Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study

Abstract

Importance: Bariatric surgery can lead to substantial improvements in type 2 diabetes (T2DM), but outcomes vary across procedures and populations. It is unclear which bariatric procedure has the most benefits for patients with T2DM.

Objective: To evaluate associations of bariatric surgery with T2DM outcomes.

Design, setting, and participants: This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study. Adult patients with T2DM who had bariatric surgery between January 1, 2005, and September 30, 2015, were included. Data analysis was conducted from April 2017 to August 2019.

Interventions: Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

Main outcome and measures: Type 2 diabetes remission, T2DM relapse, percentage of total weight lost, and change in glycosylated hemoglobin (hemoglobin A1c).

Results: A total of 9710 patients were included (median [interquartile range] follow-up time, 2.7 [2.9] years; 7051 female patients [72.6%]; mean [SD] age, 49.8 [10.5] years; mean [SD] BMI, 49.0 [8.4]; 6040 white patients [72.2%]). Weight loss was significantly greater with RYGB than SG at 1 year (mean difference, 6.3 [95% CI, 5.8-6.7] percentage points) and 5 years (mean difference, 8.1 [95% CI, 6.6-9.6] percentage points). The T2DM remission rate was approximately 10% higher in patients who had RYGB (hazard ratio, 1.10 [95% CI, 1.04-1.16]) than those who had SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% (95% CI, 57.7%-60.7%) and 55.9% (95% CI, 53.9%-57.9%), respectively, at 1 year and 86.1% (95% CI, 84.7%-87.3%) and 83.5% (95% CI, 81.6%-85.1%) at 5 years postsurgery. Among 6141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG (hazard ratio, 0.75 [95% CI, 0.67-0.84]). Estimated relapse rates for those who had RYGB and SG were 8.4% (95% CI, 7.4%-9.3%) and 11.0% (95% CI, 9.6%-12.4%) at 1 year and 33.1% (95% CI, 29.6%-36.5%) and 41.6% (95% CI, 36.8%-46.1%) at 5 years after surgery. At 5 years, compared with baseline, hemoglobin A1c was reduced 0.45 (95% CI, 0.27-0.63) percentage points more for patients who had RYGB vs patients who had SG.

Conclusions and relevance: In this large multicenter study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycemic control compared with those who had SG. These findings can help inform patient-centered surgical decision-making.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Courcoulas reports grants from Covidien/Ethicon Johnson & Johnson, during the conduct of the study. Dr Tavakkoli reports personal fees from Medtronic and AMAG pharmaceuticals. Dr Jones reports personal fees from Allurion. Mr Nadglowski reports other support from the Obesity Action Coalition outside the submitted work.

Figures

Figure 1.. Adjusted Total Weight Loss and Change in Hemoglobin A1c Level by Procedure Over 5 Years of Follow-up

Shaded areas represent 95% pointwise CIs for procedure-specific changes in hemoglobin A1c levels. RYGB indicates Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Figure 2.. Cumulative Incidence Rates of Type 2 Diabetes Remission and Relapse Across 5 Years in the National Patient-Centered Clinical Research Network Bariatric Study Cohort

Shaded areas represent 95% pointwise CIs for procedure-specific rates. RYGB indicates Roux-en-Y gastric bypass; SG, sleeve gastrectomy.