E.YEOH1, A. MOH2, S. LOW2, C.H. TAN2, B. LAM2, S. TAVINTHARAN1, C.F. SUM1, A. CHENG2
Admiralty Medical Centre1, Khoo Teck Puat Hospital2
This study compared glycaemic variability (GV) from continuous glucose monitoring (CGM) data between Roux-en-Y gastric bypass (RYGB) versus best medical therapy in Type 2 diabetes (T2D) and Class 1 Obesity [Body Mass Index (BMI) 27-32kg/m2]; data for which is currently limited.
Participants were randomized to RYGB or best medical treatment utilising novel anti-diabetic medications with weight-loss benefits [i.e. glucagon-like peptide 1 receptor agonist (GLP1RA) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)]. CGM was performed over 4 time-points (baseline, 6 weeks, ≤3 years and >3 years). EasyGV software was used to calculate GV.
From 26 subjects in the study (age:44±10 years, 34.6% males, BMI:29.4±1.6kg/m2), CGM data from 25 subjects (13 medical, 12 RYGB) was analysed. There were no differences in percent time in range (glucose 4-10mmol/L) and percent time above range (glucose >10mmol/L) between the groups. However, percent time below range (glucose <4mmol/L) was higher in the RYGB group over time (P=0.048). Among the GV parameters, lability index and mean absolute glucose was higher in the RYGB than the medical group over time (group x time P<0.001 and P=0.008, respectively). RYGB group had greater percentage weight change compared to medical group (-15.7±4.8 vs. -4.5±2.3%, P<0.001) and 42% achieved diabetes remission at year 5, while all medical subjects remained on medications.
Despite benefits of weight loss and diabetes remission in RYGB patients, improvements in glycaemia based on CGM data is comparable between RYGB and best medical therapy. The impact of the higher hypoglycaemia rates and lability index in the RYGB group warrants further study.