Bariatric surgery and diabetes remission: sleeve gastrectomy or mini-gastric bypass?

Abstract

AIM:

To investigate the weight loss and glycemic control status [blood glucose, hemoglobin A1c (HbA1c) and hypoglycaemic treatment].

METHODS:

The primary risk factor for type 2 diabetes is obesity, and 90% of all patients with type 2 diabetes are overweight or obese. Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations, little is known about the difference among various weight loss surgical procedures on diabetes remission. Data from patients referred during a 3-year period (from January 2009 to December 2011) to the University of Naples "Federico II" diagnosed with obesity and diabetes were retrieved from a prospective database. The patients were split into two groups according to the surgical intervention performed [sleeve gastrectomy (SG) and mini-gastric bypass (MGB)]. Weight loss and glycemic control status (blood glucose, HbA1c and hypoglycaemic treatment) were evaluated.

RESULTS:

A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study. Of these, 4 subjects were excluded because of surgical complications, 7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up. Thirty-one obese patients were recruited for this study. A total of 15 subjects underwent SG (48.4%), and 16 underwent MGB (51.6%). After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis, high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo (OR = 0.366, 95%CI: 0.152-0.884). Using the same regression model, MGB showed a clear trend toward higher diabetes remission rates relative to SG (OR = 3.780, 95%CI: 0.961-14.872).

CONCLUSION:

Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission, further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission.

• Authors: Marco Milone, Matteo Nicola Dario Di Minno, Maddalena Leongito, Paola Maietta, Paolo Bianco, Caterina Taffuri, Dario Gaudioso, Roberta Lupoli, Silvia Savastano, Francesco Milone, Mario Musella
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 19 Issue 39 Pg. 6590-7 (Oct 21 2013) ISSN: 2219-2840 [Electronic] United States
• PMID: 24151386 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers
• Blood Glucose
• Glycated Hemoglobin A
• hemoglobin A1c protein, human

Topics

• Adult
• Biomarkers (blood)
• Blood Glucose (drug effects, metabolism)
• Chi-Square Distribution
• Diabetes Mellitus, Type 2 (blood, diagnosis, drug therapy, etiology)
• Female
• Gastrectomy (methods)
• Gastric Bypass (methods)
• Glycated Hemoglobin (metabolism)
• Humans
• Italy
• Logistic Models
• Male
• Multivariate Analysis
• Obesity (complications, diagnosis, physiopathology, surgery)
• Odds Ratio
• Remission Induction
• Risk Factors
• Time Factors
• Treatment Outcome
• Weight Loss