Gastric Bypass or Sleeve Gastrectomy in Type 2 Diabetes With Obesity

For patients with type 2 diabetes (T2D) and obesity comorbidities, Roux-en-Y gastric bypass (RYGB) was associated with more weight loss, superior diabetes control, and lower risk for major adverse cardiovascular events (MACE) and nephropathy compared with sleeve gastrectomy (SG), according to a study published in Diabetes Care.

This retrospective, observational study analyzed data collected at the Cleveland Clinic Health System between 1998 and 2018. Patients with T2D and a body mass index (BMI) 30 kg/m² who underwent RYGB (n=1362), SG (n=693), or matched nonsurgical controls (n=11,435) were assessed for clinical outcomes.

The RYGB, SG, and controls were aged median 51.2, 54.6, and 54.8 years; 66.7%, 63.3%, and 64.2% were women; glycated hemoglobin (HbA_1C) was 7.1%, 7.0%, and 7.1%; and BMI was 45.3, 44.7, and 42.6 kg/m², respectively.

At 5 years, the cumulative incidence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and nephropathy occurred among 13.7% of the RYGB and 24.7% of the SG cohorts (adjusted hazard ratio [aHR], 0.77; 95% CI, 0.60-0.98; P =.035). Compared with a rate of 30.4% for the non-surgical controls, both RYGB (aHR, 0.53; 95% CI, 0.46-0.61; P <.001) and SG (aHR, 0.69; 95% CI, 0.56-0.85; P <.001) procedures decreased risk for the composite outcome.

For MACE (all-cause mortality, myocardial infarction, and ischemic stroke), the rates were 6.4% and 11.8% for the RYGB and SG groups, respectively (aHR, 0.81; 95% CI, 0.57-1.16; P =.258). Although no different from each other, the surgical groups had lower rates compared with the controls (15.5%; vs RYGB: aHR, 0.53; 95% CI, 0.43-0.65; P <.001); vs SG: aHR, 0.65; 95% CI, 0.48-0.88; P =.006).

For each endpoint separately, compared with controls, RYGB associated with decreased risk for all-cause mortality (P <.001), heart failure (P <.001), coronary artery disease (P <.001), nephropathy (P <.001), and cerebrovascular disease (P =.019) and SG with heart failure (P <.001), all-cause mortality (P =.004), and atrial fibrillation (P =.027). Between surgical groups, RYGB associated with decreased risk for nephropathy compared with SG (P =.005).

For obesity and diabetes changes, RYGB associated with a 9.7%-point greater weight loss (P <.001) and 0.31% lower HbA_1C (P <.001) compared with SG at 5 years.

However, RYGB recipients associated with more adverse events, requiring more upper endoscopy (45.8% vs 35.6%; P <.001) and abdominal surgery (10.8% vs 5.4%; P =.001) compared with SG, respectively.

This study may have been limited by the propensity matched cohort, which was not designed for each surgical group separately, but as a single surgical population.

These data suggested that, for patients with T2D and obesity comorbidities, superior glycemic outcomes may be achieved from RYGB than from SG.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Aminian A, Wilson R, Zajichek A, et al. Cardiovascular outcomes in patients with type 2 diabetes and obesity: comparison of gastric bypass, sleeve gastrectomy, and usual care. Diabetes Care. 2021;44(11):2552-2563. doi:10.2337/dc20-3023