Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients?

Abstract

Background The benefits of Roux-en- Y gastric bypass (RYGB) for the control of type 2 diabetes mellitus (T2DM) in morbidly obese patients are well known, although the implicated mechanisms have not yet been elucidated. However, little is known about the remission of T2DM after sleeve gastrectomy (SG). The aim of our study was to compare the outcomes of T2DM after both procedures. Methods We performed a retrospective analysis of diabetic morbidly obese patients who had undergone RYGB or SG. The variables analyzed included weight, fasting glycemia, and glycosylated hemoglobin. Results A total of 90 patients were included (60 RYGB and 30 SG). The body mass index was 46.22 kg/m 2 for the RYGB group and 56.80 kg/m 2 for the SG group. The fasting glycemia was 10.63 mmol/L and 8.05 mmol/L and the glycated hemoglobin was 8.1% and 7.3% in the RYGB and SG groups, respectively. No significant differences were seen in the amount of weight loss after 2 years between the 2 techniques. Similarly, no significant differences were found in T2DM control after either 1 year (91.8% versus 82.3%) or 2 years (91.8% versus 88.9%). No significant differences were found in the duration of T2DM in either group nor in the percentage of patients treated with insulin and oral hypoglycemic drugs before and 2 years after surgery. Conclusion We did not find any significant differences in weight loss or T2DM resolution between the 2 techniques. Our results highlight that 1 of the mechanisms implicated in T2DM remission after bariatric surgery is weight loss. The role of other factors, such as incretins, that we have not studied cannot be ruled out and should be analyzed further.