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Two-year outcomes of Roux‐en‐Y gastric bypass vs medical treatment in type 2 diabetes with a body mass index lower than 32.5 kg/m2: a multicenter propensity score-matched analysis

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Abstract

Background

Roux‐en‐Y gastric bypass (RYGB) has been widely reported to be safe and feasible, and has a powerful effect on improving metabolism and weight loss in patients with a high body mass index (BMI). A few studies have focused on the comparison of RYGB with medical treatment in type 2 diabetes (T2D) patients with a lower BMI.

Objectives

To compare the metabolic effects and safety of RYGB versus medical treatment during a 2 years follow-up in T2D patients with a BMI of 25 to 32.5 kg/m2.

Methods

This retrospective and multicenter cohort study participants were extracted from the T2D patients with a lower BMI (25–32.5 kg/m2) from three bariatric centers between 2009 and 2018. Propensity score matching (PSM) was used to minimize bias, and each patient in the surgical group was matched 1:2 to the patients in the medical group with the closest propensity score. Finally, 71 patients who received RYGB and 142 patients who underwent medical treatment with a 2 years follow-up were enrolled to compare the effects of RYGB and medical treatment. The primary endpoint was achievement of the triple endpoint (the simultaneous achievement of hemoglobin A1c (HbA1c) < 7.0%, fasting low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL (2.6 mmol/L), and systolic blood pressure (SBP) < 130 mmHg at the year-1 visit). Changes in weight, BMI, medication usage, complications, and adverse events were assessed.

Results

In total, 213 patients (mean age of 47.4 ± 9.5 years, 70.4% male, mean BMI of 28.6 ± 2.2 kg/m2) were included in this study. At the end of the first year, 17 patients (23.9%) in the surgical group and 10 (7.0%) in the medical group had achieved the composite triple endpoint (OR 4.64; 95% CI 1.82–11.81; p = 0.001). Additionally, 43 patients (60.6%) in the surgical group and 11 patients (19.7%) in the medical group experienced remission of T2D. However, more complications were observed in the surgical group (36 vs. 22, p < 0.01).

Conclusions

Among T2D patients with a BMI between 25.0 and 32.5 kg/m2, RYGB was more effective than medical treatment in resolving metabolic disorders and also resulted in more complications. The risk for complications should be considered in the clinical decision-making process for T2D patients with a low BMI.

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Acknowledgements

The authors would like to thank the research assistants and medical students who provided assistances with the study (Jun Li, Chaoqiang Cai, and Xiang Gao, from the Hospital 2); members of this multicenter study at the Hospital 1; and the Hospital 3.

Funding

This research was supported by the program of China–Japan Friendship Hospital introduction of talents grant (2018-RC-1) and by Research and promotion of clinical characteristics and results in Capital (Z151100004015065).

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Author notes

  1. J. Ling and H. Tang have contributed equally to this article.

Authors and Affiliations

  1. Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital of Central South University, 138 Tongzipo Rd, Yuelu District, Changsha, 410013, China

    J. Ling, H. Tang, L. Zhu & S. Zhu

  2. Department of General Surgery, The China-Japan Friendship Hospital, Beijing, China

    H. Meng

  3. Department of Metabolic Surgery, The Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

    L. Wu

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  1. J. Ling
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Contributions

SZ and LZ take responsibility for the contents of the article. JL and HT have contributed equally to this article. Study design: LZ, SZ, HM, and LW. Acquisition and analysis of data: LZ, HM, and LW. Drafting of the manuscript: JL and HT. Revision of the draft paper and final approval: LZ and SZhu. Statistical analysis: JL and HT.

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Correspondence to L. Zhu or S. Zhu.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki.

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Written informed consent for the study was obtained from all individual participants.

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Ling, J., Tang, H., Meng, H. et al. Two-year outcomes of Roux‐en‐Y gastric bypass vs medical treatment in type 2 diabetes with a body mass index lower than 32.5 kg/m2: a multicenter propensity score-matched analysis. J Endocrinol Invest 45, 1729–1740 (2022). https://doi.org/10.1007/s40618-022-01811-9

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  • DOI: https://doi.org/10.1007/s40618-022-01811-9

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