Abstract
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Abstract
Year 2021
October 2021

SHBC1489

Abstract Title
Roux-en-Y gastric bypass versus best medical treatment for type 2 diabetes in adults with body mass index between 27 and 32 kg/m²: A 5-year randomized control trial
Authors

A.MOH1, S.LOW1, E.YEOH2, C.H.TAN1, B.LAM1, S.TAVINTHARAN2, C.F.SUM2, S.C.LIM2, A.CHENG1

Institutions

Khoo Teck Puat Hospital1, Admiralty Medical Centre2

Background & Hypothesis

Evidence from randomized clinical trials (RCT) supporting surgical superiority in treating type 2 diabetes (T2D) among patients with mild obesity is currently limited, particularly in Asian populations. This 5-year single-centre, open-label RCT compared Roux-en-Y gastric bypass (RYGB) versus best medical treatment on glycaemia, weight control and potential costs in multi-ethnic Asians with mild obesity and T2D.

Methods

Participants with T2D and body mass index (BMI) 27–32 kg/m² were randomized to RYGB or best medical treatment utilising novel anti-diabetic medications with weight-loss benefits [e.g glucagon-like peptide 1 receptor agonist (GLP1RA) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)]. Diabetes remission was defined as HbA1c≤6% and no glucose-lowering medication at 12 months post-treatment and beyond. Percentage changes in glycaemic and weight parameters, and direct treatment costs were assessed.

Results

The final cohort involved 26 subjects (14 medical, 12 RYGB; age:44±10 years, 34.6% males, BMI:29.4±1.6 kg/m²). At 12 months post-surgery, 50% of the RYGB patients achieved diabetes remission and 83% discontinued all anti-diabetic medications. By year 5, 42% remained in remission. In contrast, none in the medical group (93% on GLP1RA/SGLT2i) reached diabetes remission. Percentage declines in fasting plasma glucose, HbA1c and BMI were significantly greater in the RYGB arm (P=0.022, P=0.011 and P<0.001, respectively). The cumulative expenditure of the medical arm exceeded that of RYGB at 12 months, largely due to the costly newer medications.

Discussion & Conclusion

RYGB is superior to best medical treatment in achieving long-term glycaemic and weight benefits in Asians with T2D and class I obesity, and is cost saving.

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