Advantage of bypass to treat type 2 diabetes
We know the spectacular development of bariatric surgery (severe obesity) and metabolic surgery, to treat certain type 2 diabetes (T2DM), with, for the latter, many debates on the indications, the criteria for judging the remission of T2DM. .
One of the crucial points of discussion is examined in this study (1): the two main surgical approaches, the bypasses gastric (often referred to as a Roux-en-Y short circuit) or the sleeve gastrectomy (gastric sleeve) are equal, does one give better results than the other in improving blood sugar levels, or even achieving remission of T2DM?
This single-center study with computer randomization (1 to 1) involved 114 adult patients with T2DM (half women, 45 years on average) with BMI between 35 and 65 kg/m2who have benefited either from sleeve either from a bypasses (here, a special technique with banding ring of the anastomosis area between intestine and stomach). The two groups were similar with regard to HbA1c, BMI, weight (123 kg ± 22 on average), ethnic group, duration of diabetes, antidiabetic treatments and even insulin therapy (for 30%).
The main objective was to quantify the remission rate of T2D, five years after the operation, remission defined by an HbA1c < 6% in the absence of any treatment for diabetes. The secondary objectives related to weight loss, the evolution of cardiovascular and metabolic risk factors, quality of life, adverse effects or postoperative complications attributable to the procedure.
Almost twice as much weight lost
Results, after five years, there were more remissions of T2D after bypasses (47%) only after the sleeve (33%). A result found by taking a threshold of less than 6.5% HbA1c: 62% vs 50%. Weight loss is much greater with the bypass: 89.8 ± 18 vs 103 ± 17 kg, but the improvements in cardiovascular and metabolic risk factors are similar, except for HDL cholesterol, which is more often increased after bypasses. Physical abilities were also further improved with this surgery.
Importantly, early and late postoperative complications were similar for both groups.
Already significant BMIs
Even if there are too many indications, it must be recognized that offering surgery as a solution to some severe T2D, very overweight, very difficult to treat despite a heavy therapeutic arsenal, is today on the agenda. .
By detailing the phenotype of the patients in this New Zealand study, we see that their BMI was particularly high, which probably determined the choice of recourse to bariatric surgery, more than the imbalance of diabetes itself.
These data nevertheless provide an essential contribution to knowing which of the surgical methods offers the best chances of seeing T2D disappear after the intervention. Here, moreover, both early and late postoperative complications were not more numerous after the bypasses… while sleeve is often chosen because it is easier to perform and considered less risky.
It should be noted that, for the first time, this random computerized randomization was truly able to compare groups that were similar in all respects, unlike previous studies.
Emeritus Professor, Grenoble-Alpes University
(1) Murphy R, Plank LD, Clarke MG et al. Effect of bandaged Roux-en-Y gastric bypass versus sleeve gastrectomy on diabetes remission at 5 years in obese patients with type 2 diabetes: a blinded randomized clinical trial. Diabetes Care 2022; 45:1503-11. doi: 10.2337/dc21-2498.
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