Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial

Bariatric surgery is gaining acceptance as a 'metabolic surgical intervention' for patients with type 2 diabetes. The optimal form of surgery and the mechanism of action of these procedures are much debated. We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA(1c) and glucose tolerance. We performed a parallel un-blinded randomised trial of Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG) in 41 obese patients with type 2 diabetes, who were bariatric surgery candidates attending the obesity clinic. HbA(1c), body composition and glucose tolerance were evaluated at baseline, and at 3 and 12 months. Of the 41 patients, 37 completed the follow-up (19 RYGB, 18 SG). Both groups had similar baseline anthropometric and biochemical measures, and showed comparable weight loss and fat:fat-free mass ratio changes at 12 months. A similar normalisation of HbA(1c) levels was observed as early as 3 months post-surgery (6.37 +/- 0.71% vs 6.23 +/- 0.69% for RYGB vs SG respectively, p < 0.001 in both groups for baseline vs follow-up). In this study, RYGB did not have a superior effect in comparison to SG with regard to HbA(1c) levels or weight loss during 12 months of follow-up. ClinicalTrials.gov NCT00667706 This work was supported by grant no. 3-000-8480 from the Israel Ministry of Health Chief Scientist, the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson.