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Gastric Bypass or Sleeve Gastrectomy in Type 2 Diabetes With Obesity

0 3 years ago

For patients with type 2 diabetes mellitus (T2D) and obesity comorbidities, Roux-en-Y gastric bypass (RYGB) was associated with more weight loss, superior diabetes control, and lower risk for major adverse cardiovascular events (MACE) and nephropathy compared with sleeve gastrectomy (SG), according to findings of a study published in Diabetes Care.

This retrospective, observational study analyzed data collected at the Cleveland Clinic Health System between 1998 and 2018. Patients with T2D and a body mass index (BMI) ³30 kg/m2 who underwent RYGB (n=1362), SG (n=693), or matched nonsurgical controls (n=11,435) were assessed for clinical outcomes.

The RYGB, SG, and controls were aged median 51.2, 54.6, and 54.8 years; 66.7%, 63.3%, and 64.2% were women; glycated hemoglobin (HbA1C) was 7.1%, 7.0%, and 7.1%; and BMI was 45.3, 44.7, and 42.6 kg/m2, respectively.

At 5 years, the cumulative incidence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and nephropathy occurred among 13.7% of the RYGB and 24.7% of the SG cohorts (adjusted hazard ratio [aHR], 0.77; 95% CI, 0.60-0.98; P =.035). Compared with a rate of 30.4% for the non-surgical controls, both RYGB (aHR, 0.53; 95% CI, 0.46-0.61; P <.001) and SG (aHR, 0.69; 95% CI, 0.56-0.85; P <.001) procedures decreased risk for the composite outcome.

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