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Gastric bypass is superior to sleeve gastrectomy for T2DM remission

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Gastric bypass is superior to sleeve gastrectomy for remission of type 2 diabetes at one year after surgery, according to a study led by researchers from Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway. The outcomes from the Obesity Surgery in Tønsberg (OSEBERG) study also showed that the two procedures had a similar beneficial effect on β-cell function, but they noted that the use of gastric bypass as the preferred bariatric procedure for patients with obesity and type 2 diabetes could improve diabetes care and reduce related societal costs.

The study, ‘Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial’, published in The Lancet Diabetes and Endocrinology, compared the effects of the two most common bariatric procedures, gastric bypass and sleeve gastrectomy, on remission of diabetes and β-cell function.

The single-centre Vestfold Hospital Trust (Tønsberg, Norway), triple-blind, randomised trial included patients with type 2 diabetes and obesity who were randomly assigned (1:1) to receive gastric bypass or sleeve gastrectomy. The primary clinical outcome was the number of patients with complete remission of T2DM (HbA 1c of ≤6·0% [42mmol/mol] without the use of glucose-lowering medication) one year after surgery. The primary physiological outcome was disposition index (a measure of β-cell function) one year after surgery, as assessed by an intravenous glucose tolerance test. Primary outcomes were analysed in the intention-to-treat and per-protocol populations.

Outcomes

After screening, total of 109 patients were enrolled and randomly assigned to gastric bypass (n=54) or sleeve gastrectomy (n=55) and 107 (98%) patients completed one-year follow-up (one patient in each group withdrew after surgery (per-protocol population). The authors reported that in the intention-to-treat population, diabetes remission rates were higher in the gastric bypass group than in the sleeve gastrectomy group (p=0.0054), these results were similar in the per-protocol population (p=0.52) and in the per-protocol population (p=0.86).

Early complications occurred in ten of 54 patients in the gastric bypass group and 17 of 53 had late complications. In the sleeve gastrectomy group, eight of 55 participants had early complications and 22 of 54 had late complications side-effects. There were no deaths in either group.

“In conclusion, the effect of gastric bypass and sleeve gastrectomy on glycaemia is not fully elucidated,” the authors concluded. “Moreover, the impact of altered beta-cell function post-surgery needs to be explored. We hypothesise that greater improvement in beta-cell function after gastric bypass than after sleeve gastrectomy translates into better glycaemic control in subjects with type 2 diabetes one year after surgery.”

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