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More persistent improvements in glycaemic control for RYGB vs LSG

Fri, 03/06/2020 - 09:10
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PCORnet Bariatric Study - Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% and 55.9%, respectively, at one year and 86.1% and 83.5% at five years post-surgery

Roux-en-Y gastric bypass (RYGB) was associated with larger and more persistent improvements in glycaemic control and 25% lower rates of T2DM relapse compared with sleeve gastrectomy (SG) patients, according to the latest analyses from the National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study.

"As with many healthcare options, no one weight-loss surgical procedure is the best choice for every patient because tradeoffs are associated with each," said co-principal investigator, Dr Kathleen McTigue, an associate professor of medicine and epidemiology at the University of Pittsburgh. "The choice requires personalised decision making that involves weighing the evidence about the pros and cons along with each person's individual circumstances and preferences."

Interestingly, the authors of the paper, ‘Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass - The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study’, published in JAMA, noted that patients with more advanced T2DM at the time of surgery for whom remission is more difficult to achieve (eg, those with older age, insulin use, more complex T2DM medications, and/or poor glycaemic control) may expect larger improvements in T2DM with RYGB compared with SG. Conversely, for patients with a higher likelihood of T2DM remission, RYGB and SG have similar five-year T2DM outcomes.

"More people with severe obesity should be having conversations about the role of bariatric surgery, which has been underused because of concerns about safety and weight regain," said the study's lead co-principal investigator, Dr David Arterburn, an internist and senior investigator at Kaiser Permanente Washington Health Research Institute in Seattle. "The results of the PCORnet Bariatric Study show that the overwhelming majority of patients maintain successful weight loss long term, especially after bypass. But bypass patients had a higher risk of subsequent operation and hospitalisation."

This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study and included a total of 9,710 patients (7,051 female patients, 72.6%). Weight loss was significantly greater with RYGB than SG at one year (mean difference, 6.3%) and five years (mean difference, 8.1%). The T2DM remission rate was approximately 10% higher in patients who had RYGB vs. SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% and 55.9%, respectively, at one year and 86.1% and 83.5% at five years post-surgery.

Among 6,141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG. Estimated relapse rates for those who had RYGB and SG were 8.4% and 11.0% at one year and 33.1% and 41.6% at five years after surgery. At five years, compared with baseline, haemoglobin A1c was reduced 0.45 percentage points more for patients who had RYGB vs patients who had SG.

“For patients, clinicians and policy makers to make informed decisions about which procedure is best suited to patients’ personal situations, additional data are needed to understand the adverse event profile of the procedures as well as patient values regarding procedure choice and the role of surgery relative to other aspects of lifelong weight management,” the authors concluded.

"Taken together, the evidence from the PCORnet Bariatric Study is vital to enabling patients and their healthcare providers to weigh the trade-offs of the procedures and make personalised decisions based on what matters most to each patient," said PCORI Interim Executive Director, Dr Josephine P Briggs. "This study is exemplary of how the comparative effectiveness research that PCORI funds can empower better-informed health care decision making."

The study was funded by the Patient-Centered Outcomes Research Institute (PCORI).

To access this paper, please click here