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- Title
Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication.
- Authors
Casajoana, Anna; Guerrero-Pérez, Fernando; García Ruiz de Gordejuela, Amador; Admella, Víctor; Sorribas, Maria; Vidal-Alabró, Anna; Virgili, Núria; Urdiales, Rafael López; Montserrat, Mónica; Pérez-Maraver, Manuel; Monasterio, Carme; Salord, Neus; Pellitero, Silvia; Fernández-Veledo, Sonia; Vendrell, Joan; Gebelli, Jordi Pujol; Vilarrasa, Núria
- Abstract
Purpose: Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. Material and Methods: Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. Results: Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group − 27.32 (7.8) vs. SG − 18.00 (10.6) and GCP − 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up. Conclusions: Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.
- Subjects
GASTRIC bypass; SLEEVE gastrectomy; GASTROINTESTINAL hormones; PROGNOSIS; CURVATURE; TYPE 2 diabetes
- Publication
Obesity Surgery, 2021, Vol 31, Issue 4, p1733
- ISSN
0960-8923
- Publication type
Article
- DOI
10.1007/s11695-020-05192-x