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RYGB superior to LAGB for weight loss, metabolic parameters
Roux-en-Y gastric bypass in adults with severe obesity and type 2 diabetes results in greater weight loss compared with laparoscopic gastric banding, according to recent study results.
Surgical weight loss is a formidable tool for improvement of diabetes,” Blandine Laferrère, MD, professor of medicine at Columbia University, told Endocrine Today. “[Roux-en-Y gastric bypass] is superior to [laparoscopic adjustable gastric banding] because it results in greater weight loss. The enhanced release of [glucagon-like peptide-1] and the greater improvement of incretin effect after [Roux-en-Y gastric bypass] contribute to postprandial glucose control, but may not be key factors for diabetes remission after this surgery.”
Laferrère and colleagues evaluated 61 adults with severe obesity and type 2 diabetes when they had reached 10% weight loss after Roux-en-Y gastric bypass (RYGB; n = 26; mean age, 43.7 years) or laparoscopic adjustable gastric banding (LAGB; n = 15; mean age, 48.5 years) and again at 1 year after surgery (RYGB, n = 27; LAGB, n = 12) to determine the effect of each procedure on metabolic parameters.
At 1 year, participants who underwent RYGB lost about twice the amount of weight (30.1%) as participants who underwent LAGB (16.6%). However, the percentage of participants who achieved diabetes remission at 1 year were similar (RYGB, 88% vs. LAGB, 83%). Compared with LAGB, RYGB yielded greater incretin effect (P = .016) and GLP-1 release (P = .001), better early beta-cell response to oral glucose (P = .006), lower 120-minute glucose level after oral glucose (P = .002) and greater improvement in oral disposition index for homeostasis model of assessment for insulin resistance (HOMA-IR; P = .001).
At 10% matched weight loss, the RYGB group lost weight twice as fast (4.2 weeks) as the LAGB group (8.7 weeks; P = .02). However, both groups had similar improvements in IV glucose and insulin sensitivity.
“Surgical weight loss is efficient at treating diabetes,” Laferrère told Endocrine Today. “Although different types of surgery, RYGB or LAGB, have difference effects on the gut hormone incretins and the response to oral glucose, weight loss is likely the main determinant of improved glucose control and diabetes remissions after bariatric surgery. When matched for 20% weight loss, RYGB and LAGB have fewer differences on their effect on glucose. Unfortunately, the gastric banding is a less popular procedure and has been supplemented by vertical sleeve gastronomy. Research should focus on mechanism of superior weight loss after RYGB compared to LAGB or [vertical sleeve gastronomy].” – by Amber Cox
For more information:
Blandine Laferr è re, MD, can be reached at BBL14@columbia.edu.
Disclosure: Laferrère reports no relevant financial disclosures.