# Comparative Mid- to Long-Term Effects of Bariatric Surgery Versus Medical/Lifestyle Management in Type 2 Diabetes Mellitus: A Network Meta-Analysis of Randomized Controlled Trials

## TL;DR

This study compares bariatric surgeries and lifestyle management for type 2 diabetes, finding that certain surgeries like BPD and RYGB are more effective in the long term.

## Contribution

The study provides a network meta-analysis ranking bariatric surgeries for diabetes remission and cardiometabolic outcomes over mid- to long-term periods.

## Key findings

- BPD is most effective for diabetes remission and HbA1c reduction, though evidence is limited.
- RYGB is most effective for managing HbA1c levels and BMI in mid-term follow-up.
- Bariatric surgeries show moderate to favorable effects on diabetes outcomes compared to medical/lifestyle treatment.

## Abstract

A network meta-analysis of randomized controlled trials (RCTs) was conducted to establish the ranking of various bariatric surgeries in mid- and long-term follow-up durations for people with type 2 diabetes mellitus (T2DM), based on T2DM remission, HbA1c levels, and cardiometabolic outcomes. We searched PubMed, Embase, Medline, and Cochrane Central databases. A common comparator was identified between interventions to develop a network. Mean difference (MD) and 95% confidence interval (CI) were estimated between interventions. Direct and indirect evidence were pooled using the random-effect model. Eleven RCTs and four bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic-adjustable gastric banding (LAGB), biliopancreatic diversion without duodenal switch (BPD), sleeve gastrectomy (SG), and medical/lifestyle treatment (MT) as a comparator group, were included. RYGB, LAGB, BPD, SG, as compared with MT, were all significantly associated with the remission of T2DM and HbA1c levels. While BPD is the best one for remission (MD: -5.14 [95% CI -7.33 to -2.96]), HbA1c (MD: -31.75 [95% CI -37.73 to -25.77]), the evidence is sparse. RYGB was the most effective surgery type for BMI, TG, and DBP for the mid-term follow-up period. Moderate mid- and long-term effects of T2DM remission and HbA1c levels were observed after all surgical procedures. However, BPD appears to be promising for achieving long-term diabetes remission, HbA1c levels, and cardiometabolic profiles. RYGB is the most favourable option to manage HbA1c levels and BMI. The effects of other surgical types on cardiometabolic profiles are inconclusive and require further research.

The online version contains supplementary material available at 10.1007/s11695-025-08451-x.

RYGB, LAGB, BPD, SG were all significantly associated with the remission of T2DM and HbA1c levels as compared with MT.

In long-term follow-up, BPD appears to be the most effective surgery for achieving diabetes remission, HbA1c levels, and cardiometabolic profiles, however evidence is sparse.

Bariatric surgery has a favourable effect on diabetes related outcomes.

The online version contains supplementary material available at 10.1007/s11695-025-08451-x.