Key result
Sleeve gastrectomy achieves similar complete diabetes remission to Roux-en-Y gastric bypass at 36 months.
Why the study?
Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass in Chinese T2DM patients with BMI 28-35 kg/m2 were not well compared.
Does laparoscopic sleeve gastrectomy compared to Roux-en-Y gastric bypass improve diabetes remission and weight loss in Chinese T2DM patients with BMI 28-35 kg/m2?
RCT (n=64)
Open-label
Computer-generated variable block schedule
Yes
Does laparoscopic sleeve gastrectomy compared to Roux-en-Y gastric bypass improve diabetes remission and weight loss in Chinese T2DM patients with BMI 28-35 kg/m2?
Absolute Event Rate: 78.6% vs 85.2%
p-value: p=0.525
In Chinese patients with T2DM and class I/II obesity, sleeve gastrectomy and Roux-en-Y gastric bypass achieved similar high rates of diabetes remission at 3 years, though gastric bypass produced greater weight loss.
SG and RYGB yield similar glycemic outcomes; leaves open optimal procedure choice for Chinese T2DM patients with BMI 28-35.
BACKGROUND: To 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/m(2). METHODS: Sixty 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. RESULTS: Fifty 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/m(2)(P = 0.017), respectively]. Serum lipids in each group were also greatly improved. CONCLUSION: In 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/m(2). Longer term follow-ups and larger sample studies are needed to confirm these outcomes, however.
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Yang et al. (2015) conducted an RCT in Type 2 diabetes mellitus with mild obesity (n=64). Laparoscopic sleeve gastrectomy (SG) vs. Roux-en-Y gastric bypass (RYGB) was evaluated on Complete remission of diabetes mellitus (HbA1c < 6.0% and fasting plasma glucose < 7.0 mmol/L without glycemic agents) (p=0.525). Laparoscopic sleeve gastrectomy achieved a similar rate of complete diabetes remission (78.6%) compared to Roux-en-Y gastric bypass (85.2%, p=0.525) at 36 months in Chinese patients with mild obesity.
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