Roux-en-Y gastric bypass and one-anastomosis gastric bypass are associated with greater HbA1c reduction and diabetic remission compared with sleeve gastrectomy: Two-year follow-up of 121 patients

Abstract

Objective: To compare the effects of Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and laparoscopic sleeve gastrectomy (LSG) on glycaemic control and weight loss in patients with type 2 diabetes mellitus (T2DM) and obesity over two years.

Methods: Retrospective analysis of a prospectively maintained database of consecutive adults with T2DM and BMI ≥35 kg/m² who underwent RYGB, OAGB, or LSG between February 2015 and February 2020. Primary outcome: change in HbA1c from baseline to two years. Secondary outcomes: T2DM remission (HbA1c <48 mmol/mol), percentage total weight loss (%TWL), and percentage excess weight loss (%EWL). Analysis used one-way ANOVA with Tukey post-hoc tests and chi-square with Bonferroni correction.

Results: Among 121 patients (27 OAGB, 68 RYGB, 26 LSG), baseline characteristics were similar across groups. Mean HbA1c reduction was greatest after RYGB (20.0 mmol/mol), followed by OAGB (15.4 mmol/mol) and LSG (2.5 mmol/mol) (p<0.001). Both bypass procedures were superior to LSG; RYGB vs OAGB did not reach significance (p=0.361). Overall, the diabetic remission rate was 71.9%. RYGB and OAGB were associated with significantly higher remission rates than LSG (p<0.001). %TWL was greater after RYGB and OAGB versus LSG (p<0.001). OAGB produced a greater %EWL than RYGB and LSG. Sex was not associated with glycaemic outcomes (p=0.95).

Conclusions: RYGB and OAGB are associated with superior glycaemic control and weight loss compared with LSG at two years. The difference between bypass procedures was not statistically significant. These findings support the use of gastric bypass over sleeve gastrectomy for patients with T2DM and obesity.