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Purpose In patients with type 2 diabetes mellitus (T2DM), bariatric surgery appears to be more effective than medical treatment (MT) at improving glycaemic control and decreasing cardiovascular risk. However, long-term effectiveness has not been systematically assessed using randomised controlled trials. In this study, we aimed to systematically assess randomised controlled trials, with at least 5 years of follow-up, on bariatric surgery in patients with T2DM and BMI ≥ 25 kg/m2, as well as to compare different bariatric procedures. Material and methods PubMed, SCOPUS and Web of Science were searched. We performed a network meta-analysis to evaluate the comparative effectiveness of the different procedures and MT in terms of full T2DM remission, weight loss, complications and cardiometabolic biomarkers. The quality of evidence was assessed using the Cochrane Risk of Bias Tool and CINeMA. Results We included 11 primary studies. Laparoscopic one-anastomosis gastric bypass (LOAGB) was found to be one of the most effective treatments for full remission of T2DM (I2 = 0, inconsistency p value = 0.9223). Biliopancreatic diversion without duodenal switch was found to be more effective than laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding regarding percent total cholesterol and low-density lipoprotein change. Regarding percent high-density lipoprotein and weight change, all analysed surgical treatments were shown to be more effective than MT. The confidence rating in our results was overall moderate, but most studies had high risk of performance and detection bias. Conclusion Bariatric surgery seems to be effective for T2DM remission. LOAGB appears to be a good option in this context, and a possible alternative to laparoscopic duodenal switch, but the included primary studies in our review are not sufficiently powered to establish a more definitive conclusion. More studies with longer follow-up times are needed to comprehensively assess bariatric surgery in T2DM.

Introdução: A cirurgia bariátrica, em pacientes com diabetes mellitus tipo 2 (DMT2), aparenta permitir manter um melhor controlo glicémico e reduzir o risco cardiovascular em comparação com o tratamento médico (TM). Ainda assim, a efetividade a longo prazo ainda não foi sistematicamente avaliada. Neste estudo, pretendeu-se avaliar sistematicamente todos os ensaios randomizados controlados sobre cirurgia bariátrica em pacientes com IMC≥25kg/m2 e DMT2, com períodos de seguimento de, no mínimo, 5 anos, assim como comparar os diferentes procedimentos bariátricos. Métodos: A pesquisa foi efetuada na PubMed, na SCOPUS e na Web of Science. Realizou-se uma meta-análise em rede com o objetivo de avaliar a efetividade comparativa das diferentes cirurgias bariátricas e do tratamento médico em termos de remissão completa da DMT2, perda de peso, complicações micro e macrovasculares e biomarcadores cardiometabólicos. A qualidade de evidência foi avaliada através da Cochrane Collaboration Risk of Bias Tool e do CINeMA. Resultados: Foram incluídos 10 estudos primários. O bypass gástrico de anastomose única laparoscópico (LOAGB) aparenta ser um tratamento mais efetivo para a DMT2 do que os restantes procedimentos (I2=0, inconsistency p-value=0.8613). A diversão biliopancreática sem switch duodenal mostrou ser mais efetiva que o bypass gástrico laparoscópico em Y de Roux e a banda gástrica ajustável laparoscópica em termos de variação em percentagem do colesterol total e da lipoproteína de baixa densidade. Todos os tratamentos cirúrgicos foram mais efetivos que o TM em termos de variação em percentagem do peso total e da lipoproteína de alta densidade aos 5 anos. A análise de confiança nos resultados mostra um nível moderado no geral, mas a maioria dos estudos apresenta um risco elevado de viés de performance e de deteção. Conclusão: A cirurgia bariátrica, especialmente o LOAGB, aparenta ser uma opção efetiva para a remissão da DMT2. Ainda assim, são necessários mais estudos e com um período de seguimento maior para ser possível compreender de forma abrangente o impacto destes procedimentos na DMT2. Purpose: In patients with type 2 diabetes mellitus (T2DM), bariatric surgery appears to be more effective than medical treatment (MT) at improving glycaemic control and decreasing cardiovascular risk. However, long-term effectiveness has not been systematically assessed. In this study, we aimed to systematically assess randomized controlled trials, with at least 5 years of follow-up, on bariatric surgery in patients with T2DM and BMI≥25kg/m2, as well as to compare different bariatric procedures. Material and methods: PubMed, SCOPUS and Web of Science were searched. We performed a network meta-analysis to evaluate the comparative effectiveness of the different procedures and MT in terms of full T2DM remission, weight loss, complications, and cardiometabolic biomarkers. The quality of evidence was assessed using the Cochrane Risk of Bias Tool and CINeMA. Results: We included 10 primary studies. Laparoscopic one-anastomosis gastric bypass (LOAGB) was found to be a more effective treatment for T2DM than the remaining procedures (I2=0, inconsistency p-value=0.861). Biliopancreatic diversion without duodenal switch was found to be more effective than laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding regarding percent total cholesterol and low-density lipoprotein change. Regarding percent high-density lipoprotein and weight change, all analysed surgical treatments were shown to be more effective than MT. The confidence rating in our results was overall moderate, but most studies had high risk of performance and detection bias. Conclusion: Bariatric surgery, especially LOAGB, seems to be effective for T2DM remission. Nevertheless, more studies with longer follow-up times are needed to comprehensively assess bariatric surgery in T2DM.