, Vol.105 (3), p.168-181 |
| issn | 0007-1323 1365-2168 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1995153175 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Bariatric Surgery Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - therapy Diabetic Angiopathies - epidemiology Diabetic Angiopathies - etiology Diabetic Angiopathies - prevention & control Diabetic nephropathy Humans Hypoglycemic Agents - therapeutic use Incidence Medical treatment Meta-analysis Metabolism Microvessels Odds Ratio Surgery Treatment Outcome |
| title | Meta‐analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus |
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