Comparison between RYGB, DS, and VSG effect on glucose homeostasis

Area of Science:

• Bariatric surgery
• Endocrinology
• Metabolic health

Background:

• Reactive hypoglycemia is common after Roux-en-Y gastric bypass (RYGB).
• Previous research focused on postprandial insulin and glucose ratios after RYGB.
• Understanding different bariatric procedures' metabolic effects is crucial.

Purpose of the Study:

• Compare the 6-month oral glucose challenge response of RYGB, duodenal switch (DS), and vertical sleeve gastrectomy (VSG).
• Evaluate post-surgical insulin secretion and glucose regulation across different bariatric procedures.

Main Methods:

• Thirty-eight patients underwent laparoscopic bariatric surgery (VSG, DS, RYGB).
• Preoperative and 6-month postoperative assessments included glucose, insulin, HbA1c, C-peptide, and oral glucose tolerance tests (OGTT).
• Calculated HOMA-IR and glucose/insulin ratios.

Main Results:

• All procedures reduced BMI, HbA1c, fasting glucose, and fasting insulin.
• RYGB showed a 20-fold 1-h insulin increase post-OGTT, unlike DS.
• DS patients had lower 1-h insulin and glucose levels, with a lower 1- to 2-h glucose ratio (1.3) compared to RYGB (1.9) and VSG (1.8).

Conclusions:

• All bariatric surgeries improve insulin sensitivity and lower HbA1c, with significant weight loss (22-29% excess body weight).
• RYGB and VSG demonstrate a marked rise in glucose and insulin post-challenge.
• DS results in a less abrupt glucose reduction and lower post-challenge insulin, with the lowest 6-month HbA1c.