Original Article: A comparative study of the effect of two procedures of classic Roux-en-Y and omega bariatric surgery on the control and management of diabetes

Authors

Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Patient management after bariatric surgery is important in controlling patients' diabetes and recurrence prevention. This study aimed to meet the medical managements of patients with diabetes 6 months after the bariatric surgery. Materials and Methods: This cross-sectional study was performed on 77 type 2 diabetes patients' candidates for bariatric surgery (Roux-en-Y [RYGP] and Omega). Postoperative implementation protocol was one-third of insulin for patients taking long-term insulin and the discontinuation of medications for patients of oral antidiabetic agents. Blood glucose (BG) level was checked regularly by the patients at home and the necessary medical management was applied. The weight, BG and HbA1C levels, and use of oral antidiabetic agents and insulin were assessed and recorded before 1, 3, and 6 months after the surgery. Results: BG levels and HbA1C percentage in the 1st, 3rd, and 6thmonths after the intervention in Omega group were significantly lower than RYGB group (P value < 0.05). At 1 and 3 months after surgery, the mean insulin dose received by the Omega and RYGB groups was reduced to <30 units/day and 10 units/day, respectively, following the management protocol in this study. Moreover, 23.1% and 7.7% of patients in RYGB group and 12.1% and 3% of patients in Omega group took oral antidiabetic agents 1and 3 months after surgery, respectively. Insulin and oral antidiabetic agents were completely discontinued 6 months after the surgery. Conclusion: The long-term management and support of the patients by the implementation of a standard protocol after surgery are of great significance in obtaining the optimal outcome after bariatric surgery.

Keywords

1.
Chobot A, Górowska-Kowolik K, SokoĊ‚owska M, Jarosz-Chobot P. Obesity and diabetes–not only a simple link between two epidemics. Diabetes Metab Res Rev 2018;34:e3042.  Back to cited text no. 1
    
2.
Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism 2019;92:6-10.  Back to cited text no. 2
    
3.
Drummen M, Tischmann L, Gatta-Cherifi B, Adam T, Westerterp-Plantenga M. Dietary protein and energy balance in relation to obesity and co-morbidities. Front Endocrinol (Lausanne) 2018;9:443.  Back to cited text no. 3
    
4.
Buscot MJ, Thomson RJ, Juonala M, Sabin MA, Burgner DP, Lehtimäki T, et al. BMI Trajectories associated with resolution of elevated youth BMI and incident adult obesity. Pediatrics 2018;141:e20172003.  Back to cited text no. 4
    
5.
Tarride JE, Haq M, Taylor VH, Sharma AM, Nakhai-Pour HR, O'Reilly D, et al. Health status, hospitalizations, day procedures, and physician costs associated with body mass index (BMI) levels in Ontario, Canada. Clinicoecon Outcomes Res 2012;4:21-30.  Back to cited text no. 5
    
6.
Chaudhury A, Duvoor C, Reddy Dendi VS, Kraleti S, Chada A, Ravilla R, et al. Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus management. Front Endocrinol (Lausanne) 2017;8:6.  Back to cited text no. 6
    
7.
Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovascular diabetology. 2018;17:1-9.  Back to cited text no. 7
    
8.
Henry RR, Chilton R, Garvey WT. New options for the treatment of obesity and type 2 diabetes mellitus (narrative review). J Diabetes Complications 2013;27:508-18.  Back to cited text no. 8
    
9.
Kaplan LM. What bariatric surgery can teach us about endoluminal treatment of obesity and metabolic disorders. Gastrointestl Endosc Clin 2017;27:213-31.  Back to cited text no. 9
    
10.
Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes 2017;8:464.  Back to cited text no. 10
    
11.
English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis 2020;16:457-63.  Back to cited text no. 11
    
12.
Angrisani L, Formisano G, Santonicola A, Hasani A, Vitiello A. Bariatric surgery worldwide. In: Bariatric and Metabolic Surgery. Milano: Springer; 2017. p. 19-24.  Back to cited text no. 12
    
13.
Leonetti F, Capoccia D, Coccia F, Casella G, Baglio G, Paradiso F, et al. Obesity, type 2 diabetes mellitus, and other comorbidities: A prospective cohort study of laparoscopic sleeve gastrectomy vs. medical treatment. Arch Surg 2012;147:694-700.  Back to cited text no. 13
    
14.
Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes. N Engl J Med 2017;376:641-51.  Back to cited text no. 14
    
15.
Slater BJ, Bellatorre N, Eisenberg D. Early postoperative outcomes and medication cost savings after laparoscopic sleeve gastrectomy in morbidly obese patients with type 2 diabetes. J Obes 2011;2011:350523.  Back to cited text no. 15
    
16.
Ruiz-Tovar J, Oller I, Tomas A, Llavero C, Arrovo A, Calero A, et al. Midterm impact of gleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose homeostatsis, lipid profiles, and comorbidities in morbidly obese patients. Am Surg 2012;78:969-74.  Back to cited text no. 16
    
17.
Mottalib A, Kasetty M, Mar JY, Elseaidy T, Ashrafzadeh S, Hamdy O. Weight management in patients with type 1 diabetes and obesity. Curr Diab Rep 2017;17:92.  Back to cited text no. 17
    
18.
Makary MA, Clark JM, Shore AD, Magnuson TH, Richards T, Bass EB, et al. Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg 2010;145:726-31.  Back to cited text no. 18
    
19.
Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: A systematic review and meta-analysis of outcomes. Obes Surg 2013;23:1994-2003.  Back to cited text no. 19
    
20.
Dillon C, Peddle J, Twells L, Lester K, Midodzi W, Manning K, et al. Rapid reduction in use of antidiabetic medication after laparoscopic sleeve gastrectomy: The newfoundland and Labrador bariatric surgery cohort (BaSCo) study. Can J Hosp Pharm 2015;68:113-20.  Back to cited text no. 20
    
21.
Goldenberg R, Punthakee Z. Canadian diabetes association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada: Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes 2013;37 Suppl 1:S8-11.  Back to cited text no. 21
    
22.
Powers KA, Rehrig ST, Jones DB. Financial impact of obesity and bariatric surgery. Med Clin North Am 2007;91:321-38, ix.  Back to cited text no. 22
    
23.
Shah A, Laferrère B. Diabetes after bariatric surgery. Can J Diabetes 2017;41:401-6.  Back to cited text no. 23
    
24.
El Khoury L, Chouillard E, Chahine E, Saikaly E, Debs T, Kassir R. Metabolic surgery and diabesity: A systematic review. Obes Surg 2018;28:2069-77.  Back to cited text no. 24
    
25.
Pérez-Pevida B, Escalada J, Miras AD, Frühbeck G. Mechanisms underlying type 2 diabetes remission after metabolic surgery. Front Endocrinol 2019;10:641.  Back to cited text no. 25
    
26.
Perna M, Romagnuolo J, Morgan K, Byrne TK, Baker M. Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Relat Dis 2012;8:685-90.  Back to cited text no. 26
    
27.
Angrisani L, Cutolo PP, Formisano G, Nosso G, Vitolo G. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis 2013;9:405-13.  Back to cited text no. 27
    
28.
Kheniser KG, Kashyap SR. Diabetes management before, during, and after bariatric and metabolic surgery. J Diabetes Complications 2018;32:870-5.  Back to cited text no. 28
    
29.
Seridi L, Leo GC, Dohm GL, Pories WJ, Lenhard J. Time course metabolome of Roux-en-Y gastric bypass confirms correlation between leptin, body weight and the microbiome. PLoS One 2018;13:e0198156.  Back to cited text no. 29
    
30.
Thorell A, Hagström-Toft E. Treatment of diabetes prior to and after bariatric surgery. J Diabetes Sci Technol 2012;6:1226-32.  Back to cited text no. 30
    
31.
Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing type 2 diabetes: A narrative review of the evidence. Nutrients 2019;11:766.  Back to cited text no. 31
    
32.
Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, et al. Practical recommendations of the obesity management task force of the European Association for the Study of obesity for the post-bariatric surgery medical management. Obesity Facts 2017;10:597-632.