Which Weight-Loss Surgery for Diabetes?

Duodenal switch and gastric bypass surgeries lead to similar weight loss in obese patients with type 2 diabetes

(RxWiki News) For some people, losing weight is not as easy as dieting and exercising. Sometimes, extremely overweight people need surgery to protect them from the dangers of obesity, such as diabetes. But which surgery is best?

Duodenal switch surgery and Roux-en-Y gastric bypass surgery led to similar amounts of weight loss in patients with type 2 diabetes.

However, patients who underwent duodenal switch surgery had greater reductions in blood sugar, compared to those who underwent Roux-en-Y gastric bypass surgery.

"Lose weight to better manage type 2 diabetes."

There is a variety of weight-loss surgeries available to people who are obese. Dr. Robert B. Dorman, of the University of Minnesota, and colleagues wanted to see which surgery option leads to the most weight loss and the greatest reduction in blood sugar.

Obesity is the leading cause of diabetes worldwide, and both conditions are still on the rise.

Weight-loss surgeries, or bariatric surgeries, are designed for extremely obese people for whom other weight-loss strategies have failed.

These people - especially if they have diabetes - run the risk of all sorts of complications, including heart disease and even death.

From their research, Dr. Dorman and colleagues found that both duodenal switch and Roux-en-Y gastric bypass surgeries were the best treatments for morbidly obese type 2 diabetes patients, compared to non-surgical treatment and laparoscopic adjustable gastric band.

Duodenal switch surgery involves removing a portion of the stomach so that it fits less food.

Roux-en-Y involves making a new stomach pouch out of a small part of the original stomach and attaching it to the small intestine. The new stomach pouch both holds less food and absorbs less fat.

Laparoscopic adjustable gastric banding is a surgery in which the surgeon puts an adjustable band around the upper part of the stomach. Like the other procedures, this surgery makes the stomach smaller, allowing for less food. The band can be loosened or tightened after surgery to protect against complications or to improve weight loss.

For the current study, the researchers compared the outcomes of morbidly obese type 2 diabetes patients who had undergone different types of weight-loss surgery. Of these patients, 29 had non-surgical treatment, 30 underwent laparoscopic adjustable gastric banding, and 27 underwent duodenal switch surgery. These patients were matched to patients who had undergone Roux-en-Y gastric bypass surgery.

According to the authors, "This study provides an important perspective about the comparative efficacy of [laparoscopic adjustable gastric banding], [duodenal switch], and [non-surgical treatments] to [Roux-en-Y gastric bypass] for treatment of [type 2 diabetes] among obese patients.

"After 1 year of follow-up, [Roux-en-Y gastric bypass] is superior to [non-surgical treatment] and [laparoscopic adjustable gastric banding] with respect to weight loss and improvement in diabetes," they write.

Duodenal switch surgery, however, was better than Roux-en-Y in reducing levels of HbA1C, a measurement of blood sugar over three months.

The full results of the study are published in the Annals of Surgery

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Review Date: 
March 12, 2012