RYGB better than Sleeve Gastrectomy to reduce CVD events in Type 2 Diabetes: Study

Metabolic surgery is popularly used to treat Type 2 Diabetes Mellitus (T2DM) that fails to respond to lifestyle and medication changes, rather than obesity.

Type 2 diabetes is associated with serious cardiovascular (CV) events. A new study by Dr Ali Aminian MD and team has found that Roux-en-Y Gastric Bypass (RYGB) was much effective than Sleeve Gastrectomy (SG) in controlling type 2 diabetes and obesity and reducing CV events . The study is published in Diabetes Care journal.

The objective of the study was to evaluate which one of the two most common metabolic surgical procedures is associated with greater reduction in risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and obesity.

The study included a total of 13,490 patients including 1,362 RYGB, 693 sleeve gastrectomy SG, and 11,435 matched nonsurgical patients with T2DM and obesity who received their care at the Cleveland Clinic (1998–2017) were analyzed, with follow-up through December 2018. With multivariable Cox regression analysis we estimated time to incident extended MACE, defined as first occurrence of coronary artery events, Cerebrovascular events, heart failure, nephropathy, atrial fibrillation, and all-cause mortality.

The results of the study were found to be

• The cumulative incidence of the primary end point at 5 years was found to be 13.7% (95% CI 11.4–15.9) in the RYGB groups and 24.7% (95% CI 19.0–30.0) in the SG group, with an adjusted hazard ratio (HR) of 0.77 (95% CI 0.60–0.98, P = 0.04).

• Out of the six individual end points, RYGB was found to be associated with a significantly lower cumulative incidence of nephropathy at 5 years compared with SG (2.8% vs. 8.3%, respectively; HR 0.47 [95% CI 0.28–0.79], P = 0.005).

• Furthermore, RYGB was associated with a greater reduction in body weight, glycated hemoglobin, and use of medications to treat diabetes and cardiovascular diseases.

• Five years after RYGB, patients required more upper endoscopy (45.8% vs. 35.6%, P < 0.001) and abdominal surgical procedures (10.8% vs. 5.4%, P = 0.001) compared with SG.

Dr Aminian and team concluded that "In patients with obesity and T2DM, RYGB may be associated with greater weight loss, better diabetes control, and lower risk of MACE and nephropathy compared with SG."

For further information: https://doi.org/10.2337/dc20-3023