Metabolic Surgery for Obese Type 2 Diabetes: Korean Multicenter Cohort Study

Metabolic/bariatric surgery is an effective treatment for obesity and type 2 diabetes mellitus (T2DM), with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) being the most common procedures. However, comparative data on their metabolic benefits in East Asian populations are limited.

This multicenter retrospective cohort study assessed outcomes of SG and RYGB in Korean adults (BMI ≥ 30 kg/m²) with T2DM who underwent surgery between January 2019 and June 2021. The primary outcome was complete T2DM remission at 1 and 2 years postoperatively. Follow-up data were available for 271 patients at 1 year and 169 at 2 years.

Unadjusted analysis showed lower complete remission rates in the RYGB group than the SG group at both 1 year (51.4% vs. 66.3%, p = 0.029) and 2 years (50.0% vs. 62.9%, p = 0.033). After adjustment using inverse probability of treatment weighting (IPTW), the pattern reversed in favor of RYGB (1 year: 67.5% vs. 48.2%; 2 years: 64.4% vs. 46.9%), though differences were not statistically significant (p = 0.127 and p = 0.373). Multivariable logistic regression identified shorter duration of T2DM and absence of insulin use as independent predictors of remission; surgical procedure type was not.

After adjusting for baseline differences, no statistically significant difference in T2DM remission was observed between SG and RYGB at 1 and 2 years in Korean patients with BMI ≥ 30 kg/m². These findings should be interpreted with caution given the modest sample size and limited follow-up. Prospective studies are needed to validate these findings and support clinical decision-making.