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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

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Abstract

Background

Bariatric surgery may be beneficial in mildly obese patients with poorly controlled diabetes. The optimal procedure to achieve diabetes remission is unknown. In 2011, we published the short-term results of a pilot study designed to evaluate the efficacy of diabetic control and the role of duodenal exclusion in mildly obese diabetic patients undergoing laparoscopic sleeve gastrectomy (SG) vs. a laparoscopic single anastomosis (mini-) gastric bypass (SAGB). This study analyzes the 5-year results and evaluates the incretin effect.

Methods

A double-blind randomized trial included 60 participants with a hemoglobin A1c (HbA1c) level higher than 7.5 %, a body mass index (BMI) between 25 and 35 Kg/m2, a C-peptide level ≥1.0 ng/mL, and a diagnosis of type 2 diabetes mellitus (T2DM) for at least 6 months. A SAGB with duodenal exclusion or a SG without duodenal exclusion was performed.

Results

The 5-year results of the primary outcome were as an intention-to-treat analysis for HbA1c ≤6.5 % without glycemic therapy. Assessments of the incretin effect and β cell function were performed at baseline and between 36 and 60 months. The patients were randomly assigned to SAGB (n = 30) and SG (n = 30). At 60 months, 18 participants (60 %; 95 % confidence interval (CI), 42 to 78 %) in the SAGB group and nine participants (30 %; 95 % CI, 13 to 47 %) in the SG group achieved the primary end points (odds ratio (OR), 0.3; 95 % CI, 0.1 to 0.8 %). The participants assigned to the SAGB procedure had a similar percentage of weight loss as the SG patients (22.8 ± 5.9 vs. 20.1 ± 5.3 %; p > 0.05) but achieved a lower level of HbA1c (6.1 ± 0.7 vs. 7.1 ± 1.2 %; p < 0.05) than the SG patients. There was a significant increase in the incretin effect before and after surgery in both groups, but the SAGB group had a higher incretin effect than the SG group at 5 years.

Conclusions

In mildly obese patients with T2DM, SG is effective at improving glycemic control at 5 years, but SAGB was more likely to achieve better glycemic control than SG and had a higher incretin effect compared to SG.

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Acknowledgments

This work was supported by the research grants from Min Sheng General Hospital, Taiwan.

Conflict of Interest

None

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Authors and Affiliations

  1. Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan

    Wei-Jei Lee & Shu-Chun Chen

  2. Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan

    Keong Chong & Jih-Hua Wei

  3. Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yu-Hung Lin

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  1. Wei-Jei Lee
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  2. Keong Chong
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Correspondence to Wei-Jei Lee.

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Trial Registration clinicaltrials.gov identifier: NCT00540462

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Lee, WJ., Chong, K., Lin, YH. et al. 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 24, 1552–1562 (2014). https://doi.org/10.1007/s11695-014-1344-5

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