Adults with type 2 diabetes who underwent Roux-en-Y gastric bypass experienced greater weight loss compared with those who underwent laparoscopic sleeve gastrectomy, but improvements in glucose control and insulin secretion were similar between the two groups, according to a study.
Wallenius, MD, PhD, of the department of gastrosurgical research and education at Sahlgrenska Academy, University of Gothenburg in Sweden, and colleagues evaluated data on 18 adults who underwent Roux-en-Y gastric bypass (RYGB; mean age, 51.2 years) or laparoscopic sleeve gastrectomy (mean age, 51.9 years) to compare early weight-dependent and later weight-dependent glycemic effects of the surgeries. A modified 30-g oral glucose tolerance test was used to measure glucose, insulin, GLP-1 and gastric inhibitory peptide levels before and 2 days, 3 weeks and 12 months after surgery. Glucose levels were also self-monitored by participants 2 weeks before and after surgery.
No differences were observed between the two groups for age, sex, weight, BMI, diabetes duration or basal HbA1c. The RYGB group had greater reductions compared with the sleeve gastrectomy group in body weight and BMI at 12 months (P < .05) for both.
At 2 days after surgery, there were no significant changes in fasting blood glucose in either group; however, at 3 weeks and 12 months, significant decreases in fasting blood glucose were observed in both groups. Significant changes in fasting plasma insulin were observed in the RYGB group at 2 days after surgery, but decreases were similar at 3 weeks and 12 months after surgery. Homeostasis model of assessment for insulin resistance improved from baseline to day 2 and 12 months after surgery in both groups.
GLP-1 levels increased in both groups 2 days after surgery during the modified OGTT; changes were maintained at 3 weeks in the RYGB group but began to decline in the sleeve gastrectomy group.
“Elucidation of other mechanisms that contribute to the positive glycemic effects of [laparoscopic sleeve gastrectomy] may hold the key to understanding how patients can be helped to maintain long-term glycemic control after bariatric surgery,” the researchers wrote. – by Amber Cox
Disclosures: Wallenius reports he received grants from Western Region of Sweden and the Erik and Lily Philipson memorial foundation during the conduct of the study and receiving personal fees from Johnson & Johnson outside of the submitted work. Please see the study for all other authors’ relevant financial disclosures.