medwireNews: Patients with type 2 diabetes and obesity experience superior weight-related quality of life (QoL) and weight loss with gastric bypass compared with sleeve gastrectomy, a study published in The Lancet shows.
Marius Svanevik (Vestfold Hospital Trust, Tønsberg, Norway) and team carried out an analysis of patients enrolled between 2012 and 2017 in the ongoing single-center Oseberg trial, in which 109 patients (66% female, 95% white) were randomly assigned to undergo gastric bypass (n=55) or sleeve gastrectomy (n=54) surgery.
The participants were at least 18 years old, had a BMI of at least 35.0 kg/m², and were diagnosed with type 2 diabetes, based on having a glycated hemoglobin of at least 6.5% (48 mmol/mol), or at least 6.1% (43 mmol/mol) if they were taking antidiabetic medications.
Patients received identical pre- and postoperative treatment, and all the participants and study personnel were blinded to the study allocations for 1 year. Patient-reported outcomes were completed by digital questionnaires at baseline, 5 weeks, 1 year, 2 years, and 3 years, with weight loss and diabetes remission also assessed at 16 and 34 weeks.
At the 3-year follow-up, patients undergoing gastric bypass had lost significantly more weight than those undergoing sleeve gastrectomy, at 25.3% versus 17.2%, an 8.1 percentage point difference.
And weight loss was significantly associated with changes in the Impact of Weight on QoL-Lite questionnaire scores, the researchers note. The patients undergoing gastric bypass had a 74% improvement in weight-related QoL outcomes, with scores increasing from 48.4 points at baseline to 84.3 points at 3 years. This was significantly better than the 49% improvement seen for the sleeve gastrectomy group, whose scores increased from 54.2 points to 80.6 points.
However, the difference in absolute values did not significantly differ at 3 years, only the percentage change, which was highlighted by Geltrude Mingrone (Università Cattolica del Sacro Cuore, Rome, Italy) and colleagues in a related editorial.
“This result can derive at least in part from the higher baseline value of quality of life found in the group of patients who had sleeve gastrectomy than that in patients who had gastric bypass,” they explain.
The gastric bypass group also showed “significantly greater improvements in the subscales [of] self-esteem, public distress, and physical function,” add the researchers.
The number of symptoms on the 20-item Weight-Related Symptom Measure, including shortness of breath, snoring, sweating, and decreased physical stamina, as well as the bothersomeness of these symptoms decreased significantly in both groups, by a respective 24% and 40% after gastric bypass and 21% and 33% after sleeve gastrectomy group, with no significant difference between the two.
Svanevik et al also note that there were significant improvements in most of the domains on the SF-36 QoL subscales in both groups, as well as in the mean Beck Depression Inventory symptom score. But again, there were no significant differences between the groups.
Moreover, there was the same burden of gastrointestinal symptoms such as diarrhoea, indigestion, constipation, and abdominal pain, as well as binge eating and gastric dumping, associated with each procedure, according to the Gastrointestinal Symptom Rating Scale. The only exception was reflux symptoms, which were reduced significantly more after gastric bypass than sleeve gastrectomy, by an average of 0.43 versus 0.11 points, respectively.
With regard to diabetes, the investigators report a twofold higher probability of diabetes remission for patients undergoing gastric bypass rather than sleeve gastrectomy, at 67% versus 33%, and while there were a respective five cases of hypoglycemia versus one in the third year, there was no overall difference between the two procedures.
Svanevik et al conclude that “[t]his new patient-reported knowledge can be used in the shared decision-making process to inform patients about similarities and differences between expected outcomes after the two surgical procedures.”
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Lancet Diabetes Endocrinol 2023; doi: 10.1016/S2213-8587(23)00127-4