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Short-term effectiveness of metabolic surgery in nonobese diabetic patients: A systematic review and meta-analysis
Wilson Salgado1, Eduardo Lemos de Souza Bastos2, Anna Carolina Batista Dantas3, Tiago Rafael Onzi4, Lyz Bezerra Silva5, Alvaro Albano6, Márcio Valle Cortez7, Luca Schiliró Tristão8, Clara Lucato dos Santos8, Wanderley Marques Bernardo9
1 Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
2 Department of Gastrointestinal Surgery, Marília School of Medicine, Marília, Brazil
3 Bariatric and Metabolic Surgery Unit, University of São Paulo, São Paulo, Brazil
4 Department of Surgery, Federal University of Santa Catarina, Florianópolis, Brazil
5 Department of Bariatric and Metabolic Surgery, King's College Hospital NHS Foundation, London, United Kingdom
6 Bariatric and Metabolic Service, Santa Casa de Misericórdia de Itabuna, Bahia, Brazil
7 Department of Surgery, Nilton Lins University, Manaus, Brazil
8 Department of Evidence Based Medicine, Lusíada University Center, Santos, Brazil
9 University of São Paulo, São Paulo, Brazil
Correspondence Address:
Eduardo Lemos de Souza Bastos
Department of Gastrointestinal Surgery, Marília School of Medicine, Marília
Brazil
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jbs.jbs_6_23
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Aim: The aim of this study was to assess the safety and short-term effectiveness of metabolic surgery (MS) in nonobese diabetic patients. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used in this systematic review. The search for evidence was performed in the Medline (PubMed), Embase, Cochrane (CENTRAL), LILACS, and ClinicalTrials.gov databases from the inception to February 2023. The main eligibility criteria were nonobese adults (body mass index [BMI] <30 kg/m2) with type 2 diabetes mellitus (T2DM) undergoing MS. T2DM remission rate, glycemic parameters, and weight loss were measured before and after surgery. Complication rate was also described. Outcomes were aggregated and the quality of evidence was sorted. Heterogeneity was assumed when I2 >50%. The random-effects model was used to perform a proportional meta-analysis. Results: Twenty-one studies were included (n = 835). The overall rate of diabetes remission was 50.1% (95% confidence interval [CI] = 43.8%–56.1%; P = 0.993; I2 = 92%). The mean reduction of glycated hemoglobin and fasting glucose was 2.42% (95% CI = 1.91%–2.93%; P < 0.00001; I2 = 89%) and 70.60 mg/dL, respectively. A drop of 3.34 points (95% CI = 1.59–5.09; P < 0.0002; I2 = 95%) was observed in the HOMA-IR, and the mean postprandial glycemia was 123.27 mg/dL. No marked weight loss was observed (−3.80 kg/m2 in BMI; 95% CI = 2.70–4.91; P < 0.00001; I2 = 95%). There was no postoperative mortality, and the overall postoperative complication rate was about 12%. The certainty of evidence was low or very low. Conclusion: MS could be effective in the surgical approach of nonobese diabetic patients, but further long-term, more robust studies are needed to strengthen the evidence.
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