Lemus R, et al. – As there was substantial evidence of the benefits of bariatric/metabolic surgery in obese diabetic patients on oral therapy (O–T2D), this study sought for more evidence in the case of insulin–treated type 2 diabetes (I–T2D) patients and the selection of surgical procedure. Researchers observed that both Roux–en–Y–gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures provided effective treatment for I–T2D patients in terms of weight loss and diabetes. However, incidence of complete remission for insulin–dependent patients was higher with RYGB in earlier years.

Methods

• Researchers performed an analysis of the Ontario Bariatric Registry data.
• They compared outcomes of Roux–en–Y–gastric bypass (RYGB) and sleeve gastrectomy (SG) on insulin–treated versus non–insulin–treated T2DM patients.
• Weight loss, medication use and remission rates during a 3–year follow up were compared.

Results

• From Jan 2010 to Feb 2017, researchers identified 3668 diabetic Bariatric Registry patients who underwent surgery, across 7 Bariatric Centers of Excellence in Ontario.
• 2872/3668 were O–T2D and 1187/3668 were I–T2D.
• The two groups were similar regarding weight loss at 3 years; with mean %WL of 30.1% for the insulin group vs. 28.3% non–insulin (p = 0.0673).
• 11.3% of the non–insulin and 59.6% of the insulin–dependent group were using anti–diabetic medication (p < 0.0001) at 3 years.
• Among insulin–dependent patients, RYGB resulted in greater reduction in insulin use with 26.5 and 40% compared to SG at 3 years.
• More complete diabetes remission was observed among O–T2D patients, with 66.5 vs. 18.5% (p < 0.0001) at 3 years.
• The RYGB group indicated higher complete remission for I–T2D patients than SG (p < 0.0001) at years 1 and 2 (8.5 vs. 5.4% and 24.4 vs. 21.1%).
• They identified the same trend regardless of insulin use; complete remission higher for RYGB at 1 and 2 years [50.7 vs. 39.8% (p < 0.0001), and 54.6 vs. 49.1% (p < 0.0001)].