Gastric Bypass Tops Banding for T2D Remission

Gastric bypass seemed to be the best obesity surgery option to relieve type 2 diabetes. Longitudinal Evaluation of Obesity Surgery-2 (LABS-2) Studies have shown.

Of the more than 800 obese and diabetic patients who underwent obesity surgery, 57% of those who underwent Roux-en-Y gastric bypass surgery achieved diabetic remission, whereas laparoscopic gastric for 7 years Jonathan Purnell reported that only 22.5% of patients underwent banding, MD, the University of Oregon Health & Sciences in Portland, and Journal of Clinical Endocrinology & Metabolism..

Even after controlling the amount of weight lost after surgery, gastric bypass patients achieved diabetic remission with 7 years of follow-up than gastric banding patients.

Remission was completed in about four-fifths of gastric bypass patients who achieved some degree of remission.

Regardless of the procedure for obesity surgery, certain factors were more predictive of achieving post-surgery diabetic remission.

For example, younger patients and patients with a short pre-procedural diabetes period were more likely to achieve remission. Similarly, patients with high postoperative weight loss, high C-peptide levels, high estimated insulin secretion (HOMA% B), and low preoperative insulin use were similar.

With a particular focus on insulin resistance, patients with gastric banding were more likely to achieve diabetic remission if they had a decrease in estimated insulin resistance (HOMA IR) after surgery. On the other hand, an increase in HOMA% B predicted remission in patients with gastric bypass.

For this analysis, Parnell said Today’s MedPage His group expanded Survey results for the past 3 years Up to 7 years after obesity surgery to determine predictors of diabetic amelioration.

“Participants who chose Roux-en-Y gastric bypass are almost twice as likely to achieve diabetic remission, even considering the difference in weight loss, compared to those who undergo laparoscopic gastric banding. I showed that, “he pointed out. “In this study, we tested the durability of this finding during a longer follow-up.”

Purnell et al. Analyzed data on 827 adult participants from 10 US centers who underwent obesity surgery between 2006 and 2009 and suffered from diabetes at baseline. The Roux-en-Y Bypass was implemented in 645. The rest received rap banding.

Complete diabetic remission was defined as HbA1c <5.7%, or fasting blood glucose levels <100 mg / dL in the absence of pharmacological treatment of diabetes. Partial diabetic remission was defined as 5.7-6.5% HbA1c or 100-125 mg / dL fasting blood glucose levels in the absence of pharmacological treatment of diabetes.

“Diabetes remission after Ruwai gastric bypass surgery is very durable over the long term,” Parnell said, despite a slight decrease in the proportion of patients who maintain remission over time. Remission rates peaked about 2-3 years after both types of procedures and then declined.

Overall, he “found evidence of a weight loss-independent benefit to glucose metabolism in people who received RYGB. A better understanding of this could lead to new or new treatments for diabetes. There is. “

“Consistent with similar studies, we found that patients’ chances of achieving diabetes remission were maximized when they had surgery shortly after the diagnosis was confirmed and needed less medication,” Parnell said. He suggested that this finding was particularly clinically relevant. “In contrast to current practice, we often wait until treatment fails and / or requires multiple medications or insulin to maintain control.”

However, he concluded that playing that waiting game is likely to reduce the likelihood of patients having the best outcomes of diabetic remission.