Roux-en-Y gastric bypass superior to sleeve gastrectomy for diabetes remission and weight loss: Study
New Zealand: Silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) provides superior weight loss and diabetes remission than laparoscopic sleeve gastrectomy (LSG) at 5 years, a recent study in Diabetes Care has suggested. Both the procedures had similar low risks of complications.
The study was conducted by Rinki Murphy, University of Auckland, Auckland, New Zealand, and colleagues with an objective to determine whether silastic ring laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy produces superior diabetes remission at 5 years in a single-center, double-blind trial.
The study included 114 adults with type 2 diabetes and BMI 35–65 kg/m2. They were randomly assigned to SR-LRYGB or LSG in the ratio of 1:1 stratified by BMI group, age group, diabetes duration, ethnicity, and insulin therapy. According to a prespecified protocol, diabetes and other metabolic medications were adjusted.
Diabetes remission assessed at 5 years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications was the primary outcome. Secondary outcomes included changes in weight, quality of life, cardiometabolic risk factors, and adverse events.
The findings of the study were as follows:
- Diabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (adjusted odds ratios of 4.5 and 4.2 in the intention-to-treat analysis).
- Percent body weight loss was greater after SR-LRYGB than after LSG (absolute difference of 10.7%).
- Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB.
- Early and late complications were similar in both groups.
- General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB.
- People of Māori or Pacific ethnicity (26%) had a lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83).
The researchers concluded, "SR-LRYGB provided superior diabetes remission and weight loss compared with LSG at 5 years, with similar low risks of complications."
Reference:
Rinki Murphy, Lindsay D. Plank, Michael G. Clarke, Nicholas J. Evennett, James Tan, David D.W. Kim, Richard Cutfield, Michael W.C. Booth; Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial. Diabetes Care 2022; dc212498. https://doi.org/10.2337/dc21-2498
