ECE2016 Guided Posters Obesity (10 abstracts)
Prognostic factors and pathophysiology of diabetes remission after metabolic gastric bypass, sleeve gastrectomy and greater curvature plication: a randomized controlled trial
Nuria Vilarrasa 1, , Anna Casajoana 3 , Amador R de Gordejuela 3 , Xavier Duran 2, , Joan Vendrell 2, , Sonia Fernández 2, , Pilar Garrido 1 , Rosa Monseny 1 & Jordi Pujol 3
1Endocrinology Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet, Barcelona, Spain; 2CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Spain; 3General Surgery Unit. Bellvitge University Hospital-IDIBELL, L’Hospitalet, Barcelona, Spain; 4Endocrinology Unit, Joan XXIII Hospital, Tarragona, Spain.
Introduction: 39% of morbidly obese patients have type 2 diabetes mellitus (T2DM) and 80% of them can achieve diabetes remission after bariatric surgery. However, there are few randomized studies comparing the metabolic results of different surgical techniques and the hormonal mechanisms involved.
Objective: To study and compare the improvement of T2DM and the hormonal pathways following three surgical techniques: metabolic gastric bypass (mGBP), sleeve gastrectomy (SG) and greater curvature plication (GCP).
Methods: Prospective, randomized controlled single-center study in patients with T2DM and morbid obesity. 45 patients aged 49.4±7 years, BMI 39.4±1.9 kg/m2, initial HbA1c 7.7±1.9%; were randomly assigned (1:1:1) to the three surgical techniques. At baseline, one and 12 months a standard meal test was performed to determine GLP-1, GLP-2, PYY, ghrelin and glucagon concentrations.
Results: Twelve months after surgery, total weight loss was higher in mGBP compared with SG and GCP (−35.2±8.1 vs −27.8±5.4 vs −20.5±6.8 kg, P=0.007, P<0.001, respectively). HbA1c at one year was significantly lower in mGBP compared with SG and GCP (5.09±0.62 vs 6.21±0.82 vs 6.61±1.30%, P=0.001, P=0.001). The percentage of patients with diabetes remission was higher in mGBP 80% vs 53.3% vs 20%. GLP-1 area under the curve (AUC) at month one and 12 was greater in mGBP than after SG and GCP. In the multiple regression analysis the absence of insulin treatment and the increase in GLP-1 AUC from baseline to month one were the factors associated with T2DM remission.
Conclusions: mGBP is the technique that has shown a higher rate of weight loss and T2DM remission. Factors associated with improved glycemic control are those that accompany a less evolved diabetes, and an enhanced secretion of GLP-1.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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