Roux-en-Y gastric bypass (RYGB) is known for its high rates of type-2 diabetes mellitus (T2DM) remission, believed to be primarily driven by weight loss. However, recent research suggests that RYGB may offer metabolic benefits beyond weight reduction, especially compared to sleeve gastrectomy (SG).
Researchers have found in a new study that Roux-en-Y gastric bypass was superior to sleeve gastrectomy (SG) in managing T2DM in obese patients.
This study was published in the Journal Of The American College Of Surgeons by Ghanem and colleagues.
This study aimed to investigate the continued diabetes remission (CDR) rates despite weight recurrence (WR) after Roux-en-Y gastric bypass compared to SG. A retrospective review was conducted on patients who underwent RYGB or SG with a BMI ≥ 35 kg/m2 and a preoperative diagnosis of T2DM. Patients with less than five years of follow-up, absence of WR, or lack of T2DM remission at nadir weight were excluded. CDR rates were stratified into WR quartiles and compared between RYGB and SG cohorts.
The key findings of the study were:
224 RYGB and 46 SG patients were analyzed.
Overall CDR rate was significantly higher in the RYGB group (75%) compared to the SG group (34.8%).
Odds of T2DM recurrence were 5.5 times higher after SG compared to RYGB.
Rates of CDR were stratified into WR quartiles: 85.5% (<25% WR), 81.7% (25-44.9% WR), 63.2% (45-74.9% WR), and 60% (>75% WR).
Baseline insulin use, higher preoperative HbA1c, and longer preoperative duration of T2DM were associated with T2DM recurrence, whereas WR was not.
Roux-en-Y gastric bypass demonstrates continued diabetes remission rates despite weight recurrence, suggesting a weight-loss independent metabolic benefit, likely facilitated by bypassing the proximal small-intestine. These findings underscore the potential superiority of RYGB over SG in managing T2DM in obese patients.
Reference:
Ghanem, O. M., Abi Mosleh, K., Kerbage, A., Lu, L., Hage, K., & Abu Dayyeh, B. K. Continued diabetes remission despite weight recurrence: Gastric bypass long-term metabolic benefit. Journal of the American College of Surgeons,2024 10.1097/XCS.0000000000000934. https://doi.org/10.1097/xcs.0000000000000934