Metabolic effects and safety of Roux‐en‐Y gastric bypass surgery vs. conventional medication in obese Chinese patients with type 2 diabetes

Abstract

Aim: To assess metabolic effects and safety of Roux-en-Y gastric bypass (RYGB) versus conventional medication (CM) in obese Chinese patients with type 2 diabetes (T2DM).Methods: This retrospective cohort study included 40 patients who underwent RYGB (mean age 44.1 years, body mass index [BMI] 33.3 kg/m 2 ) and 36 patients administered CM (mean age 49.4 years, BMI 32.1 kg/m 2 ). The primary endpoint was achievement of the triple endpoint (haemoglobin A1C [HbA1c] < 7.0%, lowdensity lipoprotein cholesterol < 2.6 mmol/L, and systolic blood pressure < 130 mmHg). Changes in weight, BMI, medication usage, complications, and adverse events were assessed.Results: After 1-year follow-up, 35% of RYGB patients and 8% of CM patients achieved the triple endpoint (P = 0.005). More patients in the RYGB group achieved complete (48% vs 3%, P < 0.001) and partial (23% vs 0%, P = 0.007) remission of diabetes, and complete remission of hypertension (58% vs 24%, P = 0.019). Patients in the RYGB group had greater weight loss and decrease in BMI, waist circumference, fasting and postprandial of blood glucose and insulin levels, HbA1c, blood pressure, triglycerides, and increased high-density cholesterol (P < 0.001-< 0.05). A lower proportion of the RYGB group received antidiabetics, antihypertensives, or antilipemic treatments, and had non-alcoholic fatty liver disease (NAFLD) than the CM group during follow-up. More patients had nutrient deficiency-related diseases in the RYGB group over 1-year follow-up.Conclusions: For obese Chinese patients with T2DM, RYGB resulted in better metabolic control, greater weight loss, and lower medication usage and NAFLD, but more frequently resulted in diseases related to nutrient deficiency.

Five‐year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes: A population‐based propensity score‐matched cohort study

“…To best of our knowledge, the present study is the largest cohort study that evaluated the effectiveness of bariatric surgery among Chinese population using population-based data. [15][16][17][38][39][40] The results of this study were in line with the conclusion of previous observational studies and randomised controlled trials (RCTs), which found that bariatric surgery provided substantial and sustainable effects on weight loss, glycaemic control, and lipid profile improvement. 15,42,[44][45][46] However, observations of the present study were at variance with other studies regarding to diabetes remission and weight loss in quantitative aspect and hypertension remission from qualitative perspective.…”

“…To best of our knowledge, the present study is the largest cohort study that evaluated the effectiveness of bariatric surgery among Chinese population using population‐based data . Also, this study made a comprehensive illustration of metabolic and weight outcomes, including complete and partial remission rates of diabetes, remission rates of hypertension, high LDL‐C, low HDL‐C, high triglycerides and dyslipidaemia, and improvement of BMI, HbA 1c , SBP, DBP, LDL‐C, %TWL, %EWL, and %REWL.…”

“…Therefore, studies with a larger sample size and longer follow‐up duration should be conducted in the future. Lastly, like most comparative studies, this study compared the patients with bariatric surgery with those under usual care. However, comparisons of effectiveness between bariatric surgery and conventional therapies, such as lifestyle interventions and medications, is not proper to some extent.…”

Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus

“…The initial search resulted in 231 papers. After duplication removal and application of inclusion and exclusion criteria, 16 articles [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included in the qualitative analysis. The flowchart of the research strategy is presented in Figure 1.…”

Microbial Adaptation Due to Gastric Bypass Surgery: The Nutritional Impact

“…Decreases in HbA1c and fasting blood glucose levels were also noticed and reached normal levels at 1-3 months after surgery. Complete NAFLD remission was achieved in 96% of post-RYGB patients as well as diabetes remission in 48% of post-RYGB patients, thereby improving cardiovascular risk factors [42].…”