For patients with type 2 diabetes mellitus (T2D) and obesity comorbidities, Roux-en-Y gastric bypass (RYGB) was associated with more weight loss, superior diabetes control, and lower risk for major adverse cardiovascular events (MACE) and nephropathy compared with sleeve gastrectomy (SG), according to findings of a study published in Diabetes Care.
This retrospective, observational study analyzed data collected at the Cleveland Clinic Health System between 1998 and 2018. Patients with T2D and a body mass index (BMI) ³30 kg/m2 who underwent RYGB (n=1362), SG (n=693), or matched nonsurgical controls (n=11,435) were assessed for clinical outcomes.
The RYGB, SG, and controls were aged median 51.2, 54.6, and 54.8 years; 66.7%, 63.3%, and 64.2% were women; glycated hemoglobin (HbA1C) was 7.1%, 7.0%, and 7.1%; and BMI was 45.3, 44.7, and 42.6 kg/m2, respectively.
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At 5 years, the cumulative incidence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and nephropathy occurred among 13.7% of the RYGB and 24.7% of the SG cohorts (adjusted hazard ratio [aHR], 0.77; 95% CI, 0.60-0.98; P =.035). Compared with a rate of 30.4% for the non-surgical controls, both RYGB (aHR, 0.53; 95% CI, 0.46-0.61; P <.001) and SG (aHR, 0.69; 95% CI, 0.56-0.85; P <.001) procedures decreased risk for the composite outcome.
For MACE (all-cause mortality, myocardial infarction, and ischemic stroke), the rates were 6.4% and 11.8% for the RYGB and SG groups, respectively (aHR, 0.81; 95% CI, 0.57-1.16; P =.258). Although no different from each other, the surgical groups had lower rates compared with the controls (15.5%; vs RYGB: aHR, 0.53; 95% CI, 0.43-0.65; P <.001); vs SG: aHR, 0.65; 95% CI, 0.48-0.88; P =.006).
For each endpoint separately, compared with controls, RYGB associated with decreased risk for all-cause mortality (P <.001), heart failure (P <.001), coronary artery disease (P <.001), nephropathy (P <.001), and cerebrovascular disease (P =.019) and SG with heart failure (P <.001), all-cause mortality (P =.004), and atrial fibrillation (P =.027). Between surgical groups, RYGB associated with decreased risk for nephropathy compared with SG (P =.005).
For obesity and diabetes changes, RYGB associated with a 9.7%-point greater weight loss (P <.001) and 0.31% lower HbA1C (P <.001) compared with SG at 5 years.
However, RYGB recipients associated with more adverse events, requiring more upper endoscopy (45.8% vs 35.6%; P <.001) and abdominal surgery (10.8% vs 5.4%; P =.001) compared with SG, respectively.
This study may have been limited by the propensity matched cohort, which was not designed for each surgical group separately, but as a single surgical population.
These data suggested that, for patients with T2D and obesity comorbidities, superior glycemic outcomes may be achieved from RYGB than from SG.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Reference
Aminian A, Wilson R, Zajichek A, et al. Cardiovascular outcomes in patients with type 2 diabetes and obesity: comparison of gastric bypass, sleeve gastrectomy, and usual care. Diabetes Care. 2021;44(11):2552-2563. doi:10.2337/dc20-3023
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