Gastric Bypass vs. Sleeve Gastrectomy in Patients with Diabetes and Marked Obesity

Several randomized trials have compared diabetes outcomes after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), but none have been blinded. In this blinded, randomized, single-center trial, 114 adults with type 2 diabetes (mean glycosylated hemoglobin [HbA_1c], 7.9%) and body-mass index (BMI) ≥35 kg/m² (mean, 43 kg/m²) received either laparoscopic RYGB or laparoscopic SG.

At 5 years, diabetes remission (i.e., HbA_1c <6% and no use of diabetes medications) had occurred in 47% of RYGB patients and 33% of SG patients — a significant difference. Percent body-weight loss was also significantly greater with RYGB than with SG (mean, 27% vs. 16%), reflecting an average difference between groups of 12 kg. Incidences of early postoperative …