Roux-en-Y Gastric Bypass or Sleeve Gastrectomy for Type 2 Diabetes: Expanding Role of Individualized Metabolic Surgery (IMS) Score
As recently summarized1, there are only four randomized clinical trials (RCTs) in patients with type 2 diabetes mellitus (T2DM) comparing Roux-en-Y gastric bypass (RYGB) with sleeve gastrectomy (SG) and providing level I evidence up to 5 years after randomization.2-5 None of the individual studies were primarily designed and adequately powered to compare the effects of RYGB with SG on T2DM. However, combined analysis of these RCTs (i.e. meta-analysis) in order to increase the sample size and statistical power (RYGB, n=176 versus SG, n=175) would indicate that either there is no significant long-term difference between RYGB and SG in improving T2DM, or in case of a true difference (and we still don ’t have enough statistical power to reveal the difference), that difference would be less than 15% favoring RYGB.
Obesity is a world-wide epidemic and it is a risk factor for type 2 diabetes mellitus (T2D). Few randomized controlled studies have compared the two most common surgical procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in the treatment of obese subjects with T2D.
Objective: We sought to compare the short and long-term outcomes of MBS in adolescents vs. adults who have undergone a Roux-en-Y gastric bypass (RYGB) or Sleeve gastrectomy (SG).Design: Retrospective cohort study.Setting: Single tertiary care academic referral center.Participants: One hundred fifty adolescent (≤ 21-years) and adult (>21-years) subjects with severe obesity between 15 and 70 years of age who underwent RYGB or SG.Outcomes: Metabolic parameters, weight and height measures were obtained pre-and post-surgery (at 3 and 6 months, and then annually for 4 years).Results: Median pre-surgical body mass index (BM...
ConclusionsMild-to-moderate PPHG is a frequent complication after bariatric surgery and results in smaller weight loss after 2 years. Age, baseline BMI, and an earlier glucose peak during OGTT predict PPHG after bariatric surgery.
CONCLUSION: This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up. However, long-term follow-up of 10 years is needed to further substantiate these findings. PMID: 32148383 [PubMed - in process]
Authors: Koch TR, Shope TR Abstract Obesity is a major factor in the worldwide rise in the prevalence of type 2 diabetes mellitus. The obesity "epidemic" will require novel, effective interventions to permit both the prevention and treatment of diabetes caused by obesity. Laparoscopic vertical sleeve gastrectomy is a newer bariatric surgical procedure with a lower risk of complications (compared to Roux-en-Y gastric bypass surgery). Based in part on restriction of daily caloric intake, sleeve gastrectomy has a major role in inducing significant weight loss and weight loss is maintained for at least 10&nbs...
We reported a significant increase of ghrelin epsilon-cells in the pancreas and basal serum after Sleeve gastrectomy versus the control groups. The epsilon cellular increment was related to neogenesis, as the neurogenin-3 marker revealed. The Roux-en Y Gastric Bypass showed neither epsilon cell increase nor basal serum changes in ghrelin release. As a conclusion, we reported that the severe suppression of the fundus gastric produced the recovery of ghrelin released by the epsilon cells, which was indicative of an ontogenic embryonic pancreatic function. PMID: 31951010 [PubMed - as supplied by publisher]
The objective of this study is to look for preoperative predictors of early T2DM relapse/no remission in patients with obesity and diabetes who underwent Roux ‐en‐Y gastric bypass (RYGB) or loop duodeno‐jejunal bypass with sleeve gastrectomy (LDJB‐SG). This is a retrospective study of 113 patients who underwent RYGB or LDJB‐SG for T2DM. All T2DM patients with BMI 27.5 to 37.5 kg/m2, having uncontrolled diabetes and T2DM patients with BMI > 37.5 were included in the study. A multivariate analysis with a logistic regression model was used for analysed factors. Nineteen patients (16.8%) had early ...
ConclusionsBoth LRYGB and LSG have comparative effect on resolving T2DM in nonseverely obese patients at midterm follow-up. Further RCTs should address the potential risks and long-term effects of LRYGB and LSG in nonseverely obese patients.
Conclusion: There are significant weight loss and improvement of glycaemic control at 12 months post-laparoscopic bariatric surgery among super-obese Malaysians.
Guiding patients with type 2 diabetes mellitus (T2DM) toward the most appropriate bariatric and metabolic procedure is crucial for improving outcomes. In recent years, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been the most commonly performed bariatric procedures worldwide. Both are safe, effective, and durable metabolic procedures. The aim of this review is to critically examine the best available evidence derived from the randomized clinical trials (RCTs) to identify which bariatric procedure is superior in an individual with T2DM to provide sustainable long-term remission.