New Procedure Bests Gastric Bypass for Improving Glycemic Control in Mildly Obese Patients

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Sleeve ileal transposition surgery improved glycemic control better than gastric bypass.
Sleeve ileal transposition surgery improved glycemic control better than gastric bypass.

BOSTON — Compared with gastric bypass or clinical treatment, mildly obese patients with type 2 diabetes experienced greater improvements in glycemic control after undergoing surgery with a new technique.

Results from a study presented at ENDO 2016 showed that 100% of patients with class I obesity and poorly controlled type 2 diabetes who underwent sleeve-IT achieved glycemic control, as defined by an HbA1c of 6.5% or less, compared with 46% of those who underwent gastric bypass and 8% of those treated clinically for diabetes after 1 year of treatment (P=.002 for sleeve-IT vs gastric bypass). 

Further, diabetes remission, defined as glycemic control without medication, was also achieved by more patients in the sleeve-IT group than the gastric bypass group (75% vs 30%; P=.02).

“Although in 2010, the International Diabetes Federation recommended surgery for diabetic patients with mild obesity if clinical treatment is not successful, few related studies on this topic have been published,” said lead study author Ana Priscilla Soggia, MD, endocrinologist in the division of clinical research at the Hospital Sirio-Libañes in São Paulo. “The first surgical choice is gastric bypass. However, sleeve-IT, a recent technique not yet approved, increases the beneficial effects of traditional surgery, due to intestinal physiological mechanisms, without increasing the risk of side effects.”

In this trial, Dr Soggia and colleagues randomly assigned 42 patients with class I obesity (BMI of 30 to 35) and poorly controlled type 2 diabetes to sleeve-IT surgery (n=12), gastric bypass (n=13), or clinical diabetes treatment (n=12). Average age was 51 years; 62% were women, and average HbA1c level was 9.3% 

Although more patients achieved glycemic control in the sleeve-IT group, average HbA1c still improved in all 3 groups (sleeve-IT, 5.6%; gastric bypass, 6.9%; clinical treatment, 8%; P=.01 for sleeve-IT vs gastric bypass).

Greater weight loss was seen among patients in the sleeve-IT and gastric bypass groups. On average, participants in the sleeve-IT group lost 18.6 kg, those in the gastric bypass group lost 22.5 kg, and those who received clinical treatment lost 4.7 kg (P=.017 for sleeve-IT and P=.003 for gastric bypass vs clinical treatment).

After surgery, drugs to lower glucose, lipid levels, and blood pressure decreased in both the sleeve-IT and gastric bypass groups.

Four patients experienced serious adverse events, but no deaths or life-threatening complications occurred.

“This recent technique that combines sleeve gastrectomy with ileal transposition was an effective and safe choice for treating patients with mild obesity,” noted Dr Soggia.

Reference

  1. Soggia AP, Salem M, Abdalla R, et al. OR12-5: Bariatric Bypass Surgery Versus Sleeve with Ileal Transposition Surgery Versus Clinical Treatment in Obese Class I Patients with Diabetes. Presented at: ENDO 2016; April 1-4, 2016; Boston, MA.
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