Comparison of Rates of Resolution of Diabetes Mellitus after Gastric Banding, Gastric Bypass, and Biliopancreatic Diversion
Presented at the American College of Surgeons’ 92nd Annual Clinical Congress, October 9, 2006, Chicago, Illinois.
Received 24 February 2007; received in revised form 24 May 2007; accepted 29 May 2007. published online 19 September 2007.
Background
Bariatric operation is the most effective treatment for diabetes mellitus in the morbidly obese. The purpose of this study is to compare the rate of resolution of diabetes mellitus after three common laparoscopic bariatric procedures: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with or without duodenal switch (BPD/DS).
Study Design
All data were prospectively collected and entered into an electronic registry. Characteristics evaluated for this study included preoperative age, body mass index, duration of diabetes, race, gender, operative time, length of stay, percent excess weight loss, oral hypoglycemic requirements, and insulin requirements.
Results
A total of 282 bariatric patients with diabetes mellitus were analyzed (218 LAGB, 53 RYGB, and 11 BPD/DS). Preoperative age (46 to 50 years), body mass index (46 to 50; calculated as kg/m2), race and gender breakdown, and baseline oral hypoglycemic (82% to 87%) and insulin requirements (18% to 28%) were comparable among the three groups (p = NS). Percent excess weight loss at 1, 2, and 3 years was: 43%, 50%, and 45% for LAGB; 66%, 68%, and 66% for RYGB; and 68%, 77%, and 82% for BPD/DS (p < 0.01 LAGB versus RYGB and LAGB versus BPD/DS at all time intervals). At 1 and 2 years, the proportion of patients requiring oral hypoglycemics postoperatively was 39% and 34% for LAGB; 22% and 13% for RYGB; and 11% and 13% for BPD/DS (p = NS). At 1 and 2 years, the proportion of patients requiring insulin postoperatively was 14% and 18% for LAGB; 7% and 13% for RYGB; and 11% and 13% for BPD/DS (p = NS).
Conclusions
Despite the disparity in percent excess weight loss between LAGB, RYGB, and BPD/DS, the rate of resolution of diabetes mellitus is equivalent.
Department of Surgery, New York University Program for Surgical Weight Loss, New York University School of Medicine, New York, NY.
Correspondence address: Christine J Ren, MD, Department of Surgery, New York University Program for Surgical Weight Loss, New York University School of Medicine, 530 First Ave, Ste 10S, New York, NY 10016.
Competing Interests Declared: Drs Ren and Fielding are on the Medical Advisory Board for Allergan. Dr Ren is on the Medical Advisory Board for Ethicon Endosurgery. Unrestricted research grant was received from US Surgical Corporation.
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