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Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy: Which is More Effective for Diabetes Remission?

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Zara Nwosu
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Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy: Which is More Effective for Diabetes Remission?

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Type 2 diabetes (T2D) is a chronic condition that affects millions globally, with obesity being one of the leading risk factors for its development. For those struggling with weight management and T2D, bariatric surgery has emerged as a potential treatment option. Research has indicated that certain types of bariatric surgery can even lead to T2D remission. Two of the most common types of these surgeries are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). But which of these surgeries offers the best chance for diabetes remission? Recent studies provide some insights.

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Roux-en-Y Gastric Bypass and Diabetes Remission

A study conducted by Omar M. Ghanem, MD, of the Department of Endocrine and Metabolic Surgery, Mayo Clinic, and published in the Journal of the American College of Surgeons in February 2024, compared the rates of continued diabetes remission (CDR) in patients with T2D who underwent RYGB and SG. The study found that RYGB patients had a significantly higher overall rate of CDR — 75% compared to 34.8% in the SG group. Even more compelling, the odds of T2D recurrence were 5.5 times higher after SG compared to RYGB.

The Role of Weight Regain and the Proximal Small Intestine

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Interestingly, the study found that the high remission rates after RYGB were maintained even when patients regained weight. This suggests a weight-loss independent metabolic benefit likely facilitated by bypassing the proximal small intestine. The duodenum, a part of the proximal small intestine, plays a vital role in digestion and metabolism regulation. Bypassing it during RYGB can lead to significant physiological changes, ultimately helping regulate glycemia and promote diabetes remission.

Sleeve Gastrectomy and Diabetes Recurrence

While both RYGB and SG are effective bariatric procedures, the study found that patients who underwent SG were five times more likely to see their diabetes return. This was true even after accounting for weight-related factors and patient-specific variables such as insulin use, preoperative A1c levels, and the preoperative duration of diabetes.

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Long-Term Diabetes Control and Bariatric Surgery

These findings underscore the potential benefits of RYGB for long-term diabetes control. In the face of obesity and T2D, RYGB surgery appears to offer a higher chance of diabetes remission, even if weight is regained. The choice of surgery could be a crucial decision for patients aiming to eliminate diabetes or reduce the chances of its recurrence in the long term. However, while the long-term follow-up of these findings is a strength, it's important to note that the study is a retrospective single-center study. Therefore, the results may not apply to all bariatric programs across the country.

Conclusion

Ultimately, the decision between RYGB and SG should be made on a case-by-case basis, taking into account each patient's individual health profile and goals for surgery. While both surgeries are effective for weight loss and diabetes management, the current evidence suggests that RYGB may offer a greater chance for lasting diabetes remission. However, as researchers continue to explore this connection on a cellular level, our understanding and treatment approaches for obesity and diabetes will continue to evolve.

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