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STAMPEDE study

Gastric bypass has unique effect on pancreas

A randomised controlled trial has concluded that gastric bypass has a unique effect to normalise blood glucose levels.
Study links bypass with increased pancreatic beta cell function
Authors suggest link between decreased belly fat and beta cell function

Gastric bypass surgery has a unique benefit on pancreatic function absent from other bariatric procedures, according to the latest substudy report from the STAMPEDE investigations.

The findings, the result of a randomised controlled substudy into 60 trial participants comparing gastric bypass, sleeve gastrectomy, and intensive medical treatment, found that patients in the gastric bypass cohort had a markedly increased beta-cell function at two years than the participants who were given either of the other two treatments.

“The substudy results extend the findings from our initial 12-month report that showed bariatric surgery can eliminate the need for diabetes medications in many obese patients with uncontrolled diabetes,” said lead investigator Dr Sangeeta Kashyap, an endocrinologist at Cleveland Clinic's Endocrinology & Metabolism Institute and the lead author of the study. “Furthermore, we observed that gastric bypass can resurrect a failing pancreas.”

Sixty patients, who had a mean BMI of 36±2 and were suffering from uncontrolled type 2 diabetes, were recruited for the study. They were randomised evenly into three groups, who received gastric bypass with intensive medical treatment, sleeve gastrectomy with intensive medical treatment, or the control group, who received intensive medical treatment alone.

At two years, the participants’ HbA1c had dropped from a starting average of 9.7±1% in all three groups: the bypass group dropped to 6.7±1.2%, the sleeve gastrectomy group dropped to 7.1±0.8%, and the control group dropped to 8.4±2.3%.

Based on the oral disposition index, the beta cell function in the bypass group had increased 5.8-fold, significantly higher than the two-fold increase seen in both the sleeve gastrectomy and control groups.

The investigators found a correlation between decreased belly fat and improved beta cell function. At two years, the bypass group had lost an average of 16% of their belly fat; over the same period, the sleeve gastrectomy group lost 10%.

"Gastric bypass surgery seems to uniquely restore pancreatic beta-cell function, presumably by targeting belly fat and modifying the hormones in the gastrointestinal tract," said Kashyap. "Gastric bypass remarkably targets belly fat where hormones that are toxic to the body develop."

At two years, 41% of the bypass group saw their blood glucose levels return to normal, compared to 10% in the sleeve gastrectomy group and 6% in the control group.

The authors say that the results warrant further investigation, and so the study will be continued for three years.

The study is funded by the American Diabetes Association and Ethicon Endo-Surgery.

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