SFEEU2017 Obesity Update Poster Presentations (14 abstracts)
Comparison of the impact of Roux-en-Y gastric bypass and sleeve gastrectomy on 2-year post-operative glycaemic outcomes in people with type 2 diabetes: the role of weight-loss
Andrea Pucci , Janine Makaronidis , Wui-Hang Cheung , Andrew Jenkinson , Marco Adamo , Mohamed Elkalaawy , Urszula Tymoszuk , Majid Hashemi , Nicholas Finer & Rachel Batterham
University College London Hospital, London, UK.
Background & aims: Data comparing the effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on type-2 diabetes (T2D) outcomes and the relationship between weight-loss (WL) and T2D remission are limited. Thus, we undertook a retrospective study of patients with obesity and T2D who underwent RYGB or SG and examined the relationship between 2-year (2y) post-surgery T2D and WL outcomes.
Material & methods: Patients who underwent RYGB (107) or SG (103) as a primary procedure were included in the study and followed up to 2y post-surgery. The DiaRem score, a validated pre-surgery T2D remission score utilising HbA1c, age, glycemic medications and insulin usage, was calculated for each patient. Combined T2D remission (CR = total + partial) was defined according to the 2nd Diabetes Surgery Summit (DSS-II) Consensus group criteria (HbA1c <6.5%/48 mmol/mol for ≥12 months without T2D medications). Multivariate adjustment analysis was used to correct for baseline confounding factors and odds of CR were tested categorizing %WL in quintiles, continuous scale and 5%WL groups.
Results: Pre-surgery the RYGB group had a lower BMI (43.1+6.3 vs 48.2+7.8, P<0.001), greater insulin usage (70% vs 30%, P<0.05) and higher DiaRem score (8.3+5.2 vs 6.0+4.4, P<0.001). At 2y post-surgery the %WL was higher in the RYGB compared to the SG [26.6% vs 20.6%, P<0.001]. CR was associated with younger age, female gender, higher BMI and lower pre-surgery DiaRem scores. RYGB patients had 175% higher odds of CR compared to SG, (P=0.012). This association became non-significant when adjusted for WL (P=0.157). For every 5%WL the odds of CR increased by 61% (P<0.001). This association remained after adjusting for gender, BMI and surgery type.
Conclusion: In conclusion, at 2y, RYGB led to greater %WL accompanied by superior T2D outcomes compared to SG. %WL plays a major role in determining glycaemic improvements.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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