• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • 2022 NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
    • All Blog Posts
  • Log In

Comparison Between RYGB, DS, and VSG Effect On Glucose Homeostasis: Interim Report of Prospective Study

Mitchell S Roslin, MD FACS, Yuriy Dudiy, MD, Joanne Weiskopf, PA, Paresh Shah, MD FACS, Paresh Shah, MD FACS. Lenox Hill Hospital, Northern Westchester Hospital Center

Introduction: The effect of Roux en Y gastric bypass (RYGB) on insulin resistance and resolution of diabetes has been documented. Our group has reported a high incidence of reactive hypoglycemia, following RYGB. The purpose of this study is to compare the six month response to oral glucose challenge, improvement in insulin resistance, and diabetes resolution in patients undergoing RYGB, duodenal switch (DS), and vertical sleeve gastrectomy (VSG).

Methods and procedures: Sixty patients meeting criteria for bariatric surgery are enrolled in this prospective non-randomized study. Twenty-six patients who have reached the six month mark are the basis of this report. Prior to the surgery and at six months follow-up, patients underwent blood draw to determine fasting glucose, fasting insulin, HbA1c, C peptide level. Two hours oral liquid glucose challenge test was done to evaluate glucose response. A ratio of serum glucose levels at the 1 hour and 2 hour marks was calculated. HOMA-IR was calculated using standard formula. All patients signed an informed consent and the protocol was approved by the institutional IRB.

Results: All patients underwent a successful laparoscopic bariatric procedure (VSG =12, DS =7 and RYGB = 7). Although self selected, the groups were similar except for the higher preoperative BMI of the switch patients (BMI=62.2±13.6 compare to 47.9±9.0 in VSG patients and 49.1±12.07 in RYGB patients). Preoperatively, 18 patients had increased insulin resistance based on HOMA> 2.5, 12 were diabetic or pre diabetic based on HgbA1c > 6.0%, and five had fasting blood glucose level (FBS) > 120 mg/dL. At six month follow-up, mean BMI decreased by 16.55±10.7, HgbA1c decreased by 0.39±1.43%, fasting glucose decreased by 15.8±29.3 mg/dL. 12/18 patients had HOMA < 2.5, 9/12 had HgbA1c < 6.0% (1 > 6% with each procedure), and 3/5 had FBS < 120 mg/d. Table 1 shows the results by procedure HOMA-IR decreased from a mean of 7.9 to 0.85 (RYGB), from 3.08 to 1.08 (DS) and 12.04 to 4.2 (VSG). Six month GTT 1hr/2hrs glucose ratio was 2.2(RYGB), 1.56 (DS), 1.66 (VSG).

Conclusions: Our data demonstrates that all the stapling weight loss operations improve insulin resistance and improve HgbA1c. Six month weight loss was similar between RYGB and VSG, and highest in DS. Improvement in insulin resistance, measured by HOMA-IR, did not correlate with weight loss. Higher 1hr/2hrs glucose ratio with RYGB suggests rapid absorption of nutrients with a sharper rise and fall in glucose level. The combination of rapid emptying and improved insulin sensitivity may result in hypoglycemia promoting maladaptive eating, or in the extreme, neuroglycopenia. Preserving the pyloric valve may result in a more physiologic improvement in insulin resistance, while demonstrating meaningful improvement in HgbA1. Our completed study that will include 60 patients, one year follow up with solid meal and liquid glucose challenge will hopefully clarify these issues.

Table 1.

Change in BMI

Change in HgbA1c

HOMA

PRE/POST

1hr/2hrs glucose Ratio

VSG

11.29±5.44

0.45±0.69

286%

1.66±0.64

DS

18.4±9.0

0.91±0.81

285%

1.56±0.5

RYGB

13.3±6.9

0.68±0.86

929%

2.2±0.84


Session: SS14
Program Number: S087

130

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons