Metabolic Effects of Bariatric Surgeryin Patients With Moderate Obesity

and Type 2 Diabetes

Analysis of a randomized control trial comparing surgery with intensive medical treatment

Featured Article:

Sangeeta R. Kashyap, M.D., Deepak L. Bhatt, M.D., M.P.H., Kathy Wolski, M.P.H., Richard M. Watanabe, P.H.D., Muhammad Abdul-Ghani,

M.D., P.H.D., Beth Abood, R.N., Claire E. Pothier, M.P.H., Stacy Brethauer, M.D., Steven Nissen, M.D., Manjula Gupta, P.H.D., John P.

Kirwan, P.H.D., Philip R. Schauer, M.D.

Diabetes Care Volume 36: 2175-2182

August, 2013

STUDY OBJECTIVE 

• To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

STUDY DESIGN AND METHODS

• Prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes and moderate obesity, randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy

• Assessment of β-cell function (mixed-meal tolerance testing) and body composition was performed at baseline and 12 and 24 months

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

RESULTS

• Glycemic control improved in all three groups at 24 months

• Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy

• Insulin sensitivity increased significantly from baseline in gastric bypass and did not change in sleeve gastrectomy or IMT

• β-Cell function increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT, and was not different between sleeve gastrectomy versus IMT

• At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182

CONCLUSIONS

• Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years

• Despite similar weight loss as sleeve gastrectomy, gastric bypass restores pancreatic β-cell function and reduces truncal fat

Kashyap S. R. et al. Diabetes Care 2013;36:2175-2182