Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial

Ramón, José́; Salvans, Sílvia; Crous, Xènia; Puig, Sònia; Goday, Albert; Benaiges, David; Trillo, Lourdes; Pera, Manuel; Grande, Luís

doi:10.1007/s11605-012-1855-0

Cited by 155 publications

(99 citation statements)

References 43 publications

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“…Since rats consume large meals shortly after dark onset, we suspect that these meals were followed by episodes of severe hypoglycemia and would be consistent with reports of postprandial hypoglycemia in patients after RYGB surgery possibly reflective of an increased incretin response and/or relative of increases in ␤-cell mass of a magnitude greater than that observed in animals that underwent SG (27,35,37). Notably, clinical studies indicate that postprandial GLP-1 release does not differ significantly between RYGB and SG (28,34). Further, a recent pilot experiment in our laboratory using real-time telemetric recordings of blood glucose levels in nondiabetic Wistar rats indicated that RYGB rats had much larger fluxes in glycemia compared with sham-operated controls, which extended into the hypoglycemic range (unpublished data), which is also consistent with continuous glucose monitoring in humans after RYGB (17).…”

Section: Discussionsupporting

confidence: 86%

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Abegg

Corteville

Docherty

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

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Abegg K, Corteville C, Docherty NG, Boza C, Lutz TA, Muñoz R, le Roux CW. Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats. Am J Physiol Regul Integr Comp Physiol 308: R321-R329, 2015. First published December 24, 2014 doi:10.1152/ajpregu.00331.2014.-Bariatric surgery rapidly improves Type 2 diabetes mellitus (T2DM). Our objective was to profile and compare the extent and duration of improved glycemic control following Roux-en-Y gastric (RYGB) bypass surgery and vertical sleeve gastrectomy (SG) and compare against calorie restriction/weight loss and medical combination therapy-based approaches using the Zucker diabetic fatty rat (ZDF) rodent model of advanced T2DM. Male ZDF rats underwent RYGB (n ϭ 15) or SG surgery (n ϭ 10) at 18 wk of age and received postsurgical insulin treatment, as required to maintain mid-light-phase glycemia within a predefined range (10 -15 mmol/l). In parallel, other groups of animals underwent sham surgery with ad libitum feeding (n ϭ 6), with body weight (n ϭ 8), or glycemic matching (n ϭ 8) to the RYGB group, using food restriction or a combination of insulin, metformin, and liraglutide, respectively. Both bariatric procedures decreased the daily insulin dose required to maintain mid-light-phase blood glucose levels below 15 mmol/l, compared with those required by body weight or glycemia-matched rats (P Ͻ 0.001). No difference was noted between RYGB and SG with regard to initial efficacy. SG was, however, associated with higher food intake, weight regain, and higher insulin requirements vs. RYGB at study end (P Ͻ 0.05). Severe hypoglycemia occurred in several rats after RYGB. RYGB and SG significantly improved glycemic control in a rodent model of advanced T2DM. While short-term outcomes are similar, long-term efficacy appears marginally better after RYGB, although this is tempered by the increased risk of hypoglycemia. bariatric surgery; Roux-en-Y gastric bypass; sleeve gastrectomy; glycemic control; medical therapy; caloric restriction; Zucker diabetic fatty rat ROUX-EN-Y GASTRIC BYPASS (RYGB) and vertical sleeve gastrectomy (SG) surgery can be used as a treatment alternative to intensive management in obese patients (body mass index Ͼ30 kg/m 2 ) with Type 2 diabetes mellitus (T2DM) (5, 29, 39).After these operations, most patients have improved glycemic control, and ϳ40% of patients achieve a HbA1c Ͻ42 mmol/ mol (6%) after one year. It remains controversial whether RYGB and SG lead to comparable rates of metabolic improvement and T2DM remission. Some studies report a higher T2DM remission rate or that glycemic targets can be achieved with fewer medications after RYGB compared with SG surgery (3, 22, 23, 32), while others show a similar glycemic outcome for both procedures (12,16,28,46). Data on longterm remission and relapse rates are scarce, but at 3 years, 38% of those after RYGB and 24% of those after SG had a HbA1c Ͻ42 mmol/l (6%) (39). The use ...

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Section: Discussionsupporting

confidence: 86%

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Abegg

Corteville

Docherty

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

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“…The initial search identified 581 publications, of which 576 were excluded, leaving 5 publications for analysis. [14][15][16][17][18] One study, 19 which was the subset of another study, 14 was excluded; another study 20 was the republication of the trial by Woelnerhanssen and colleagues 15 and was also excluded. The 5 trials of LRYGB and LSG for morbid obesity or T2DM with a total of 396 patients that we included in our analysis were retrieved from the electronic databases.…”

Section: Discussionmentioning

confidence: 99%

“…56, No. 6, December 2013 15 Helmiö et al 16 Kehagias et al 17 R a m ón et al 18 or less 1 year after randomization than those patients receiving medical therapy alone. Notably, many patients in the surgical group, particularly those in the gastric bypass group, achieved glycemic control without the use of diabetes medications.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Lai

et al. 2013

CJS

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Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for treating morbid obesity is becoming more popular. We compared both techniques to evaluate their efficacy in treating morbid obesity or type 2 diabetes mellitus (T2DM). Methods:We searched the Cochrane Controlled Trials Register databases, Medline, Embase, ISI databases and the Chinese Biomedical Literature Database to identify randomized controlled trials (RCTs) of LRYGB and LSG for morbid obesity or T2DM published in any language. Statistical analyses were carried out using RevMan software.Results: Five worldwide RCTs with 196 patients in the LRYGB group and 200 in the LSG group were included in our analysis. Compared with patients who had LSG, those who had LRYGB had a higher remission rate of T2MD, lost more weight and had lower low-density lipoprotein, triglycerides, homeostasis model assessment index and insulin levels. There was no difference in the reoperation rate between the groups. However, patients treated with LRYGB had a higher incidence of complication than those treated with LSG. Conclusion:Our meta-analysis demonstrates that LRYGB is more effective than LSG for the surgical treatment of T2DM and control of metabolic syndrome. However, LSG is safer and has a reduced rate of complications. Further high-quality RCTs with long follow-up periods are needed to provide more reliable evidence.Contexte : La dérivation gastrique laparoscopique Roux-en-Y (DGRY) est l'une des interventions bariatriques les plus utilisées, et la gastrectomie longitudinale laparoscopique (GLL) gagne en popularité comme intervention en une seule étape pour le traitement de l'obésité morbide. Nous avons comparé les 2 techniques pour en évaluer l'efficacité dans le traitement de l'obésité morbide ou du diabète de type 2 (DT2).

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“…Rapid improvement of fasting glucose, insulin secretion and insulin resistance has been reported within days of Roux-en-Y gastric bypass (GBP) [3][4][5] and sleeve gastrectomy (SG) [6,7]. Hypocaloric dieting has also been shown to restore normal glucose levels [8,9].…”

Section: Introductionmentioning

confidence: 99%

Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes

Thomas

Smith

et al. 2016

OBES SURG

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Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial

Abstract: LRYGB and LSG markedly improved glucose homeostasis. Only LSG decreased fasting and postprandial ghrelin levels, whereas GLP-1 and PYY levels increased similarly after both procedures.

Cited by 155 publications

References 43 publications

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes

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