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Purpose <p>The long-term effects of metabolic bariatric surgery (MBS) on weight loss and diabetes remission over 10 years remain incompletely characterized. This network meta-analysis aimed to compare the outcomes of various types of MBS with those of medical therapy.</p> Methods <p>PubMed and EMBASE were searched from inception to September 30, 2025, for randomized clinical trials (RCTs) with ≥ 10 years of follow-up comparing MBS and medical therapy in adults with obesity or type 2 diabetes. A random-effects model was applied.</p> Results <p>Ten RCTs including 1004 participants were analyzed. Procedures assessed included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion with duodenal switch (BPD/DS), and adjustable gastric banding (AGB). All procedures except AGB resulted in significantly greater percentage total weight loss than medical therapy, ranging from SG (mean difference [MD] = 17.73%; 95% CI, 6.96–28.50) to RYGB (MD = 20.18%; 95% CI, 11.18–29.18) and BPD/DS (MD = 28.87%; 95% CI, 19.80-37.93). A similar gradient (medical therapy &lt; AGB &lt; SG &lt; RYGB &lt; BPD/DS) was observed for reductions in body weight and BMI. Although only BPD/DS (odds ratio = 24.91; 95% CI, 1.19–519.94) achieved a statistically significant advantage over medical therapy in diabetes remission, other procedures also demonstrated a potential benefit.</p> Conclusions <p>Over 10 years of follow-up, most MBS procedures were associated with greater weight loss than medical therapy, while only BPD/DS achieved a statistically significant improvement in diabetes remission.</p>

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Effects of Metabolic Bariatric Surgery on Weight Loss and Diabetes Remission Over 10 Years: A Network Meta-Analysis of Randomized Controlled Trials

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Beibei Cui,
  • Jun He,
  • Hongliang Yao

摘要

Purpose

The long-term effects of metabolic bariatric surgery (MBS) on weight loss and diabetes remission over 10 years remain incompletely characterized. This network meta-analysis aimed to compare the outcomes of various types of MBS with those of medical therapy.

Methods

PubMed and EMBASE were searched from inception to September 30, 2025, for randomized clinical trials (RCTs) with ≥ 10 years of follow-up comparing MBS and medical therapy in adults with obesity or type 2 diabetes. A random-effects model was applied.

Results

Ten RCTs including 1004 participants were analyzed. Procedures assessed included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion with duodenal switch (BPD/DS), and adjustable gastric banding (AGB). All procedures except AGB resulted in significantly greater percentage total weight loss than medical therapy, ranging from SG (mean difference [MD] = 17.73%; 95% CI, 6.96–28.50) to RYGB (MD = 20.18%; 95% CI, 11.18–29.18) and BPD/DS (MD = 28.87%; 95% CI, 19.80-37.93). A similar gradient (medical therapy < AGB < SG < RYGB < BPD/DS) was observed for reductions in body weight and BMI. Although only BPD/DS (odds ratio = 24.91; 95% CI, 1.19–519.94) achieved a statistically significant advantage over medical therapy in diabetes remission, other procedures also demonstrated a potential benefit.

Conclusions

Over 10 years of follow-up, most MBS procedures were associated with greater weight loss than medical therapy, while only BPD/DS achieved a statistically significant improvement in diabetes remission.