Endocrine Abstracts

Introduction: The American Diabetes Association (ADA) produced a triple composite outcome that summarizes the therapeutic targets of the three most prevalent complications of obesity: type 2 diabetes (T2D), hypertension and dyslipidemia (HbA1c <7.0%; LDL cholesterol<100 mg/dl and systolic blood pressure <130 mmHg). The present study primarily investigates the difference between VSG and RYGB in achieving the composite target one year after the surgery. The secondary outcome assessed the success rate in achieving the separate components’ target at months 6, 12 and 24 post-surgery, the 2-year remission of DT2 and postoperative adverse events.

Methods: This retrospective observational study evaluated 103 patients with obesity and T2D (75/28 F/M). Sixty-two (60%) underwent VSG and 41 (40%) RYGB. Patient data were collected before surgery and subsequently during the follow-up visits at 6, 12 and 24 months post-surgery. At each visit, anthropometric measurements were recorded, and the metabolic and lipid profile was evaluated. Pharmacological therapies for diabetes, hypertension, dyslipidemia and any adverse events were also collected.

Results: Twelve months after surgery, patients undergoing RYGB did not show a significant difference compared to those undergoing VSG in achieving the composite target [RYGB vs VSG OR 2.21 (95% CI: 0.61–8.05), P=.57]. Patients undergoing RYGB showed greater LDL target achievement (<100 mg/dl) at 6 months post-surgery than the VSG group (P=.005). Total cholesterol and LDL cholesterol were significantly reduced over time (months 6–12-24 post-surgery) in the RYGB compared to the VSG group (P=.023 and P=.010 respectively). No significant differences were observed in the T2D remission rate and the use of antidiabetic, cholesterol-lowering and antihypertensive drugs between the two groups at months 6–12-24 post-surgery. There was a significant increase in the frequency of constipation episodes in the VSG compared to the RYGB group (P=.002).

Conclusion: Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy showed similar efficacy in reaching the cardiometabolic ADA composite target in subject with T2D undergoing bariatric surgery. Patients undergoing RYGB showed a greater achievement of the LDL target <100 mg/dl at 6 months after surgery and also a significant reduction over time in LDL and total cholesterol compared to the VSG group. More extended randomized studies are needed to evaluate the effectiveness of the two surgical procedures in the improvement and remission of cardiovascular risk factors associated with obesity.