Gastric Bypass vs Sleeve Gastrectomy for Type 2 Diabetes Mellitus

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Lee WJ,et al. "Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial". Archives of Surgery. 2011. 146(2):143-148.
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Clinical Question

In patients with type 2 diabetes mellitus (T2DM) is gastric bypass or sleeve gastrectomy more effective at induccing remission of T2DM?

Bottom Line

Patients who were treated with gastric bypass surgery were more likely to experience remission of their T2DM than those treated with sleeve gastrectomy group.

Major Points

In the Western world T2DM and obesity are one of the most common chronic conditions, and represent risk factors for a large variety of disease processes [1] [2]. Historically, management of these conditions have involvled diet, exercise, and medical therapy, however more recently there has been evidencce ot suggest that bariatric surgery has an important role to play in the management of T2DM [3] [4] [5] [6].

This double blinded, randomized control trial examined two common bariatric surgeries; the gastric bypass (GB) and the sleeve gastrectomy (SG). Overall 70% of patients had remission of their T2DM within 12 months of their procedure. Specifically the 93% of GB patients and 47% of SG patients experienced remission (P=0.02). The GB group experienced a significant decrease in weight, waist circumference, HbA1C and resolution of their metabolic syndrome. Fasting glucose was also significantly reduced, 4.2% in the GB group and 3.0% in the SG group.

The investigators posit 4 hypotheses as to why the GB group was more successful than the SG group. The first being starvation followed by weight loss, the second the ghrelin hypothesis, the thrid the hindgut hypothesis, and finally the ypper intestinal hypothesis.

Guidelines

Design

  • (design details, multicenter? randomized trial?)
  • N=###
    • Intensive (n=###)
    • Standard (n=##)
  • Setting: ## centers in ## countries
  • Enrollment: YYYY-YYYY
  • Mean follow-up: ## years
  • Analysis: Intention-to-treat
  • Primary outcome:

Population

Inclusion Criteria

Exclusion Criteria

Baseline Characteristics

  • Demographics: Age ## years, ##% female

Interventions

Outcomes

Comparisons are GROUP 1 vs. GROUP 2.

Primary Outcomes

OUTCOME NAME
##% vs. ##% (HR ##; 95% CI ##-##; P=##)

Secondary Outcomes

Subgroup Analysis

Adverse Events

Criticisms

Funding

Further Reading

  1. King H et al. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998. 21:1414-31.
  2. Zimmet P et al. Global and societal implications of the diabetes epidemic. Nature 2001. 414:782-7.
  3. Pories WJ et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann. Surg. 1995. 222:339-50; discussion 350-2.
  4. Dixon JB & O'Brien PE Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 2002. 25:358-63.
  5. Sjöström L et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N. Engl. J. Med. 2004. 351:2683-93.
  6. Schauer PR et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann. Surg. 2003. 238:467-84; discussion 84-5.