PMID- 29748734
OWN - NLM
STAT- MEDLINE
DCOM- 20191023
LR  - 20191023
IS  - 1708-0428 (Electronic)
IS  - 0960-8923 (Linking)
VI  - 28
IP  - 10
DP  - 2018 Oct
TI  - Selection of Bypass vs Sleeve for the Management of Type-2 Diabetes in Severely 
      Obese: Could Ethnicity Play a Role?
PG  - 3073-3079
LID - 10.1007/s11695-018-3294-9 [doi]
AB  - PURPOSE: Prospective data was evaluated to see whether bariatric procedure type 
      made any difference to diabetes remission. METHODS: One hundred eighty-six 
      consecutive patients of Indian ethnicity (M:F 89:97) with type 2 diabetes 
      mellitus (T2DM) and HbA1c > 6.5 were assessed before and at 1 year following 
      surgery. Age, BMI, C-peptide and duration of diabetes (ABCD - described by WJ 
      Lee), insulin use, baseline HbA1c, and % weight loss were tested as modifiers. We 
      present remission rates (HbA1c </= 6.0%) and between group remission odds ratio 
      (OR) and adjusted OR after controlling for key modifiers. RESULTS: Patients 
      selecting RYGB (n = 113) vs SG (n = 73) were older (50.7 vs 44.2 years), had a 
      lower BMI (44.1 vs 46.7), lower C-peptide (3.5 vs 4.7 ng/ml), greater duration of 
      diabetes (8 vs 3 years), and higher HbA1c (8.90 and 7.9%) respectively p < 0.05 
      for all (combined R(2) = 0.38). Weight loss at 1 year was 27 and 30% for RYGB and 
      SG respectively (p = 0.01). Remission at 1 year was achieved by 37% of patient 
      selecting RYGB and 74% for the SG (OR = 0.21, 95% CI 0.11-0.41, p < 0.001). After 
      adjusting for ABCD, the adjusted OR (AOR) still favored the SG (AOR = 0.32, 
      0.14-0.74, p = 0.01), and adjustment for HbA1c and weight loss (AOR 0.4, 
      0.17-0.95, p = 0.038) attenuated the effect. CONCLUSION: The analysis suggests SG 
      may be superior to RYGB in this Indian population. Ethnicity may play a role in 
      predicting the response to bariatric surgery and hence the choice of procedure. A 
      randomized controlled trial is needed to clarify the relative benefit.
FAU - Bhasker, Aparna Govil
AU  - Bhasker AG
AD  - Global Hospital, 35, Dr. E Borges Road, Opposite Shirodkar High school, Hospital 
      Avenue, Parel, Mumbai, Maharashtra, 400012, India. draparnagovil@gmail.com.
FAU - Dixon, John B
AU  - Dixon JB
AD  - Baker Heart and Diabetes Institute, Primary Care Research Unit, Monash 
      University, Melbourne, Australia.
FAU - Lakdawala, Muffazal
AU  - Lakdawala M
AD  - Saifee Hospital, Mumbai, India.
AD  - Minimal Access Bariatric and Metabolic Surgery, Fortis Memorial Research 
      Institute, Gurgaon, India.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
SB  - IM
MH  - Adult
MH  - *Bariatric Surgery/methods/statistics & numerical data
MH  - *Diabetes Mellitus, Type 2/epidemiology/surgery
MH  - Female
MH  - Humans
MH  - India/epidemiology
MH  - Male
MH  - Middle Aged
MH  - *Obesity, Morbid/epidemiology/surgery
MH  - Prospective Studies
OTO - NOTNLM
OT  - Comparison
OT  - Diabetes remission
OT  - Ethnicity
OT  - Roux-en-Y gastric bypass
OT  - Sleeve gastrectomy
OT  - Type 2 diabetes mellitus
EDAT- 2018/05/12 06:00
MHDA- 2019/10/24 06:00
CRDT- 2018/05/12 06:00
PHST- 2018/05/12 06:00 [pubmed]
PHST- 2019/10/24 06:00 [medline]
PHST- 2018/05/12 06:00 [entrez]
AID - 10.1007/s11695-018-3294-9 [pii]
AID - 10.1007/s11695-018-3294-9 [doi]
PST - ppublish
SO  - Obes Surg. 2018 Oct;28(10):3073-3079. doi: 10.1007/s11695-018-3294-9.