PMID- 24965545
OWN - NLM
STAT- MEDLINE
DCOM- 20150715
LR  - 20221207
IS  - 1708-0428 (Electronic)
IS  - 0960-8923 (Linking)
VI  - 24
IP  - 9
DP  - 2014 Sep
TI  - Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass 
      for the treatment of type 2 diabetes mellitus: 5-year results of a randomized 
      trial and study of incretin effect.
PG  - 1552-62
LID - 10.1007/s11695-014-1344-5 [doi]
AB  - BACKGROUND: Bariatric surgery may be beneficial in mildly obese patients with 
      poorly controlled diabetes. The optimal procedure to achieve diabetes remission 
      is unknown. In 2011, we published the short-term results of a pilot study 
      designed to evaluate the efficacy of diabetic control and the role of duodenal 
      exclusion in mildly obese diabetic patients undergoing laparoscopic sleeve 
      gastrectomy (SG) vs. a laparoscopic single anastomosis (mini-) gastric bypass 
      (SAGB). This study analyzes the 5-year results and evaluates the incretin effect. 
      METHODS: A double-blind randomized trial included 60 participants with a 
      hemoglobin A1c (HbA1c) level higher than 7.5%, a body mass index (BMI) between 25 
      and 35 Kg/m(2), a C-peptide level >/=1.0 ng/mL, and a diagnosis of type 2 diabetes 
      mellitus (T2DM) for at least 6 months. A SAGB with duodenal exclusion or a SG 
      without duodenal exclusion was performed. RESULTS: The 5-year results of the 
      primary outcome were as an intention-to-treat analysis for HbA1c </=6.5% without 
      glycemic therapy. Assessments of the incretin effect and beta cell function were 
      performed at baseline and between 36 and 60 months. The patients were randomly 
      assigned to SAGB (n = 30) and SG (n = 30). At 60 months, 18 participants (60%; 
      95% confidence interval (CI), 42 to 78%) in the SAGB group and nine participants 
      (30%; 95% CI, 13 to 47%) in the SG group achieved the primary end points (odds 
      ratio (OR), 0.3; 95% CI, 0.1 to 0.8%). The participants assigned to the SAGB 
      procedure had a similar percentage of weight loss as the SG patients (22.8 +/- 5.9 
      vs. 20.1 +/- 5.3%; p > 0.05) but achieved a lower level of HbA1c (6.1 +/- 0.7 vs. 
      7.1 +/- 1.2 %; p < 0.05) than the SG patients. There was a significant increase in 
      the incretin effect before and after surgery in both groups, but the SAGB group 
      had a higher incretin effect than the SG group at 5 years. CONCLUSIONS: In mildly 
      obese patients with T2DM, SG is effective at improving glycemic control at 5 
      years, but SAGB was more likely to achieve better glycemic control than SG and 
      had a higher incretin effect compared to SG.
FAU - Lee, Wei-Jei
AU  - Lee WJ
AD  - Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, 
      Taoyuan, Taiwan, wjlee_obessurg_tw@yahoo.com.tw.
FAU - Chong, Keong
AU  - Chong K
FAU - Lin, Yu-Hung
AU  - Lin YH
FAU - Wei, Jih-Hua
AU  - Wei JH
FAU - Chen, Shu-Chun
AU  - Chen SC
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Blood Glucose
MH  - Body Mass Index
MH  - Diabetes Mellitus, Type 2/complications/*surgery
MH  - Double-Blind Method
MH  - Female
MH  - Gastrectomy/*methods
MH  - Gastric Bypass/*methods
MH  - Glucose Clamp Technique
MH  - Glucose Tolerance Test
MH  - Glycated Hemoglobin
MH  - Humans
MH  - Insulin/*metabolism
MH  - Insulin Resistance
MH  - Insulin-Secreting Cells/*metabolism
MH  - Laparoscopy/methods
MH  - Male
MH  - Middle Aged
MH  - Obesity/complications/*surgery
MH  - Pilot Projects
MH  - Treatment Outcome
MH  - Weight Loss
EDAT- 2014/06/27 06:00
MHDA- 2015/07/16 06:00
CRDT- 2014/06/27 06:00
PHST- 2014/06/27 06:00 [entrez]
PHST- 2014/06/27 06:00 [pubmed]
PHST- 2015/07/16 06:00 [medline]
AID - 10.1007/s11695-014-1344-5 [doi]
PST - ppublish
SO  - Obes Surg. 2014 Sep;24(9):1552-62. doi: 10.1007/s11695-014-1344-5.