Sleeve Gastrectomy and Roux-En-Y Gastric Bypass Achieve Similar Early Improvements in Beta-Cell Function in Obese Patients with Type 2 Diabetes

Presentation Number: OR14-4
Date of Presentation: April 3rd, 2017

Jamie A. Mullally*, Gerardo Febres, Amanda J. Tsang, Marc Bessler and Judith Korner
Columbia University College of Physicians & Surgeons, New York, NY

Abstract

Bariatric surgery is the most effective long-term treatment for obesity and is considered a treatment option for type 2 diabetes mellitus (T2DM). The two most commonly performed bariatric surgeries are laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG). Although SG is growing in favor, some randomized clinical trials show less weight loss and improvement in HbA1c compared with RYGB. The objective of the present study was to better delineate changes in beta-cell function after SG in patients with T2DM, and to compare these changes to a RYGB cohort with similar baseline characteristics and weight loss.

Obese subjects with T2DM who underwent SG (N=10) and RYGB (N=10) were studied with a frequently sampled insulin supplemented intravenous glucose tolerance test (fsIVGTT) before and approximately three weeks after surgery. Glucostatic parameters were assessed using Bergman minimal model analysis of fsIVGTT, which provides measures of sensitivity of glucose elimination to insulin (Si), acute insulin response to glucose (AIR), and a measure of insulin secretion in relation to insulin sensitivity (disposition index (DI)). The primary endpoint was improvement in beta-cell function as measured by DI.

Baseline characteristics including mean ± SEM age (45.1 ± 1.9 years), BMI (44.7 ± 1.4 kg/m²), HbA1C (7.4% ± 0.2), fasting glucose (161.4 ± 12.8 mg/dL), and diabetes duration (4.2 ± 0.9 years) were similar between groups. No patients were taking insulin. Mean weight loss between groups was similar (8.9 ± 0.6% for SG and 8.4 ± 0.8% for RYGB, p = 0.60) after a period of 22.4 ± 2.0 days. Both groups showed improvements in DI from baseline to post-surgery (20.2 to 163.3, p=0.03 for SG, and 32.3 to 211.5, p=0.04 for RYGB) with no significant difference in the change in DI between groups (p=0.70). Additionally, similar improvements in fasting glucose (reduction of 40.1 ± 4.5mg/dL for SG and 43.2 ± 0.8 mg/dL for RYGB, p=0.89), AIR (increase of 82.9 ± 27.7 ml-1 x µU x min for SG and 93.2 ± 27.8 ml-1 x µU x min for RYGB, p=0.80), and Si (increase of 0.60 ± 0.3 mL x µU-1 x min-1 for SG and 0.13 ± 0.3 mL x µU-1 x min-1for RYGB, p=0.25) were observed.

In conclusion, SG improves beta-cell function as well as RYGB in the short term, although it remains unclear if longer-term outcomes are better after RYGB due to greater weight loss and/or other factors.

 

Disclosure: MB: Management Position, EndObetes, Medical Advisory Board Member, ValenTx. JK: Investigator, Covidien/Medtronic. Nothing to Disclose: JAM, GF, AJT