Comparison of Benefits and Risks of Metabolic Surgery for Long-Term (5 Years) Weight Loss and Diabetes Remission in Overweight/Obese Patients With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Randomized Trials.

Summary

Across 16 RCTs with 5-year follow-up, OAGB ranked best for long-term complete diabetes remission, while BPD led for partial remission and the greatest weight loss. Both surgeries outperformed non-surgical care; overall, OAGB balanced efficacy and safety best, whereas BPD maximized metabolic weight outcomes.

Key Findings

• OAGB achieved the highest long-term complete diabetes remission (RR 10.28, 95% CI 1.87–56.40 vs non-surgical treatment).
• BPD achieved the highest partial remission (RR 16.74, 95% CI 4.66–60.12) and the greatest weight loss (BMI mean difference −11.68; weight −32.01 kg).
• Both OAGB and BPD outperformed non-surgical care over 5 years; overall evidence quality rated moderate; safety profiles varied by procedure.

Clinical Implications

For overweight/obese patients with T2DM, OAGB should be considered when aiming for complete remission, while BPD may be preferred when maximizing weight loss or partial remission is prioritized; individualized risk–benefit discussions remain essential.

Limitations

• Moderate overall evidence quality; some procedures supported by small RCTs with wide confidence intervals
• Heterogeneity in surgical techniques, perioperative care, and definitions of remission across trials

Future Directions

Head-to-head pragmatic RCTs comparing OAGB vs BPD with standardized definitions and adverse event reporting; long-term nutritional and micronutrient outcomes and quality-of-life assessments.