Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyNovember 2022
In a blinded randomised trial, the five year diabetes remission rate was somewhat higher with RouxenY gastric bypass.
Several randomised trials have compared diabetes outcomes after Roux-en-Y gastric by-pass (RYGB) and sleeve gastrectomy (SG), but none have been blinded. In this blinded, randomised, single-centre trial, 114 adults with type 2 diabetes (mean glycated haemoglobin [HbA1c], 63 mmol/mol [7.9%]) and body mass index (BMI) 35 kg/m2 or higher (mean, 43 kg/m2) received either laparoscopic RYGB or laparoscopic SG.
At five years, diabetes remission (i.e. HbA1c below 42 mmol/mol [6%] and no use of diabetes medications) had occurred in 47% of RYGB patients and 33% of SG patients – a significant difference. Per cent bodyweight loss was also significantly greater with RYGB than with SG (mean, 27% vs 16%), reflecting an average difference between groups of 12 kg. Incidences of early postoperative adverse events were not significantly different, but a small difference in later major complications (12% with RYGB and 3% with SG) almost reached statistical significance; perforated anastomotic ulcer and dysphagia accounted for the difference.
Comment: This trial is noteworthy both for being double-blind and for having extended follow up of diabetes outcomes. Diabetes remission occurred more commonly with gastric bypass than with sleeve gastrectomy (but the difference was not huge), and major complications were slightly more frequent with gastric bypass. The findings provide helpful information for patients with diabetes and class 3 obesity (BMI 40 kg/m2 or higher) who are considering bariatric surgery.
ALLAN S. BRETT, MD
Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.
Murphy R, et al. Effect of banded RouxenY gastric bypass versus sleeve gastrectomy on diabetes remission at 5 years among patients with obesity and type 2 diabetes: a blinded randomized clinical trial. Diabetes Care 2022; 45: 1503-1511.
This summary is taken from the following Journal Watch title: Gastroenterology.