Bariatric Surgery for Weight Loss and Glycemic Control in Nonmorbidly Obese Adults With Diabetes

医学 血糖性 减肥 体质指数 糖尿病 随机对照试验 2型糖尿病 外科 科克伦图书馆 肥胖 观察研究 内科学 内分泌学
作者
Melinda Maggard-Gibbons,Margaret Maglione,Masha J. Livhits,Brett Ewing,Alicia Ruelaz Maher,Jianhui Hu,Zhaoping Li,Paul G Shekelle
出处
期刊:JAMA [American Medical Association]
卷期号:309 (21): 2250-2250 被引量:211
标识
DOI:10.1001/jama.2013.4851
摘要

Importance

Bariatric surgery is beneficial in persons with a body mass index (BMI) of 35 or greater with obesity-related comorbidities. There is interest in using these procedures in persons with lower BMI and diabetes.

Objective

To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35.

Evidence Review

PubMed, EMBASE, and Cochrane Library databases were searched from January 1985 through September 2012. Of 1291 screened articles, we included 32 surgical studies, 11 systematic reviews on nonsurgical treatments, and 11 large nonsurgical studies published after those reviews. Weight loss, metabolic outcomes, and adverse events were abstracted by 2 independent reviewers.

Findings

Three randomized clinical trials (RCTs) (N = 290; including 1 trial of 150 patients with type 2 diabetes and mean BMI of 37, 1 trial of 80 patients without diabetes [38% with metabolic syndrome] and BMI of 30 to 35, and 1 trial of 60 patients with diabetes and BMI of 30 to 40 [13 patients with BMI <35]) found that surgery was associated with greater weight loss (range, 14.4-24 kg) and glycemic control (range, 0.9-1.43 point improvements in hemoglobin A1c levels) during 1 to 2 years of follow-up than nonsurgical treatment. Indirect comparisons of evidence from observational studies of bariatric procedures (n ≈ 600 patients) and meta-analyses of nonsurgical therapies (containing more than 300 RCTs) support this finding at 1 or 2 years of follow-up. However, there are no robust surgical data beyond 5 years of follow-up on outcomes of diabetes, glucose control, or macrovascular and microvascular outcomes. In contrast, some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more. Surgeon-reported adverse events were low (eg, hospital deaths of 0.3%-1.0%), but data were from select centers and surgeons. Long-term adverse events are unknown.

Conclusions and Relevance

Current evidence suggests that, when compared with nonsurgical treatments, bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes. Evidence is insufficient to reach conclusions about the appropriate use of bariatric surgery in this population until more data are available about long-term outcomes and complications of surgery.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
顾念完成签到 ,获得积分10
3秒前
Lucas应助liuyichen采纳,获得10
5秒前
6秒前
俊逸书琴完成签到 ,获得积分10
9秒前
简奥斯汀完成签到 ,获得积分10
11秒前
YC发布了新的文献求助10
11秒前
帆帆帆完成签到 ,获得积分10
13秒前
JY'完成签到,获得积分10
16秒前
16秒前
此时正舞完成签到,获得积分10
20秒前
20秒前
YC完成签到,获得积分20
21秒前
和谐曼凝完成签到 ,获得积分10
25秒前
abner完成签到,获得积分10
28秒前
十一完成签到 ,获得积分10
40秒前
落后箴完成签到,获得积分10
43秒前
爱学习的YY完成签到 ,获得积分10
44秒前
46秒前
jingjing完成签到 ,获得积分10
47秒前
道道sy完成签到,获得积分10
48秒前
Silence完成签到,获得积分10
51秒前
自由的中蓝完成签到 ,获得积分10
56秒前
秋雪瑶应助科研通管家采纳,获得10
56秒前
酷波er应助科研通管家采纳,获得30
56秒前
56秒前
充电宝应助科研通管家采纳,获得10
56秒前
小涛完成签到,获得积分10
57秒前
嗯哼大王完成签到 ,获得积分10
57秒前
58秒前
醉生梦死完成签到 ,获得积分10
1分钟前
Alone离殇完成签到 ,获得积分10
1分钟前
小怪兽完成签到,获得积分10
1分钟前
darwin发布了新的文献求助10
1分钟前
C5b6789n完成签到,获得积分10
1分钟前
氟兊锝钼完成签到 ,获得积分10
1分钟前
1分钟前
河马完成签到,获得积分10
1分钟前
哈哈哈完成签到 ,获得积分10
1分钟前
tennisgirl完成签到 ,获得积分10
1分钟前
hahaha完成签到,获得积分10
1分钟前
高分求助中
Un calendrier babylonien des travaux, des signes et des mois: Séries iqqur îpuš 1036
Sustainable Land Management: Strategies to Cope with the Marginalisation of Agriculture 1000
Corrosion and Oxygen Control 600
Python Programming for Linguistics and Digital Humanities: Applications for Text-Focused Fields 500
Heterocyclic Stilbene and Bibenzyl Derivatives in Liverworts: Distribution, Structures, Total Synthesis and Biological Activity 500
重庆市新能源汽车产业大数据招商指南(两链两图两池两库两平台两清单两报告) 400
Division and square root. Digit-recurrence algorithms and implementations 400
热门求助领域 (近24小时)
化学 材料科学 医学 生物 有机化学 工程类 生物化学 纳米技术 物理 内科学 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 电极 光电子学 量子力学
热门帖子
关注 科研通微信公众号,转发送积分 2546302
求助须知:如何正确求助?哪些是违规求助? 2175744
关于积分的说明 5600587
捐赠科研通 1896461
什么是DOI,文献DOI怎么找? 946308
版权声明 565379
科研通“疑难数据库(出版商)”最低求助积分说明 503557