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Selection of Bypass vs Sleeve for the Management of Type-2 Diabetes in Severely Obese: Could Ethnicity Play a Role?

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Abstract

Purpose

Prospective data was evaluated to see whether bariatric procedure type made any difference to diabetes remission.

Methods

One hundred eighty-six consecutive patients of Indian ethnicity (M:F 89:97) with type 2 diabetes mellitus (T2DM) and HbA1c > 6.5 were assessed before and at 1 year following surgery. Age, BMI, C-peptide and duration of diabetes (ABCD - described by WJ Lee), insulin use, baseline HbA1c, and % weight loss were tested as modifiers. We present remission rates (HbA1c ≤ 6.0%) and between group remission odds ratio (OR) and adjusted OR after controlling for key modifiers.

Results

Patients selecting RYGB (n = 113) vs SG (n = 73) were older (50.7 vs 44.2 years), had a lower BMI (44.1 vs 46.7), lower C-peptide (3.5 vs 4.7 ng/ml), greater duration of diabetes (8 vs 3 years), and higher HbA1c (8.90 and 7.9%) respectively p < 0.05 for all (combined R2 = 0.38). Weight loss at 1 year was 27 and 30% for RYGB and SG respectively (p = 0.01). Remission at 1 year was achieved by 37% of patient selecting RYGB and 74% for the SG (OR = 0.21, 95% CI 0.11–0.41, p < 0.001). After adjusting for ABCD, the adjusted OR (AOR) still favored the SG (AOR = 0.32, 0.14–0.74, p = 0.01), and adjustment for HbA1c and weight loss (AOR 0.4, 0.17–0.95, p = 0.038) attenuated the effect.

Conclusion

The analysis suggests SG may be superior to RYGB in this Indian population. Ethnicity may play a role in predicting the response to bariatric surgery and hence the choice of procedure. A randomized controlled trial is needed to clarify the relative benefit.

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Authors and Affiliations

  1. Global Hospital, 35, Dr. E Borges Road, Opposite Shirodkar High school, Hospital Avenue, Parel, Mumbai, Maharashtra, 400012, India

    Aparna Govil Bhasker

  2. Baker Heart and Diabetes Institute, Primary Care Research Unit, Monash University, Melbourne, Australia

    John B. Dixon

  3. Saifee Hospital, Mumbai, India

    Muffazal Lakdawala

  4. Minimal Access Bariatric and Metabolic Surgery, Fortis Memorial Research Institute, Gurgaon, India

    Muffazal Lakdawala

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  1. Aparna Govil Bhasker
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  2. John B. Dixon
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  3. Muffazal Lakdawala
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Correspondence to Aparna Govil Bhasker.

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Bhasker, A.G., Dixon, J.B. & Lakdawala, M. Selection of Bypass vs Sleeve for the Management of Type-2 Diabetes in Severely Obese: Could Ethnicity Play a Role?. OBES SURG 28, 3073–3079 (2018). https://doi.org/10.1007/s11695-018-3294-9

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  • DOI: https://doi.org/10.1007/s11695-018-3294-9

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