OBESE PATIENTS WITH DIABETES MELITTUS TYPE II (T2DM). SLEEVE GASTRECTOMY OR ONE ANASTOMOSIS GASTRIC BYPASS SHOULD BE THE TREATMENT OF CHOICE? RESULTS OF A SINGLE-CENTER STUDY IN GREECE
Gavriella Zoi Vrakopoulou*1, Charalampos Theodoropoulos1, Vasileios Kalles1, Maria Matiatou1, Fotini Kostopoulou2, George K. Zografos1, Emmanouil Leandros1, Konstantinos Albanopoulos1
1Laparoendoscopic Unit, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece; 2Deparment of Anesthesiology, Hippocration General Hospital, Athens, Greece
Background: The number of individuals with T2DM has increased rapidly over the last decades with the vast majority of them being obese. Weight-loss surgery has proven itsself effective, with laparoscopic sleeve gastrectomy (LSG) being the most popular bariatric operation worldwide over the last decades. Meanwhile, laparoscopic one anastomosis gastric bypass (OAGB) is gaining popularity among an increasing number of surgeons. The aim of this study was to evaluate and compare the efficacy of these two weight-reducing operations on diabetic control T2DM for obese patients.
Methods: This is a single-centre study of a tertiary hospital, certified as center of Excellence for Bariatric and Metabolic Surgery. The data were collected prospectively and analyzed retrospectively. Included were T2DM obese patients who underwent LSG (Group A) and OAGB (Group B) from September 2011 to October 2015. Patient demographic characteristics, weight, co-morbidities, HbA1c, anti-diabetic medications, and changes or discontinuation of treatment were recorded at baseline, 1, 3, 6, 12, 18, 24 and 36 months. All patients were followed-up for at least 36 months. The primary outcome was remission of T2DM (HbA1c <6.5% without glycemic therapy). Secondary measures included weight and changes of lifestyle related to the glucose levels.
Results: In a total of 900 patients submitted to LSG or OAGB during the study period, 53 T2DM obese patients have been followed-up for a minimum period of three years. Group A (n=28) had preoperatively a mean value of BMI 52.2 ± 8.5 kg/m2, while for Group B (n=25) the mean value of BMI was 52.9 ± 10.9 kg/m2. In group A 6/28 patients (21.4%) had an Insulin Dependent Diabetes Mellitus II (IDDM), while in Group B 8/25 patients (32%) were insulin dependent. The pre-treatment HbA1c mean was 7.1 ± 1.2% and 7.8 ± 2.0%, respectively. After a follow-up period of 36 months, Excess Weight Loss% (EWL%) was statistically significant different for the two groups, (MA=79.8±14.5%, MB=93.3±16.0%, p<0.05). Furthermore, there was a significant decrease of HbA1c%, with ΔHbA1c (%) reaching 1.4±1.5% for Group A, and 2.7±2.1% for Group B, p=0.02. Diabetes remission was achieved only by 10 patients (35.7%) for Group A, while in Group B 22 patients (88%) had no need for anti-diabetic medication 36 months postoperatively, and this was statistically significant p<0.05.
Conclusion: OAGB seems to be a more efficient method for the treatment of Diabetes Mellitus Type II in obese patients. In comparison to LSG, OAGB is more effective in %EWL and improvement of glycemic control, with almost immediate resolution of diabetes, as well as long-term weight loss.
Preoperative patients' characteristics
| Preoperatively | LSG | OAGB | |
| N (patients) | 28 | 25 | |
| Age (years) | 45.9 ± 7.5 | 46.6 ± 7.9 | NS |
| Sex Distribution | 12♂ (42.9%) / 16♀ (57.1%) | 10♂ (40.0%) / 15♀ (60.0%) | NS |
| IBW (kg)1 | 73.7 ± 9.7 | 73.4 ± 8.5 | NS |
| TBW (kg)2 | 153.8 ± 30.4 | 155.7 ± 38.0 | NS |
| BMI (kg/m2)3 | 52.2 ± 8.6 | 52.9 ± 10.9 | NS |
| 1st Dgr Diabetics (pts) | 19 (67.9%) | 15 (60.0%) | NS |
| HbA1c (%) | 7.1 ± 1.2 | 7.8 ± 2.0 | NS |
| IDDM (pts)4 | 6 (21.4%) | 8 (32.0%) | 0.046 |
| >1 Antidiabetic Agents | 8 (28.6%) | 9 (36%) | NS |
1 Ideal Body Weight 2 Total Body Weight 3 Body Mass Index 4 Insulin Dependent Diabetes Mellitus
Postoperative results after 36 months follow up for both groups
| Follow-up (36 months) | LSG | OAGB | |
| N (patients) | 28 | 25 | |
| TBW 1 | 97.7 ± 18.8 | 90.7 ± 17.6 | NS |
| BMI (Kg/ m2)2 | 33.8 ± 6.5 | 31.4 ± 6.1 | NS |
| ΔBMI (kg/ m2) | 18.4 ± 6.3 | 19.4 ± 4.7 | NS |
| %EWL3 | 79.8 ± 14.5 | 93.3 ± 16.0 | 0.003 |
| HbA1c (%) | 5.8 ± 0.5 | 5.2 ± 0.8 | |
| ΔHbA1c (%) | 1.4 ± 1.5 | 2.7 ± 2.1 | 0.02 |
| Treatment Discont. (pts) | 10 (35.7%) | 22 (88.0%) | <0.01 |
| Postop Month of Discont. | 1st (70%) | 1st (81.8%) | |
| Hypoglycemic Episodes | 7 (25.0%) | 8 (32.0%) | NS |
1Total Body Weight, 2 Body Mass Index, 3 Excess Weight Loss %
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