Patients who underwent Roux-en-Y gastric bypass experienced greater weight loss, slightly higher diabetes remission rates, less diabetes relapse, and better long-term glycemic control compared with patients who underwent sleeve gastrectomy, according to large multicenter observational study results published in JAMA Surgery.
Although bariatric surgery appears more effective than medical care alone for diabetes remission, type 2 diabetes (T2D) remission rates after bariatric surgery vary significantly across procedures and populations. Sleeve gastrectomy (SG) has begun to supplant Roux-en-Y gastric bypass (RYGB), but study findings have been mixed in terms of T2D outcomes, especially in the longer term.
To compare the T2D outcomes of patients who underwent SG or RYGB procedures, data from 9710 patients who received care at 34 facilities between January 1, 2005 and September 30, 2015 were analyzed. The average age of patients was 49.8±10.5 years. Most of the cohort were women (72.6%) and most had undergone RYGB surgery (64.2%). The average preoperative body mass index was 49.0±8.4 kg/m2 and the average preoperative hemoglobin A1c (HbA1c) was 7.2%±1.3%. The researchers used data that included information up to 5 years after surgery. Patients ≥80 years of age, patients without T2D, and patients missing any relevant outcomes data were excluded. Remission from T2D was defined as the first postsurgical occurrence of HbA1c level <6.5% following at least 6 months without T2D medication prescription orders.
Five years after undergoing surgery, patients who underwent RYGB had an 8.1% greater average total weight loss compared with patients who underwent SG (95% CI, 6.6-9.6; P <.001 for trend), as well as a 0.45% greater average decrease in HbA1c levels (95% CI, 0.27-0.63; P <.001 for trend). Patients who underwent RYGB also had a higher average T2D remission rate than patients who underwent SG (hazard ratio, 1.10; 95% CI, 1.04-1.16; P =.007 for trend) and a lower average rate of T2D relapse (hazard ratio, 0.75; 95% CI, 0.67-0.84; P <.001 for trend).
Overall, this study showed better long-term T2D and weight outcomes in patients who underwent RYGB compared with patients who underwent SG.
A limitation to the study was its observational design, which may have prevented all covariates from being captured. This observational design, however, provides a strength over a randomized clinical trial design as it eliminates patient bias toward only selecting patients who would willingly be randomly assigned to a surgery type, who may not represent patients in an uncontrolled setting.
The researchers concluded that although long-term diabetes outcomes are similar between these 2 common bariatric procedures for individuals with a high likelihood of remission, “[p]atients with more advanced [T2D] at the time of surgery for whom remission is more difficult to achieve (eg, those with older age, insulin use, more complex [T2D] medications, and/or poor glycemic control) may expect larger improvements in [T2D] with RYGB compared with SG.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
McTigue KM, Wellman R, Nauman E, et al. Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: the National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study [published online March 4, 2020]. JAMA Surg. doi:10.1001/jamasurg.2020.0087
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