Study on Roux-en-Y Gastric Bypass and Diabetic Kidney Disease

Individuals who receive Roux-en-Y Gastric Bypass have a greater reduction in microalbuminuria and A1c compared with those treated with empagliflozin and liraglutide, according to a study published in Diabetes Care.

Baseline albuminuria in patients with diabetic kidney disease (DKD) is strongly associated with progressive deterioration in kidney function.

The remission of microalbuminuria in patients with type 2 diabetes and obesity attenuates the decline in the estimated glomerular filtration rate. In the Microvascular Outcomes after Metabolic Surgery (MOMS) randomized controlled trial (RCT), a group of researchers demonstrated that the combination of best medical care and Roux-en-Y gastric bypass (RYGB) surgery is more effective in inducing remission of microalbuminuria than best medical care alone. During the MOMS RCT, type 2 diabetes care guidelines were updated to reflect the potent renoprotective effects of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in people with DKD. Thus, the rate of use of the combination of these two agents (Combo) in the study was increased.

They conducted a post hoc analysis of the MOMS RCT, to determine whether the combination of two potent renoprotective medications can match the reductions of albuminuria observed after RYGB.

Results of the Study

• Both interventions resulted in significant reductions in uACR, but RYGB was significantly superior.
• The percentage of patients who achieved remission of albuminuria/DKD was 59.3% in the Combo and 81.8% in the RYGB group.
• RYGB was superior to the Combo for reductions in HbA1c and LDL cholesterol but not systolic blood pressure.
• The American Diabetes Association (ADA) triple end point was achieved in 25.9% in the Combo group and 44.2% in the RYGB group.

Thus, the researchers concluded that individuals who received RYGB had a greater reduction in microalbuminuria and A1c compared with those treated with empagliflozin and liraglutide.

Reference

Renoprotective Effects of the Combination of Empagliflozin and Liraglutide Compared With Roux-en-Y Gastric Bypass in Early-Stage Diabetic Kidney Disease: A Post Hoc Analysis of the Microvascular Outcomes after Metabolic Surgery (MOMS) Randomized Controlled Clinical Trial by Ricardo V. Cohen published in Diabetes Care.

https://doi.org/10.2337/dc21-1192