Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 5/2021

01-05-2021 | Sleeve Gastrectomy | Original Contributions

Efficacy of Different Procedures of Metabolic Surgery for Type 2 Diabetes in Asia: a Multinational and Multicenter Exploratory Study

Published in: Obesity Surgery | Issue 5/2021

Login to get access

Abstract

Introduction

Asian patients with diabetes exhibit different characteristics from Western patients. However, limited large-scale data are available on metabolic surgery procedures in Asia. We compared the short-term efficacies of metabolic surgery procedures for the management of Asian patients with different severities of diabetes.

Methods

We included patients undergoing metabolic surgery in five Asian institutions from January 2008 to December 2015 with at least 1-year postoperative follow-up. Outcomes of weight loss and diabetes control were determined. Diabetes remission rates in different ABCD scores and factors affecting diabetes remission were analyzed.

Results

A total of 1016 patients (mean BMI, 39.0 ± 7.2 kg/m2; HbA1c, 8.3% ± 1.7%) underwent metabolic surgery (197, Roux-en-Y gastric bypass [RYGB]; 171, one anastomosis gastric bypass [OAGB]; 437, sleeve gastrectomy [SG]; 130, SG with duodenal-jejunal bypass [SG-DJB]; and 81, single anastomosis duodenal-jejunal bypass with SG [SA-DJBSG]). The OAGB group exhibited significantly higher 1-year total weight loss (30.5%) and type 2 diabetes mellitus (T2DM) remission (78.4%) rates than did the other groups (p < .001). The patients with higher preoperative ABCD scores exhibited higher T2DM remission rates (81.8–100% and 9.5–46.2% in ABCD score subgroups of 9–10 and 1–2, respectively). In multivariate analysis, bypass was found to be an independent predictor of T2DM remission compared with SG (odds ratio of OAGB vs SG, 3.72; RYGB vs SG, 1.96; SG-DJB vs SG, 2.73; SA-DJBSG vs SG, 2.12).

Conclusion

The metabolic surgeries are highly effective in T2DM treatment. However, SG may not be as effective as gastric bypass and duodenal-jejunum bypass.
Appendix
Available only for authorised users
Literature
1.
Chan JCN, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40.CrossRef
2.
3.
Lear SA, Humphries KH, Kohli S, et al. Visceral adipose tissue accumulation differs according to ethnic background: results of the multicultural community health assessment trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–9.CrossRef
4.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRef
5.
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.CrossRef
6.
Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77.CrossRef
7.
Yska JP, van Roon EN, de Boer A, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015;150(12):1126–33.CrossRef
8.
Lemus R, Karni D, Hong D, et al. The impact of bariatric surgery on insulin-treated type 2 diabetes patients. Surg Endosc. 2018;32(2):990–1001.CrossRef
9.
Yeo D, Yeo C, Low TY, et al. Outcomes after metabolic surgery in Asians—a meta-analysis. Obes Surg. 2019;29(1):114–26.CrossRef
10.
Lee W-J, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9(3):379–84.CrossRef
11.
Kasama K, Tagaya N, Kanehira E, et al. Laparoscopic sleeve gastrectomy with duodenojejunal bypass: technique and preliminary results. Obes Surg. 2009;19(10):1341–5.CrossRef
12.
Ser K-H, Lee W-J, Chen J-C, et al. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): surgical risk and long-term results. Surg Obes Relat Dis. 2019;15(2):236–43.CrossRef
13.
Liu SY-W, Wong SK-H, Lam CC-H, et al. Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese Chinese population. Obes Surg. 2015;25(10):1901–8.CrossRef
14.
Alkhalifah N, Lee W-J, Hai TC, et al. 15-year experience of laparoscopic single anastomosis (mini-)gastric bypass: comparison with other bariatric procedures. Surg Endosc. 2018;32(7):3024–31.CrossRef
15.
Huang C-C, Wang W, Chen R-J, et al. Predicted coronary heart disease risk decreases in obese patients after laparoscopic sleeve gastrectomy. World J Surg. 2018;42(7):2173–82.CrossRef
16.
Shen S-C, Wang W, Tam K-W, et al. Validating risk prediction models of diabetes remission after sleeve gastrectomy. Obes Surg. 2019;29(1):221–9.CrossRef
17.
Naitoh T, Kasama K, Seki Y, et al. Efficacy of sleeve gastrectomy with duodenal-jejunal bypass for the treatment of obese severe diabetes patients in Japan: a retrospective multicenter study. Obes Surg. 2018;28(2):497–505.CrossRef
18.
Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.CrossRef
19.
Pucci A, Tymoszuk U, Cheung W, et al. Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores. Diabet Med. 2018;35(3):360–7.CrossRef
20.
Huang X, Liu T, Zhong M, et al. Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: a meta-analysis, meta-regression, and systematic review. Surg Obes Relat Dis. 2018;14(12):1822–31.CrossRef
21.
Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019;393(10178):1299–309.CrossRef
22.
Ruiz-Tovar J, Carbajo MA, Jimenez JM, et al. Long-term follow-up after sleeve gastrectomy versus roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities. Surg Endosc. 2019;33(2):401–10.CrossRef
23.
Magouliotis DE, Tasiopoulou VS, Tzovaras G. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: an updated meta-analysis. Obes Surg. 2019:1–10.
24.
Jia D, Tan H, Faramand A, et al. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity: a systematic review and meta-analysis of randomized clinical trials. Obes Surg. 2019;
25.
Zorrilla-Nunez LF, Campbell A, Giambartolomei G, et al. The importance of the biliopancreatic limb length in gastric bypass: a systematic review. Surg Obes Relat Dis. 2019;15(1):43–9.CrossRef
26.
De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg. 2018;28(5):1188–206.CrossRef
27.
Mahawar KK, Himpens J, Shikora SA, et al. The first consensus statement on one anastomosis/mini gastric bypass (OAGB/MGB) using a modified Delphi approach. Obes Surg. 2018;28(2):303–12.CrossRef
28.
Yang P, Chen B, Xiang S, et al. Long-term outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: results from a meta-analysis of randomized controlled trials. Surg Obes Relat Dis. 2019;15(4):546–55.CrossRef
29.
Park CH, Nam S-J, Choi HS, et al. Comparative efficacy of bariatric surgery in the treatment of morbid obesity and diabetes mellitus: a systematic review and network meta-analysis. Obes Surg. 2019;29(7):2180–90.CrossRef
30.
Rogers AM. Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: a meta-analysis, meta-regression, and systematic review. Surg Obes Relat Dis. 2019;15(1):e3–4.CrossRef
31.
Seki Y, Kasama K, Haruta H, et al. Five-year-results of laparoscopic sleeve gastrectomy with duodenojejunal bypass for weight loss and type 2 diabetes mellitus. Obes Surg. 2017;27(3):795–801.CrossRef
32.
Hanipah ZN, Hsin M-C, Liu C-C, et al. Laparoscopic loop duodenaljejunal bypass with sleeve gastrectomy in type 2 diabetic patients. Surg Obes Relat Dis. 2019;
33.
Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, et al. Is laparoscopic duodenojejunal bypass with sleeve an effective alternative to Roux en Y gastric bypass in morbidly obese patients: preliminary results of a randomized trial. Obes Surg. 2012;22(3):422–6.CrossRef
34.
Wang G-F, Yan Y-X, Xu N, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2015;25(2):199–208.CrossRef
35.
Fang Y-L, Lee W-J. Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery. Ann Laparosc Endosc Surg. 2017;2(7).
36.
Panunzi S, De Gaetano A, Carnicelli A, Mingrone G. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis. LWW; 2015.
Metadata
Title
Efficacy of Different Procedures of Metabolic Surgery for Type 2 Diabetes in Asia: a Multinational and Multicenter Exploratory Study
Publication date
01-05-2021
Published in
Obesity Surgery / Issue 5/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-021-05239-7

Other articles of this Issue 5/2021

Obesity Surgery 5/2021 Go to the issue

Original Contributions

Gastric Bypass Improves Microvascular Perfusion in Patients with Obesity

Letter to the Editor

Bariatric Surgery for Cowden Syndrome with PTEN Mutation: a Case Report

Original Contributions

Can Metabolite and Hormone Profiles Provide a Rationale for Choosing Between Bariatric Procedures?

Letter to the Editor

The Significant Hormonal Traits of Laparoscopic Sleeve Gastrectomy Are Further Supported Using Three-Dimensional MDCT Gastrography

Multimedia Article

Modified Nissen Fundoplication for Late Dumping Syndrome After Roux-en-Y Gastric Bypass

Original Contributions

Factors Related to Weight Gain in Subjects with Sleeve Gastrectomy During Lockdown by the COVID-19 Pandemic