Gastric Bypass Beats Sleeve Gastrectomy for Weight Loss, Cardiovascular Risk in Type 2

One common form of bariatric (weight-loss) surgery — known as Roux-en-Y gastric bypass — was found to lead to greater weight loss and better cardiovascular outcomes than another common form of bariatric surgery in people with type 2 diabetes, according to a new study published in the journal Diabetes Care.

In recent years, bariatric surgery — also sometimes called metabolic surgery in the context of diabetes — has gained widespread attention as a potentially dramatic treatment for type 2 diabetes in people who also have obesity. In fact, high-quality studies have shown that in many people with type 2, bariatric surgery leads to long-term diabetes remission — meaning a person has normal blood glucose levels without having to take any diabetes medications. Even in people who don’t achieve diabetes remission, bariatric surgery typically leads to improved outcomes, including reporting having more energy and less fatigue — especially in people who no longer need to take insulin after the surgery, and can take oral diabetes drugs instead.

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For the latest study, researchers looked at records covering a total of 13,490 patients who got their routine diabetes care at the Cleveland Clinic in Ohio between 1998 and 2017. During this period, 1,362 of the participants underwent Roux-en-Y gastric bypass surgery, and 693 underwent a procedure called sleeve gastrectomy. Gastric bypass involved reducing the size of the stomach to a small pouch, effectively bypassing most of the stomach so that food doesn’t pass through it. Sleeve gastrectomy, on the other hand, involves removing most of the width of the stomach, reducing it to a “sleeve” that is typically much longer than a small pouch.

Outcomes for all study participants were tracked through the end of 2018. During the study period, the researchers found that members of the gastric bypass group were significantly less likely to have a major cardiovascular event — like a stroke or heart attack — than members of the sleeve gastrectomy group, with a rate of 13.7% compared with 24.7%. After adjusting for differences in other risk factors between the two groups, they found that members of the gastric bypass group were 23% less likely to have a major cardiovascular event. Gastric bypass was also linked to more weight loss, lower A1C levels (a measure of long-term blood glucose control), and less use of medications to treat diabetes and cardiovascular disease. But they were also more likely to need endoscopy (imaging using scope) or abdominal surgery in the five years following the initial surgery, indicating that gastric bypass may also carry a higher risk for complications.

But perhaps the most important finding from the study was that both surgery groups had better outcomes than study participants who received “usual diabetes care,” as noted in a Healio article on the study. Compared with the “usual care” group, those who underwent gastric bypass were 47% less likely to have a major cardiovascular event, while those who underwent sleeve gastrectomy were 31% less likely — showing that bariatric surgery of any type leads to improved outcomes in most people with diabetes who are candidates for the procedure.

Want to learn more about bariatric surgery and type 2 diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”

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