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Background <p>Bariatric surgery has been shown to improve glycemic outcomes in patients with obesity and diabetes. Patients requiring insulin indicate advanced disease. Surgery selection for patients with type&#xa0;2 diabetes requiring insulin therapy (T2-IDM) and obesity is not clear. The purpose of this study is to compare glycemic outcomes between gastric bypass (GB) and sleeve gastrectomy (SG) in T2-IDM patients.</p> Methods <p>A&#xa0;retrospective review of 52&#xa0;patients with T2-IDM and obesity undergoing either GB or SG was conducted. Outcomes included target of A1C &lt; 7%, insulin dependency, and remission.</p> Results <p>Follow-up ranged from 2&#xa0;to 8&#xa0;years. There was no difference in the preoperative duration of diabetes, A1C level, and insulin requirement between GB and SG. GB was associated with greater weight loss at 1&#xa0;year (30.1% total weight loss) compared to SG (24.7%). There was a&#xa0;significant difference in A1C level at postoperative year&#xa0;2 favoring the GB group (6.9% vs. 8.04%). GB was associated with a&#xa0;72% reduction in the hazard of obtaining a&#xa0;postoperative A1C above 7% (HR: 0.28, 95% CI: 0.10–0.78; <i>p</i> = 0.015). GB was associated with an over eightfold reduction in long-acting insulin requirements compared to SG (coefficient: −8.35, 95% CI: −15.6 to −1.12; <i>p</i> = 0.025). Of those reaching A1C &lt; 6.5% in the postoperative period, after adjusting for age, body mass index (BMI), and preoperative A1C, patients who underwent GB had a&#xa0;~58% decreased hazard of relapsing.</p> Conclusion <p>In patients with type&#xa0;2 diabetes requiring insulin therapy, GB may offer improved glycemic outcomes compared to SG. Larger studies with longer follow-up are needed to address this clinical problem.</p>

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A comparison of mid- to long-term diabetic outcomes between laparoscopic gastric bypass and sleeve gastrectomy in type 2 insulin-dependent diabetes

  • 期刊论文

  • 发表日期：

    2025年3月5日

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  • Samer Elkassem

摘要

Background

Bariatric surgery has been shown to improve glycemic outcomes in patients with obesity and diabetes. Patients requiring insulin indicate advanced disease. Surgery selection for patients with type 2 diabetes requiring insulin therapy (T2-IDM) and obesity is not clear. The purpose of this study is to compare glycemic outcomes between gastric bypass (GB) and sleeve gastrectomy (SG) in T2-IDM patients.

Methods

A retrospective review of 52 patients with T2-IDM and obesity undergoing either GB or SG was conducted. Outcomes included target of A1C < 7%, insulin dependency, and remission.

Results

Follow-up ranged from 2 to 8 years. There was no difference in the preoperative duration of diabetes, A1C level, and insulin requirement between GB and SG. GB was associated with greater weight loss at 1 year (30.1% total weight loss) compared to SG (24.7%). There was a significant difference in A1C level at postoperative year 2 favoring the GB group (6.9% vs. 8.04%). GB was associated with a 72% reduction in the hazard of obtaining a postoperative A1C above 7% (HR: 0.28, 95% CI: 0.10–0.78; p = 0.015). GB was associated with an over eightfold reduction in long-acting insulin requirements compared to SG (coefficient: −8.35, 95% CI: −15.6 to −1.12; p = 0.025). Of those reaching A1C < 6.5% in the postoperative period, after adjusting for age, body mass index (BMI), and preoperative A1C, patients who underwent GB had a ~58% decreased hazard of relapsing.

Conclusion

In patients with type 2 diabetes requiring insulin therapy, GB may offer improved glycemic outcomes compared to SG. Larger studies with longer follow-up are needed to address this clinical problem.