Background

Obesity is associated with type-2 diabetes (T2D), which can lead to both microvascular and macrovascular complications. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are effective interventions in achieving diabetes remission (DR). However, it remains unclear whether RYGB or SG is more beneficial for patients with or without diabetes-related complications. Hence, we aim to compare the long-term effectiveness of bariatric surgeries in achieving DR in individuals with diabetes-related complications.

Methods

This is a multicenter retrospective cohort study in patients with T2D who underwent bariatric surgery. We systematically collected data pertaining to preoperative diabetes-related conditions, encompassing microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular comorbidities (coronary artery disease, cerebrovascular accidents, and peripheral artery disease). Our endpoint was comparing the efficacy of RYGB and SG in achieving DR in patients with and without diabetes-related complications.

Results

A total of 1177 patients (67%female, 92%White) were included in this study with a mean follow-up of 5.5 years. Baseline BMI was the only baseline parameter that was different between RYGB and SG (Table1). In patients with diabetes-related complications, patients who underwent RYGB had an OR of 1.98 (95%CI 1.2 to 3.2) to achieve DR compared to SG (40% vs 25%; p<0.01, respectively). In patients without complications, there was no statistical difference in DR when comparing RYGB to SG (56% vs 51%; p=0.34). Subgroup analysis by microvascular and macrovascular complications is presented in Figure1.

Conclusions

Among patients with diabetes-related complications, particularly microvascular diseases, RYGB was associated with a significantly higher rate of DR compared to SG.