Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m2

Abstract

BackgroundTo compare long term effects of two bariatric procedures for Chinese type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) of 28-35 kg/m2.MethodsSixty four T2DM patients with Glycated hemoglobin A1c (HbA1c) ≧ 7.0 % were randomly assigned to receive laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedure. Weight, percentage of excess weight loss (%EWL), BMI, waist circumference, HbA1c, fasting blood glucose (FBG), and C-peptide were measured. Serum lipid levels were also measured during three-year postoperative follow-up visits.ResultsFifty five patients completed the 36-month follow-up. Both groups had similar baseline anthropometric and biochemical measures. At the end point, 22 patients (78.6 %) in SG group and 23 patients (85.2 %) in RYGB group achieved complete remission of diabetes mellitus with HbA1c < 6.0 % (P = 0.525) and without taking diabetic medications, and 25 patients in each group (89.3 % vs. 92.6 %) gained successful treatment of diabetes with HbA1c≦6.5 % (P = 0.100). Change in HbA1c, FBG and C peptide were comparable in the two groups. The RYGB group had significantly greater weight loss than the SG group [percentage of total weight loss (%TWL) of 31.0 % vs. 27.1 % (P = 0.049), %EWL of 92.3 % vs. 81.9 % (P = 0.003), and change in BMI of 11.0 vs. 9.1 kg/m2(P = 0.017), respectively]. Serum lipids in each group were also greatly improved.ConclusionIn this three-year study, SG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2DM patients with BMI of 28-35 kg/m2. Longer term follow-ups and larger sample studies are needed to confirm these outcomes, however.

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

“…A third arm who received lifestyle treatment had no patients in remission at the end of the study. 166 The second larger study did find a significant difference in remission rates at 1 year after surgery in patients with a BMI ≥ 50 kg/m 2 , with remission in 48% of SG and 71% of GBP patients. 167 The third study, a RCT of patients with BMI 30-40 kg/m 2 , compared GBP, gastric banding and an intensive lifestyle intervention.…”

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

“…However, the remission rate decreased to 50% in patients with BMI <30 kg/m 2 [16]. Many reports have been published from different areas of Asia [1718192021222324252627282930]. Table 1 summarizes the reported T2DM remission rate according to different criteria and follow-up years.…”

“…Six RCTs about metabolic surgery had been published from Asia [31217252829]. Table 4 listed the detail of each studies.…”

How Does Bariatric Surgery Improve Type II Diabetes? The Neglected Importance of the Liver in Clearing Glucose and Insulin from the Portal Blood

“…RYGB group had significantly greater BW loss than the LSG group. Serum lipids in each group were also greatly improved [15].…”

“…Data from a recently published Cochrane review is based just on 1798 patients (22 trials!) reported, and Yang et al studied 3-years effects of Laparoscopic Sleeve Gastrectomy (LSG) versus Roux-En-Y Gastric Bypass (RYGP) on T2DM patients (BMI ≥ 28-35 kg/m 2 ) [15]. Interestingly, it was found that 78.6% in the LSG and 85.2% in the RYGB group achieved complete remission of T2DM with HbA1c <6.0% without taking diabetic medications, and 89.3% LSG vs. 92.6% RYGB group gained successful treatment of diabetes with HbA1c ≤ 6.5%.…”