EFFECTS OF GASTRIC BYPASS ON NON-OBESE TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW AND META-ANALYSIS
*Dr. Mohamed Dahir Aden, Prof. Dr. Deng Tao
Objective: To assess the therapeutic effect of gastric bypass on non-obese type 2 diabetes mellitus (T2DM). Methods: Databases including PubMed, Web of Science, CNKI and Wan fang database were searched from 1985 to November 2016, and references of articles were also searched to collect randomized controlled trails or before-after self-controlled trails on gastric bypass in treating T2DM. We screened articles according to the predefined inclusion and exclusion criteria, extracted data, and evaluated quality of the included studies. Then meta-analyses were performed using RevcMan 5.2. Results: A total of 7 before-after self-controlled trials involving 230 patients were finally included. All these trials were graded as low quality, and all is three scores by Jadad scale. The results of meta-analysis showed that the therapeutic effect of gastric bypass on non-obese T2DM after twelve months treatment was good, There were significant reductions in both glycosylated hemoglobin[MD=-2.76，95%CI (-3.55,-1.97), P<0.00001] and fasting plasma glucose[MD=- 4.13,95%CI (-5.70,-2.56), P<0.00001], And the level of glycosylated hemoglobin to reduce postoperative twelve months after six months significantly[MD=0.27, 95% CI(0.05,0.49), P=0.02] the therapeutic effect of gastric bypass on non-obese T2DM after six months treatment was good. There were significant reductions in both glycosylated hemoglobin [MD=-2.78, 95%CI (-3.48,-2.08), P<0.00001] and fasting plasma glucose [MD=-4.62, 95% CI (-5.86,- 3.38), P<0.00001], the same time, the differences were statistically significant. Sensitivity analysis indicated that these results were stable, but funnel-plots indicated possible publication bias existed. Conclusion: The short-term therapeutic effect of gastric bypass on non-obese type 2 diabetes mellitus is better, medium-term curative effect is stable, but because of the small sample size into literature, methodological quality defects, still need to high quality, large sample and long-term follow-up studies to further verify the therapeutic effect.
Keywords: Type 2 diabetes mellitus; Gastric bypass; Non-obese; Systematic review; Meta- analysis.
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