title: Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect.
abstract: BACKGROUND
  Bariatric surgery may be beneficial in mildly obese patients with poorly controlled diabetes. The optimal procedure to achieve diabetes remission is unknown. In 2011, we published the short-term results of a pilot study designed to evaluate the efficacy of diabetic control and the role of duodenal exclusion in mildly obese diabetic patients undergoing laparoscopic sleeve gastrectomy (SG) vs. a laparoscopic single anastomosis (mini-) gastric bypass (SAGB). This study analyzes the 5-year results and evaluates the incretin effect.
  
  
  METHODS
  A double-blind randomized trial included 60 participants with a hemoglobin A1c (HbA1c) level higher than 7.5%, a body mass index (BMI) between 25 and 35 Kg/m(2), a C-peptide level ≥1.0 ng/mL, and a diagnosis of type 2 diabetes mellitus (T2DM) for at least 6 months. A SAGB with duodenal exclusion or a SG without duodenal exclusion was performed.
  
  
  RESULTS
  The 5-year results of the primary outcome were as an intention-to-treat analysis for HbA1c ≤6.5% without glycemic therapy. Assessments of the incretin effect and β cell function were performed at baseline and between 36 and 60 months. The patients were randomly assigned to SAGB (n = 30) and SG (n = 30). At 60 months, 18 participants (60%; 95% confidence interval (CI), 42 to 78%) in the SAGB group and nine participants (30%; 95% CI, 13 to 47%) in the SG group achieved the primary end points (odds ratio (OR), 0.3; 95% CI, 0.1 to 0.8%). The participants assigned to the SAGB procedure had a similar percentage of weight loss as the SG patients (22.8 ± 5.9 vs. 20.1 ± 5.3%; p > 0.05) but achieved a lower level of HbA1c (6.1 ± 0.7 vs. 7.1 ± 1.2 %; p < 0.05) than the SG patients. There was a significant increase in the incretin effect before and after surgery in both groups, but the SAGB group had a higher incretin effect than the SG group at 5 years.
  
  
  CONCLUSIONS
  In mildly obese patients with T2DM, SG is effective at improving glycemic control at 5 years, but SAGB was more likely to achieve better glycemic control than SG and had a higher incretin effect compared to SG.
authors: Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan, wjlee_obessurg_tw@yahoo.com.tw.
authors: Wei-Jei
authors: WJ
authors: Lee
authors: Keong
authors: K
authors: Chong
authors: Yu-Hung
authors: YH
authors: Lin
authors: Jih-Hua
authors: JH
authors: Wei
authors: Shu-Chun
authors: SC
authors: Chen
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D010865:Pilot Projects; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin