P850 - BARIATRIC SURGERY IN ADULTS WITH OBESITY AND DIABETES MELLITUS: A COCHRANE REVIEW WITH NETWORK META-ANALYSIS

P850

BARIATRIC SURGERY IN ADULTS WITH OBESITY AND DIABETES MELLITUS: A COCHRANE REVIEW WITH NETWORK META-ANALYSIS

E. Kiesswetter^1,*, L. Gorenflo^1,2, G. Schwarzer³, J. Stadelmaier¹, S. Wallerer¹, G. Marjanovic⁴, J. M. Fink⁴, C. Lehane⁵, M.-I. Metzendorf⁶, S. Dias⁷, J. J. Meerpohl^1,2, L. Schwingshackl¹

¹Institute for Evidence in Medicine, Medical Faculty and Medical Center - University of Freiburg, ²Cochrane Germany, Cochrane Germany Foundation, ³Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center - University of Freiburg, ⁴Centre for Obesity and Metabolic Surgery, Center of Surgery, Department of General and Visceral Surgery, Medical Faculty and Medical Center - University of Freiburg, ⁵Department of Anesthesiology and Critical Care, University Heart Center Freiburg-Bad Krozingen, Medical Faculty and Medical Center - University of Freiburg, Freiburg, ⁶Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany, ⁷Centre for Reviews and Dissemination, University of York, York, United Kingdom

Rationale: This systematic review with network meta-analysis (NMA) compared the long-term (≥5 years) effects and safety of different bariatric procedures and lifestyle/medical therapy (LI/MT) on outcomes relevant to adults with obesity and type 2 diabetes (T2D).

Methods: We conducted a systematic search in 6 databases and 2 study registries (date: 25.06.2024). Using random-effects NMAs, we calculated relative risks (RR), incidence rate ratios and mean differences (MD) with 95% confidence intervals (95%CI). We assessed the certainty of the evidence using GRADE. We present results of randomized controlled trials (RCTs) for T2D remission, weight loss [%], serious adverse events (SAE), and all-cause mortality.

Results: We included 10 RCTs with the following interventions: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), laparoscopic gastric banding, gastric plication, and LI/MT. Low to very low certainty of evidence suggests more frequent T2D remissions (RR [95%CI]: 12.49 [1.73; 90.36], 15.00 [1.85; 121.62], 7.50 [1.02; 55.36]) and greater weight loss (MD [95%CI]: -16.95 [-24.19; -9.71], -12.10 [-22.85; -1.34], -9.40 [-17.45; -1.34]) after RYGB, OAGB or SG compared to LI/MT. For T2D remission, RYGB and OAGB may be more effective than SG and for weight loss only RYGB ([very] low certainty). For SAE and all-cause mortality, evidence is (very) uncertain.

Conclusion: Although results imply that RYGB and OAGB are effective and safe long-term treatment options for people with obesity and T2D, no robust conclusions can be drawn due to (very) low-certainty evidence. This abstract is based on a pre-peer review draft of a Cochrane Review (DOI:10.1002/14651858.CD015622). Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews. Funding: German Federal Ministry of Education and Research, grant no. 01KG2201.

Disclosure of Interest: None declared