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Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus

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Title: Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus
Authors: Wallenius, V
Dirinck, E
Fandriks, L
Maleckas, A
Le Roux, CW
Thorell, A
Item Type: Journal Article
Abstract: Background Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG. Methods Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery. Results Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline—8.1 ± 0.6 vs. 8.2 ± 0.4 mmol/l, 2 days—7.8 ± 0.5 vs. 7.4 ± 0.3 mmol/l, 3 weeks—6.6 ± 0.4 vs. 6.6 ± 0.3 mmol/l, respectively, P < 0.01 vs. baseline for both groups; 12 months—6.6 ± 0.4 vs. 5.9 ± 0.4, respectively, P < 0.05 for LRYGB and P < 0.001 for LSG vs. baseline, P = ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean ± SEM; LSG + 58 ± 14%, P < 0.01; LRYGB − 8 ± 17%, P = ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525 ± 1258 vs. 4779 ± 712 pmol × min, respectively, P < 0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (− 10.1 ± 0.9 vs. − 7.9 ± 0.5 kg/m2, respectively, P < 0.05). Conclusion LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.
Issue Date: 1-Jun-2018
Date of Acceptance: 1-Dec-2017
URI: http://hdl.handle.net/10044/1/62761
DOI: https://dx.doi.org/10.1007/s11695-017-3061-3
ISSN: 0960-8923
Publisher: SPRINGER
Start Page: 1461
End Page: 1472
Journal / Book Title: OBESITY SURGERY
Volume: 28
Issue: 6
Copyright Statement: © 2017 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: ONO Pharmaceuticals Co Ltd
Funder's Grant Number: N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Obesity
Type 2 diabetes
Gastric bypass
Sleeve gastrectomy
Glycemic
INTENSIVE MEDICAL THERAPY
PROSPECTIVE-RANDOMIZED-TRIAL
IMPROVED GLUCOSE-METABOLISM
BETA-CELL FUNCTION
BARIATRIC SURGERY
TREATMENT ALGORITHM
JOINT STATEMENT
WEIGHT-LOSS
ORGANIZATIONS
IMPROVEMENT
1103 Clinical Sciences
1117 Public Health And Health Services
Publication Status: Published
Online Publication Date: 2017-12-20
Appears in Collections:Department of Medicine (up to 2019)