Bariatric Surgery for Obese Type 2 Diabetes Patients in Mainland China: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

PAN Wen ¹ ,  GONG Jian ² , ZHENG Gang ³ , ZHAI Dejun ⁴ , SUN Yunping ⁵ , REN Lina ⁶ , LI Jingdong ⁷

1. Liaoning Center for Disease Control and Prevention, Shenyang 110005, China; 2. Department of Clinical Pharmacy, School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang 110016, China; 3. Department of Orthopedics, Fengtian Hospital Affiliated to Shenyang Medical College, Shenyang 110024, China; 4. Department of Urinary Surgery, Panjin Second People Hospital, Panjin 124000, China;;

Corresponding author：

GONG Jian, Email: fanxing1230@163.com

Keywords：

Bariatric surgery; Diabetes mellitus; Obesity; Systematic review; Meta-analysis; Controlled before-and-after studies

DOI：

10.7507/1672-2531.20130076

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Objective 　To assess the effectiveness of bariatric surgery for obese type 2 diabetes mellitus (T2DM) in Mainland China.
Methods 　Such databases as the Cochrane Central Register of Controlled Trials (Issue 2, 2012), MEDLINE (1990 to February 2012), EMbase (1990 to February 2012), CBM (1990 to February 2012), CNKI (1990 to February 2012), WanFang Data (1999 to February 2012) and VIP (1996 to February 2012) were searched, and the references of the included literature were also retrieved. The studies were screened according to the predefined inclusion and exclusion criteria, the data were extracted, the quality was evaluated, and then the meta-analysis was performed using RevMan 5.2 software.
Results 　A total of 6 controlled before-and-after studies involving 100 patients were included. The overall quality of all literature was as low as grade C. The results of meta-analysis showed that the following indexes after operation obviously decreased than before: 1-month postoperative fasting plasma glucose (MD= –2.27, 95%CI ?4.12 to ?0.42, P=0.02), 6-month postoperative fasting plasma glucose (MD= ?2.73, 95%CI ?2.91 to 2.56, P lt;0.000 01), and 6-month postoperative glycated hemoglobin (SMD= ?1.97, 95%CI ?2.98 to ?0.96, P=0.000 1), and the differences were statistically significant. The sensitivity analysis indicated the results of meta-analysis were credible and stable, but the funnel-plot analysis displayed publication bias might exist in the included studies.
Conclusion 　Current studies show that bariatric surgery is effective for obese T2DM patients in mainland China. However, due to small sample size and low methodological quality of the included studies, its effect has to be proved by high quality, large sample, and long follow-up studies.

Citation： PAN Wen,GONG Jian,ZHENG Gang,ZHAI Dejun,SUN Yunping,REN Lina,LI Jingdong. Bariatric Surgery for Obese Type 2 Diabetes Patients in Mainland China: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(4): 441-445. doi: 10.7507/1672-2531.20130076 Copy

1.	Yang W, Lu J, Wang J, et al. Prevalence of diabetes among men and women in china. N Engl J Med, 2010, 362(12): 1090-1101.
2.	Lima MM, Pareja JC, Alegre SM, et al. Acute effect of roux-en-Y gastric bypass on whole-body insulin sensitivity: a study with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab, 2010, 95(8): 3871-3875．.
3.	Bevilacqua M, Dominguez LJ, Righini V, et al. Acute parathyroid hormone increase by oral peptones administration after roux-en-Y gastric bypass surgery in obese subjects: role of phosphate in the rapid control of parathyroid hormone release. Surgery, 2010, 147(5): 655-661.
4.	Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric by-pass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes( Lond), 2010, 34(3): 462-471．.
5.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
6.	王吉耀, 主编. 循证医学与临床实践. 北京: 科学出版社, 2006: p15.
7.	宫建. 循证医学中“循证”问题的探讨. 西部医学, 2012, 24(11): 2237-2239.
8.	Cui W, Gong J, Wang Q, et al. Myocardial protection with sevoflurane in coronary artery bypass grafting surgery. Pak J MedSci, 2012, 28(32): 761-766.
9.	胡旭光, 郑成竹, 季新荣, 等. 腹腔镜胃旁路术和迷你胃旁路术对肥胖症合并2型糖尿病患者的短期治疗效果. 中华胃肠外科杂志, 2009, 12(6): 554-557.
10.	吴金声. 胃转流手术对2型糖尿病患者糖代谢的影响. 实用医学杂志, 2011, 27(5): 795-797.
11.	江兆涛, 邹一平, 黄辉, 等. 腹腔镜可调控性胃束带术治疗肥胖伴2型糖尿病的机制研究. 中华胃肠外科杂志, 2010, 13(7): 520-523.
12.	杨景哥, 王存川, 胡友主, 等. 腹腔镜Roux_en_Y胃旁路手术治疗肥胖症和2型糖尿病. 中华胃肠外科杂志, 2010, 13(8): 594-597.
13.	赵文嫣. 减肥手术对肥胖症合并2型糖尿病的近期疗效评价. 沈阳: 中国医科大学, 2010.
14.	张玉新, 吴良平, 戴晓江, 等. 腹腔镜下胃转流术治疗 2 型糖尿病临床疗效评价. 局解手术学杂志, 2011, 20(3): 296-298.
15.	World Health Organization. Health experts accept use of HbA1c for diagnosing diabetes. Geneva: WHO Diabetes Unit. 2011. Available from: www.who.int/diabetes.
16.	Laferrère B, Swerdlow N, Bawa B, et al. Rise of oxyntomodulin in response to oral glucose after gastric bypass surgery in patients with type 2 diabetes. J Clin Endocrinol Metab, 2010, 95(8): 4072-4076.
17.	徐锦华, 宫建, 顾敏华, 等. 某三级甲等医院住院高血压病患者临床特征分析. 医学临床研究杂志, 2012, 29(7): 1243-1246.
18.	Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr, 1992, 55(2 Suppl): 582S-585S.
19.	王坤, 宫建 , 杨国春, 等. 中国大陆地区胃转流手术治疗2型糖尿病的Meta分析. 医学临床研究, 2012, 29(8): 1343-1347.
20.	朱淑平, 宫建, 孙永发, 等. 妇产科围手术期患者抗菌药物不良事件调查. 中国公共卫生, 2012, 28(12): 1660-1661.
21.	宫建, 潘雯, 黄晓艳, 等. 中国内地2型糖尿病患者胃转流术后1年疗效的Meta分析. 中国循证医学杂志, 2012, 12(10): 1241-1245.

1. Yang W, Lu J, Wang J, et al. Prevalence of diabetes among men and women in china. N Engl J Med, 2010, 362(12): 1090-1101.
2. Lima MM, Pareja JC, Alegre SM, et al. Acute effect of roux-en-Y gastric bypass on whole-body insulin sensitivity: a study with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab, 2010, 95(8): 3871-3875．.
3. Bevilacqua M, Dominguez LJ, Righini V, et al. Acute parathyroid hormone increase by oral peptones administration after roux-en-Y gastric bypass surgery in obese subjects: role of phosphate in the rapid control of parathyroid hormone release. Surgery, 2010, 147(5): 655-661.
4. Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric by-pass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes( Lond), 2010, 34(3): 462-471．.
5. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
6. 王吉耀, 主编. 循证医学与临床实践. 北京: 科学出版社, 2006: p15.
7. 宫建. 循证医学中“循证”问题的探讨. 西部医学, 2012, 24(11): 2237-2239.
8. Cui W, Gong J, Wang Q, et al. Myocardial protection with sevoflurane in coronary artery bypass grafting surgery. Pak J MedSci, 2012, 28(32): 761-766.
9. 胡旭光, 郑成竹, 季新荣, 等. 腹腔镜胃旁路术和迷你胃旁路术对肥胖症合并2型糖尿病患者的短期治疗效果. 中华胃肠外科杂志, 2009, 12(6): 554-557.
10. 吴金声. 胃转流手术对2型糖尿病患者糖代谢的影响. 实用医学杂志, 2011, 27(5): 795-797.
11. 江兆涛, 邹一平, 黄辉, 等. 腹腔镜可调控性胃束带术治疗肥胖伴2型糖尿病的机制研究. 中华胃肠外科杂志, 2010, 13(7): 520-523.
12. 杨景哥, 王存川, 胡友主, 等. 腹腔镜Roux_en_Y胃旁路手术治疗肥胖症和2型糖尿病. 中华胃肠外科杂志, 2010, 13(8): 594-597.
13. 赵文嫣. 减肥手术对肥胖症合并2型糖尿病的近期疗效评价. 沈阳: 中国医科大学, 2010.
14. 张玉新, 吴良平, 戴晓江, 等. 腹腔镜下胃转流术治疗 2 型糖尿病临床疗效评价. 局解手术学杂志, 2011, 20(3): 296-298.
15. World Health Organization. Health experts accept use of HbA1c for diagnosing diabetes. Geneva: WHO Diabetes Unit. 2011. Available from: www.who.int/diabetes.
16. Laferrère B, Swerdlow N, Bawa B, et al. Rise of oxyntomodulin in response to oral glucose after gastric bypass surgery in patients with type 2 diabetes. J Clin Endocrinol Metab, 2010, 95(8): 4072-4076.
17. 徐锦华, 宫建, 顾敏华, 等. 某三级甲等医院住院高血压病患者临床特征分析. 医学临床研究杂志, 2012, 29(7): 1243-1246.
18. Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr, 1992, 55(2 Suppl): 582S-585S.
19. 王坤, 宫建 , 杨国春, 等. 中国大陆地区胃转流手术治疗2型糖尿病的Meta分析. 医学临床研究, 2012, 29(8): 1343-1347.
20. 朱淑平, 宫建, 孙永发, 等. 妇产科围手术期患者抗菌药物不良事件调查. 中国公共卫生, 2012, 28(12): 1660-1661.
21. 宫建, 潘雯, 黄晓艳, 等. 中国内地2型糖尿病患者胃转流术后1年疗效的Meta分析. 中国循证医学杂志, 2012, 12(10): 1241-1245.

Chinese Journal of Evidence-Based Medicine

Bariatric Surgery for Obese Type 2 Diabetes Patients in Mainland China: A Systematic Review

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