Comparing weight loss surgery methods for T2D remission

This review compared the effects of two types of bariatric surgery (weight loss surgery) on type 2 diabetes (T2D) remission over five years. It found that Roux-en-Y gastric bypass (RYGB) led to better diabetes outcomes than sleeve gastrectomy (SG). It also found that both types of surgery led to improvements in T2D.

T2D is a metabolic condition in which the body does not respond well to the hormone insulin, which controls the amount of glucose (sugar) in the blood. T2D is connected to body weight. For patients with obesity and T2D, bariatric surgery can lead to remission from T2D.

There are multiple types of weight loss surgery. RYGB connects the top part of the stomach directly to the small intestines. The smaller size of the new stomach pouch leads to feeling full after eating a smaller amount of food. Additionally, food reaches the small intestines faster after RYGB surgery. The intestines release the GLP-1 hormone, which causes feelings of satiety and influence metabolism.

SG is a different form of surgery which narrows the size of the stomach. Both surgeries are very effective treatments for obesity, although RYGB typically leads to greater weight loss. However, patients may be more likely to experience nutritional deficiencies following RYGB compared to SG. It is not clear whether one type of weight loss surgery leads to greater improvement in T2D.

This review included 10 studies including 778 patients with obesity and T2D who were undergoing weight loss surgery. 387 patients were randomly assigned to receive RYGB surgery. The other 391 patients had SG surgery. All of the surgeries were done using robotic arms (laparoscopically), which allows for a smaller surgical cut. Patients were followed for 5 years.

A year after surgery, 73% of all patients were in remission from T2D. Remission was defined as an HbA1c (a blood measure of glucose controller over the past 2-3 months) below 6.5%. Five years after surgery, 51% of patients remained in remission.

RYGB had significantly higher rates of remission than SG at one year (84% vs. 60%) and after five years (56% vs. 45%).

This review found that RYGB led to greater improvements in blood glucose control than SG for patients with obesity and T2D.

Remission from T2D can be defined strictly (HbA1c below 6.0%) or more broadly (HbA1c below 6.5%). RYGB trended toward higher rates of remission from T2D using both definitions.

Bariatric surgery can lead to long-term health improvements. However, like all major surgery, it can have serious complications. Talk to your doctor about whether weight loss surgery is right for you.