Hung P Truong, MD, Eden Koo, Racquel S Bueno, MD, Cedric Lorenzo, MD. University of Hawaii, General Surgery
INTRODUCTION: Obesity and its related co-morbidities affect Native Hawaiians at an alarmingly higher rate, particularly when compared to non-Hispanic whites. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) have been shown to be effective therapies for obesity. Their efficacy, effect on diabetes (DM), and effect on the brain-gut axis specifically in the Native Hawaiian (NH) population, however, are not known. This pilot study reports their efficacy and characterizes their effects on fasting blood glucose levels, HbA1c, and changes in the hormonal brain-gut axis to address the impact of obesity and bariatric surgical therapy on this underserved population.
METHODS AND PROCEDURES: Twenty-Six NH patients with DM were prospectively randomized to undergo either LRYGB or LSG. Patients were followed for 2-years with primary end points consisting of total weight loss (TWL), percent excess body weight loss (%EBW) and impact on DM as measured by fasting blood glucose (FBS) and HbA1c. In addition, baseline, 1 week, and 1, 6, 12, 18, and 24 months post-operative levels of glucagon-like peptide (GLP-1), peptide YY (PYY), leptin, and ghrelin were collected.
RESULTS: A total of 25/26 patients completed follow-up. The %EBW at 1 year for LRYGB and LSG were 54% and 49%, respectively. Resolution of DM occurred in 22/25 patients, the remaining three subjects were in the LGS arm. Pre-operative FBS in LRGYB and LSG groups, were 127 and 131, respectively. Pre-operative HbA1c in the LRYGB and LSG groups, were 7.06 and 7.15, respectively. FBS at 1 year for LRYGB and LSG were 93 and 110, while HbA1c for LRYGB and LSG were 5.89 and 6.54, respectively. A consistent post-operative decrease in FBS was only seen in LRYGB. LRYGB ghrelin percentages increased at 6, 12, and 18 months, while levels decreased in LSG. Leptin percentages decreased in both groups. The PPY levels remained relatively unchanged in both groups. LRYGB GLP-1 levels increased at 1 week, 6, 12, and 18 months. LSG GLP-1 trends were similar except at 18 months where GLP-1 levels decreased.
CONCLUSION: LRYGB and LSG resulted in equivalent post-surgical weight loss and resolution of DM in the NH population. Ghrelin levels decreased with LSG and increased with LRYGB possibly from a compensatory response in LRYGB. Leptin and GLP-1 levels decreased in both groups. GLP-1 levels, however, decreased in LSG at 18 months consistent with decrease in %EBW and likely efficacy; suggesting a more durable metabolic response from LRYGB.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88104
Program Number: P679
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster