People with type 2 diabetes (T2DM) who had Roux-en-Y gastric bypass (RYGB) had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycaemic control compared with those who had sleeve gastrectomy (SG), a large study* from the US has shown. The team who conducted the research said in JAMA Surgery that their findings would help patients and their surgeons to make an informed choice about their options.
The researchers pointed out that it was already known that bariatric surgery can lead to substantial improvements in T2DM, but outcomes vary across procedures and populations and it is unclear which bariatric procedure has the most benefits for people with T2DM, so they evaluated associations of bariatric surgery with T2DM outcomes.
They conducted a cohort study among 9,710 adult women and men with T2DM (mean age 49.8 years; mean body mass index (BMI) 49.0; 72.2% of them white) who had bariatric surgery, followed for a median of 2.7 years. Of these, 6,233 (64.2%) underwent RYGB, and 3477 (35.8%) had SGs.
They reported that most patients who had RYGB or SG experienced T2DM remission at some point over five years’ follow-up, which occurred primarily in the first two years, but there were differences between the two groups. Patients who underwent RYGB showed slightly but significantly higher T2DM remission rates than those who had SG (hazard ratio, HR 1.10). The researchers estimated that at one-year post-surgery, 59.2% of RYGB patients had experienced remission vs 55.9% of SG patients; 84.3% vs 81.5% at three years; and 86.1% vs 83.5% at five years.
They also found that among the 6,141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was significantly lower for those who had RYGB than for those who had SG (HR 0.75). They estimated relapse rates for those who had RYGB and SG as 8.4% and 11.0% at one year, and 33.1% and 41.6% at five years after surgery.
Furthermore, at five years, compared with baseline, haemoglobin A1c was reduced 0.45 percentage points more for patients who had RYGB compared with those who had SG. And weight loss was significantly greater with RYGB than SG at one year (mean difference 6.3 percentage points) and at five years (mean difference 8.1 percentage points).
The study authors concluded: “In this large multicentre study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycaemic control compared with those who had SG. These findings can help inform patient-centred surgical decision-making.”
*McTigue KM, Wellman R, Nauman E, et al. Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: the national patient-centered clinical research network (PCORNet) bariatric study. JAMA Surg, 04 March 2020. DOI:10.1001/jamasurg.2020.0087