Background: Bariatric surgical procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are increasingly being utilized to manage type 2 diabetes in those with morbid obesity. It is unclear which procedure is more effective for diabetes remission.

Methods: In a prospective, parallel, two-arm, study conducted in a single centre, eligible patients aged 20-55 years, with BMI 35-65kg/m2 and type 2 diabetes of at least 6 months duration were randomized 1:1 to silastic ring (SR)-LRYGB or LSG using random number codes. Patients and assessors remained blinded to treatment allocation until after primary outcome of type 2 diabetes remission was assessed at 5 years, defined by HbA1c <6% (42mmol/mol) without the use of glucose lowering medications.

Results: Of the 114 patients randomized, 5 died during the 5 year follow up. Diabetes remission assessed in 108/109 (99%) patients, was achieved by 26/53 (49%) after SR-LRYGB vs. 18/55 (33%) after LSG (adjusted odds ratio 6.8; 95% confidence interval, 2.1 to 22.1, p=0.002). Percentage body weight loss assessed in 99/109 (91%) patients, was also greater after SR-LRYGB than after LSG, (26.9± 8.5% vs. 16.3±8.2%, p<0.0001). Acute, 30-day complication rates were similar in both groups. Late re-intervention rates were higher after SR-LRYGB (20 vs. 12). General health and physical functioning domains improved after both types of surgery, with greater improvements in physical functioning after SR-LRYGB (p<0.01).

Conclusions: Among patients with obesity and type 2 diabetes, SR-LRYGB provides greater diabetes remission and weight loss compared to LSG at 5 years.

Disclosure

R. Murphy: None. R. G. Cutfield: None. M. W. C. Booth: None.

© 2021 by the American Diabetes Association
2021
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