Gastric bypass better than gastric banding for inducing remission in diabetes

22 June 2016

People with  type 2 diabetes undergoing bariatric surgery are considerably more likely to experience remission with a Roux-en-Y gastric bypass (RYGBP), compared with gastric banding.

The finding comes from a US study of more than 600 people with diabetes. It shows that after 3 years, 69% of those who had Roux-en-Y gastric bypass (RYGBP) were in remission from their diabetes, compared with only 30% in the laparoscopic gastric banding group.

Even after adjusting for weight at the start and after surgery as well as other differences between the groups, gastric bypass patients were still almost twice as likely to experience long-term remission.

The odds of remission after lap banding were linked to metabolic parameters that closely tracked weight loss, but this was not the case with RYGBP, say the researchers from Oregon Health & Science University and other institutions.

“These data suggest that factors unique to RYGBP may have added benefits beyond weight loss on glucose control,” they write.

This “unexpected” finding may be due to a range of factors, including larger reductions in caloric intake with RYGBP directly after the procedure. Other longer term factors may be changes in the microbiome (the population of microbes that live in your intestine) with RYGBP and alterations in jejunal nutrient sensing.

Until recently, gastric banding was the most commonly performed bariatric procedure in Australia. In the past year it was still more than twice as common as RYGBP.

However, sleeve gastrectomy has now overtaken banding, with more than 11,000 procedures carried out in the past year compared with around 3000 for gastric banding and 1300 for RYGBP.

Last Reviewed: 23 June 2016
Reproduced with kind permission from Medical Observer.

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Hugo Wilcken

Hugo Wilcken

Hugo Wilcken is the editor of Medical Observer's sister publications, Specialist Updates.