Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m 2

BMC Surgery

Yunlong Pan¹  Hening Zhai¹  Shuqing Yu¹  Wah Yang¹  Guo Cao¹  Cunchuan Wang¹  Jingge Yang¹ 

[1] Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou 510630, China

关键词: Mild obesity;    Type 2 diabetes;    Sleeve gastrectomy;    Roux-en-Y gastric bypass;    Bariatric surgery;   

Others  :  1220833
DOI  :  10.1186/s12893-015-0074-5

 received in 2015-02-07, accepted in 2015-07-14,  发布年份 2015

【 摘 要 】

Background

To compare long term effects of two bariatric procedures for Chinese type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) of 28-35 kg/m ² .

Methods

Sixty four T2DM patients with Glycated hemoglobin A1c (HbA1c) ≧ 7.0 % were randomly assigned to receive laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedure. Weight, percentage of excess weight loss (%EWL), BMI, waist circumference, HbA1c, fasting blood glucose (FBG), and C-peptide were measured. Serum lipid levels were also measured during three-year postoperative follow-up visits.

Results

Fifty five patients completed the 36-month follow-up. Both groups had similar baseline anthropometric and biochemical measures. At the end point, 22 patients (78.6 %) in SG group and 23 patients (85.2 %) in RYGB group achieved complete remission of diabetes mellitus with HbA1c < 6.0 % (P = 0.525) and without taking diabetic medications, and 25 patients in each group (89.3 % vs. 92.6 %) gained successful treatment of diabetes with HbA1c≦6.5 % (P = 0.100). Change in HbA1c, FBG and C peptide were comparable in the two groups. The RYGB group had significantly greater weight loss than the SG group [percentage of total weight loss (%TWL) of 31.0 % vs. 27.1 % (P = 0.049), %EWL of 92.3 % vs. 81.9 % (P = 0.003), and change in BMI of 11.0 vs. 9.1 kg/m ² (P = 0.017), respectively]. Serum lipids in each group were also greatly improved.

Conclusion

In this three-year study, SG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2DM patients with BMI of 28-35 kg/m ² . Longer term follow-ups and larger sample studies are needed to confirm these outcomes, however.

【 授权许可】

   
2015 Yang et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Wadden TA, Brownell KD, Foster GD. Obesity: responding to the global epidemic. J Consult Clin Psychol. 2002; 70(3):510-25.
• [2]Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014; 103(2):137-49.
• [3]Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.
• [4]Bariatric surgery-mediated weight loss and its metabolic consequences for type-2 diabetes. World J Diabetes. 2013; 4(3):47-50.
• [5]Still CD, Wood GC, Benotti P, Petrick AT, Gabrielsen J, Strodel WE, Ibele A, Seiler J, Irving BA, Celaya MP, Blackstone R, Gerhard GS, Argyropoulos G. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014; 2(1):38-45.
• [6]Zimmet P, Alberti KG. Surgery or medical therapy for obese patients with type 2 diabetes? New England journal of medicine. N Engl J Med. 2012; 366(17):1635-6.
• [7]Alexandrou A, Athanasiou A, Michalinos A, Felekouras E, Tsigris C, Diamantis T. Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results. Am J Surg. 2014 Jun 20. pii: S0002-9610 (14) 00262-1. doi:10.1016/j.amjsurg.2014.04.006. [Epub ahead of print]
• [8]Van Rutte PW, Smulders JF, De Zoete JP, Nienhuijs SW. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014; 101(6):661-8.
• [9]De Gordejuela AG, Pujol Gebelli J, García NV, Alsina EF, Medayo LS, Masdevall NC. Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients? Surg Obes Relat Dis. 2011; 7(4):506-9.
• [10]Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, Tsai MH, Chuang LM. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011; 146(2):143-8.
• [11]Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G. Prevalence and control of diabetes in Chinese adults. JAMA. 2010; 310(9):948-59.
• [12]Abbatini F, Rizzello M, Casella G, Alessandri G, Capoccia D, Leonetti F, Basso N. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010; 24(5):1005-10.
• [13]Keidar A, Hershkop KJ, Marko L, Schweiger C, Hecht L, Bartov N, Kedar A, Weiss R. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomized trial. Diabetologia. 2013; 56(9):1914-8.
• [14]Pham S, Gancel A, Scotte M, Houivet E, Huet E, Lefebvre H, Kuhn JM, Prevost G. Comparison of the effectiveness of four bariatric surgery procedures in obese patients With type 2 diabetes: a retrospective study. J Obes. 2014; 2014:638203.
• [15]Al SJ. STAMPEDE: Bariatric surgery gains more evidence based support. Glob Cardiol Sci Pract. 2014; 2014(1):45-8.
• [16]Lee WJ, Chong K, Lin YH, Wei JH, Chen SC. Laparoscopic sleeve gastrectomy versus Single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014; 24(9):1552-62.
• [17]Ko GT, Tang JS. Waist circumference and BMI cut-off based on 10-year cardiovascular risk: evidence for central pre-obesity. Obesity. 2007; 15(11):2832-9.
• [18]Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S, Pierson RN. Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr. 1994; 60(1):23-8.
• [19]Chang CJ, Wu CH, Chang CS, Yao WJ, Yang YC, Wu JS, Lu FH. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. Int J Obes Relat Metab Disord. 2003; 27(2):253-9.
• [20]Lakdawala M, Bhasker A. Asian consensus meeting on metabolic surgery (ACMOMS).Asian consensus meeting on metabolic surgery (ACMOMS).report: Asian consensus meeting on metabolic surgery. Recommendations for the use of bariatric and gastrointestinal metabolic surgery for treatment of obesity and type 2 diabetes mellitus in the Asian population: august 9th and 10th, 2008, Trivandrum, India. Obes Surg. 2010; 20(7):929-36.
• [21]Dixon JB, Zimmet P, Alberti KG, Rubino F. International diabetes federation taskforce on epidemiology and prevention. Bariatric surgery: an IDF statement for obese type2 diabetes. Diabet Med. 2011; 28(6):628-42.
• [22]Campos GM1, Rabl C, Roll GR, Peeva S, Prado K, Smith J, Vittinghoff E. Better weight loss, resolution of diabetes, and quality of life for laparoscopic gastric bypass versus banding results of a 2-cohort pair-matched study. Arch Surg. 2011; 146(2):149-55.
• [23]Li K, Gao F, Xue H, Jiang Q, Wang Y, Shen Q, Tian Y, Yang Y. Comparative study on laparoscopic sleeve gastrectomy and laparoscopic gastric bypass for treatment of morbid obesity patients. Hepatogastroenterol. 2014; 61(130):319-22.
• [24]Zerrweck C, Sepúlveda EM, Maydón HG, Campos F, Spaventa AG, Pratti V, Fernández I. Laparoscopic gastric bypass vs. sleeve gastrectomy in the super obese patient: early outcomes of an observational study. Obes Surg. 2014; 24(5):712-7.
• [25]Samat A, Malin SK, Huang H, Schauer PR, Kirwan JP, Kashyap SR. Ghrelin suppression is associated with weight loss and insulin action following gastric bypass surgery at 12 months in obese adults with type 2 diabetes. Diabetes Obes Metab. 2013; 15(10):963-6.
• [26]Allen RE, Hughes TD, Ng JL, Ortiz RD, Ghantous MA, Bouhali O, Froguel P, Arredouani A. Mechanisms behind the immediate effects of Roux-en-Y gastric bypass surgery on type 2 diabetes. Theor Biol Med Model. 2013; 10:45. BioMed Central Full Text
• [27]Anderson B, Switzer NJ, Almamar A, Shi X, Birch DW, Karmali S. The impact of laparoscopic sleeve gastrectomy on plasma ghrelin levels: a systematic review. Obes Surg. 2013; 23(9):1476-80.
• [28]Mallipedhi A, Prior SL, Barry JD, Caplin S, Baxter JN, Stephens JW. Temporal changes in glucose homeostasis and incretin hormone response at 1 and 6 months after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014; 10(5):860-9.
• [29]Eickhoff H, Guimarães A, Louro TM, Seiça RM, Castro E Sousa F. Insulin resistance and beta cell function before and after sleeve Gastrectomy in obese patients with impaired fasting glucose or type 2 diabetes. Surg Endosc. 2014 Jul 4. [Epub ahead of print].
• [30]Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, Kern B, VonFluee M, Beglinger C. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: arandomized, prospective trial. Obes Surg. 2012; 22(5):740-8.
• [31]Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, Aminian A, Pothier CE, Kim ES, Nissen SE, Kashyap SR. STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014; 370(21):2002-13.