Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication
Por:
Casajoana, A, Guerrero-Perez, F, de Gordejuela, AGR, Admella, V, Sorribas, M, Vidal-Alabro, A, Virgili, N, Urdiales, RL, Montserrat, M, Perez-Maraver, M, Monasterio, C, Salord, N, Pellitero, S, Fernandez-Veledo, S, Vendrell, J, Gebelli, JP and Vilarrasa, N
Publicada:
1 abr 2021
Ahead of Print:
1 ene 2021
Resumen:
Purpose Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. Material and Methods Forty-five patients with mean BMI of 39.4(1.9)kg/m(2) and T2DM with HbA(1c) of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. Results Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up. Conclusions Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.
Filiaciones:
Casajoana, A:
Bellvitge Univ Hosp IDIBELL, Dept Gen & Gastrointestinal Surg, Bariatr Surg Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Guerrero-Perez, F:
Bellvitge Univ Hosp IDIBELL, Dept Endocrinol & Nutr, Feixa Llarga S-N, Barcelona 08907, Spain
de Gordejuela, AGR:
Vall dHebron Univ Hosp, Dept Gen Surg, Endocrine Bariatr & Metab Surg Unit, Ps Vall dHebron 119-129, Barcelona 119129, Spain
Admella, V:
Bellvitge Univ Hosp IDIBELL, Dept Gen & Gastrointestinal Surg, Bariatr Surg Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Sorribas, M:
Bellvitge Univ Hosp IDIBELL, Dept Gen & Gastrointestinal Surg, Bariatr Surg Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Vidal-Alabro, A:
Bellvitge Biomed Res Inst IDIBELL, Feixa Llarga S-N, Barcelona 08907, Spain
Virgili, N:
Bellvitge Univ Hosp IDIBELL, Dept Endocrinol & Nutr, Feixa Llarga S-N, Barcelona 08907, Spain
Urdiales, RL:
Bellvitge Univ Hosp IDIBELL, Dept Endocrinol & Nutr, Feixa Llarga S-N, Barcelona 08907, Spain
Montserrat, M:
Bellvitge Univ Hosp IDIBELL, Dept Endocrinol & Nutr, Feixa Llarga S-N, Barcelona 08907, Spain
Perez-Maraver, M:
Bellvitge Univ Hosp IDIBELL, Dept Endocrinol & Nutr, Feixa Llarga S-N, Barcelona 08907, Spain
Monasterio, C:
Bellvitge Univ Hosp IDIBELL, Dept Pneumol, Sleep Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Salord, N:
Bellvitge Univ Hosp IDIBELL, Dept Pneumol, Sleep Unit, Feixa Llarga S-N, Barcelona 08907, Spain
:
Univ Hosp Germans Trias & Pujol, Dept Endocrinol, Badalona, Spain
Univ Hosp Germans Trias & Pujol, Hlth Sci Res Inst, Badalona, Spain
Fernandez-Veledo, S:
Hosp Univ Joan XXIII, Inst Invest Sanitaria Pere Virgili, Diabet & Metab Associated Dis Res Grp, Tarragona, Spain
Inst Salud Carlos III, CIBER Diabet & Enfermedades Metab Asociadas CIBER, Madrid, Spain
Vendrell, J:
Hosp Univ Joan XXIII, Inst Invest Sanitaria Pere Virgili, Diabet & Metab Associated Dis Res Grp, Tarragona, Spain
Inst Salud Carlos III, CIBER Diabet & Enfermedades Metab Asociadas CIBER, Madrid, Spain
Univ Rovira & Virgili, Sch Med, Tarragona, Spain
Gebelli, JP:
Bellvitge Univ Hosp IDIBELL, Dept Gen & Gastrointestinal Surg, Bariatr Surg Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Vilarrasa, N:
Bellvitge Univ Hosp IDIBELL, Dept Endocrinol & Nutr, Feixa Llarga S-N, Barcelona 08907, Spain
Inst Salud Carlos III, CIBER Diabet & Enfermedades Metab Asociadas CIBER, Madrid, Spain
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