Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance.

Abstract

BACKGROUND:

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are associated with glucose metabolism improvement although data on insulin resistance remission rates after these procedures are lacking.

AIMS:

Primary aim was to compare insulin resistance remission rates achieved after LRYGB and LSG, using population-specific HOMA-IR cut-off points. Secondary objectives were to analyze factors associated with type 2 diabetes mellitus (T2DM) complete remission according to the new American Diabetes Association criteria and to examine changes in HOMA-B during follow-up.

METHODS:

Non-randomized, prospective cohort study of patients undergoing LRYGB or LSG with a minimal follow-up of 24 months. Patients on insulin therapy were excluded.

RESULTS:

At baseline, 56 (48.7%) of the 115 LRYGB group and 48 (61.5%) of the 78 LSG group had insulin resistance, and 29 (25.2%) and 20 (25.6%) T2DM, respectively. No differences were detected in insulin resistance remission rate (92.9% LRYGB and 87.5% LSG, p = 0.355) nor in T2DM complete remission at 2 years (62.1 vs 60% respectively, p = 0.992). Factors independently associated with T2DM complete remission were diabetes treatment and a greater decrease in 3-month HOMA-IR index. The HOMA-B index showed a progressive decline during follow-up.

CONCLUSION:

Both surgical techniques are equally effective in achieving insulin resistance normalization in the majority of severely obese patients. Three-month HOMA-IR reduction after surgery was the main predictor of T2DM complete remission.

• Authors: David Benaiges, Juana A Flores Le-Roux, Juan Pedro-Botet, Juan J Chillarón, Marine Renard, Alejandra Parri, José M Ramón, Manuel Pera, Alberto Goday
• Journal: International journal of surgery (London, England) (Int J Surg) Vol. 11 Issue 4 Pg. 309-13 ( 2013) ISSN: 1743-9159 [Electronic] England
• PMID: 23462580 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Cohort Studies
• Diabetes Mellitus, Type 2 (metabolism, physiopathology, surgery)
• Female
• Gastrectomy (methods, statistics & numerical data)
• Gastric Bypass (methods, statistics & numerical data)
• Humans
• Insulin Resistance (physiology)
• Laparoscopy (methods, statistics & numerical data)
• Male
• Middle Aged
• Obesity (metabolism, physiopathology, surgery)
• Prospective Studies