Background

Bariatric surgery procedures with both restrictive and malabsorptive mechanisms have shown favorable type 2 diabetes mellitus (T2DM) remission rates. Historically, the Roux-en-Y gastric bypass (RYGB) has been the most commonly performed of such procedures. We sought to compare T2DM outcomes in patients undergoing RYGB versus single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S).

Methods

We performed a multicenter retrospective review of patients who underwent RYGB or SADI-S between 2008-2023. Patient demographics, weight loss outcomes, and T2DM remission were reported. An unpaired t-test was performed to identify differences in percentage total weight loss (%TWL) between surgical groups. Rates of T2DM remission were compared between groups using a Chi-squared test. Statistical analysis was performed using GraphPad Prism 5.0.

Results

A total of 612 patients (72.4% RYGB, 27.6% SADI-S) were identified with a mean age of 51.9+-11.3 years and body mass index (BMI) of 49.1+-9.1 kg/m2. On average, patients who underwent SADI-S were younger with a greater preoperative BMI (Table 1). All patients had a diagnosis of T2DM at the time of bariatric surgery and 546 (89.2%) had follow-up regarding T2DM remission status. SADI-S demonstrated a greater T2DM remission rate (80.5% versus 48.4%, p<0.001) and %TWL at 6, 12, 24, and 60 months (Fig. 1) compared to RYGB.

Conclusions

RYGB and SADI-S offer excellent weight loss and resolution of T2DM, in which SADI-S may have superior results. Future studies with larger cohorts and longer follow-up are required, particularly with attention to surgical outcomes and safety.