Endocrine Abstracts

Background: Gastric Bypass surgery (Bypass) is recognized as the ultimate metabolic surgery. The success in type 2 Diabetes (DM2) remission documented in patients submitted to Vertical Sleeve Gastrectomy (Sleeve) made questionable the hypothesis that this restrictive surgery has beneficial metabolic effects.

Main goal: Comparing the Bypass and Sleeve’s efficacy in DM2 remission.

Methods: Retrospective study of 112 diabetic patients submitted to bariatric surgery in Hospital de Braga from January of 2011 to December of 2016. For each patient, the data was collected from the clinical process and Body Mass Index (BMI), fasting glucose and insulin, glycated haemoglobin (HbA1c) and diabetic therapy were compared at 0 and 12 months. The criteria used for the definition of DM2 remission was the American Diabetes Association’s. The statistical analysis was made through the SPSSvs22 program, with T-test for correlated and independent samples (significance level of 0.05).

Results: From the 112 patients included in the study, 63 performed Sleeve, with 74.6% female (n=47) with a medium age of 47.63±11.7 years. The remaining 49 performed Bypass, with 79.6% female (n=39) and a medium age of 50.29±10.0 years. Twelve months later, with Sleeve, patients presented a medium reduction of the BMI of –13.40±4.7 kg/m² and with Bypass of −13.55±5.3 kg/m², statistically significant. Nevertheless there were no differences statistically significant in the magnitude of reduction of BMI between both surgeries. Concerning fasting glucose, Sleeve allowed a medium reduction of −29.69±31.8 mg/dl and Bypass of −47.23±53.0 mg/dl, without differences in the magnitude of reduction between both surgeries (P=0.076). Fasting insulin after Sleeve decreased a medium of −10.75±10.5 uUI/ml and after Bypass −20.68±12.9 uUI/ml. Regarding HbA1c, with Sleeve, patients obtained differences of −0.85±0.9% and with Bypass a medium of -1.50±1.6%. Bypass showed a more significant reduction in insulinemia (P=0.001) and HbA1c (P=0.039). One year after Sleeve, 42.9% of the patients kept the DM2 therapy (n=27). Of the patients submitted to Bypass, 46,9% didn’t suspend the medication (n=23). Twenty patients went on DM2 remission after Sleeve (n=31.7%) and 17 after Bypass (34.7%).

Conclusion: Both surgeries allowed DM2 remission after one year. Despite Sleeve and Bypass had equivalent reductions of BMI and fasting glucose, Bypass allowed a more significant reduction in fasting insulin and HbA1c values, independently of weight loss.