Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial

Arch Surg. 2011 Feb;146(2):143-8. doi: 10.1001/archsurg.2010.326.

Abstract

Objectives: To determine the efficacies of 2 weight-reducing operations on diabetic control and the role of duodenum exclusion.

Design: Double-blind randomized controlled trial.

Setting: Department of Surgery of the Min-Sheng General Hospital, National Taiwan University.

Patients: We studied 60 moderately obese patients (body mass index >25 and <35) aged >30 to <60 years who had poorly controlled type 2 diabetes mellitus (T2DM) (hemoglobin A(1c) [HbA(1c)] >7.5%) after conventional treatment (>6 months) from September 1, 2007, through June 30, 2008. Patients and observers were masked during the follow-up, which ended in 2009, 1 year after final enrollment.

Interventions: Gastric bypass with duodenum exclusion (n = 30) vs sleeve gastrectomy without duodenum exclusion (n = 30).

Main outcome measures: The primary outcome was remission of T2DM (fasting glucose <126 mg/dL and HbA(1c) <6.5% without glycemic therapy). Secondary measures included weight and metabolic syndrome. Analysis was by intention to treat.

Results: Of the 60 patients enrolled, all completed the 12-month follow-up. Remission of T2DM was achieved by 28 (93%) in the gastric bypass group and 14 (47%) in the sleeve gastrectomy group (P = .02). Participants assigned to gastric bypass had lost more weight, achieved a lower waist circumference, and had lower glucose, HbA(1c), and blood lipid levels than the sleeve gastrectomy group. No serious complications occurred in either group.

Conclusions: Participants randomized to gastric bypass were more likely to achieve remission of T2DM. Duodenum exclusion plays a role in T2DM treatment and should be assessed. Trial Registration clinicaltrials.gov Identifier: NCT00540462 (http://www.clinicaltrials.gov).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / metabolism*
  • Body Mass Index
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / surgery*
  • Double-Blind Method
  • Follow-Up Studies
  • Gastrectomy / methods*
  • Gastric Bypass / methods*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Blood Glucose
  • Glycated Hemoglobin A

Associated data

  • ClinicalTrials.gov/NCT00540462