New real-world evidence helps individuals make informed decisions about weight-loss surgery
Latest research adds to decision aids for patients with Type 2 diabetes receiving weight-loss surgery, meaning patients are better informed to choose the right surgical approach for them.
Investigators funded by the Patient-Centered Outcomes Research Institute (PCORI; DC, USA) have published the latest clinical findings from the PCORnet Bariatric Study – the largest study so far to compare outcomes data of individuals who underwent the longer-used Roux-en-Y gastric bypass procedure or the newer, simpler surgical approach of sleeve gastrectomy. The study results add to the Shared Decision Making for Bariatric Surgery in Patients with Severe Obesity project, creating a decision aid for patients to consider and discuss with their doctors when choosing weight-loss surgery.
Over the past decade, sleeve gastrectomy has become more popular than Roux-en-Y and now accounts for two-thirds of bariatric surgeries in the USA. The preference for sleeve gastrectomy has emerged despite limited availability of long-term data, reducing the information available to patients and healthcare providers when deciding which surgical approach to take.
In this cohort study involving 9710 participants, researchers observed that amongst patients with Type 2 diabetes who underwent either of the surgeries, 56–59% experienced remission within 1 year and 84–86% within 5 years. For patients who received Roux-en-Y gastric bypass, 33% relapsed within 5 years of remission – a figure 9% less than the observed rate amongst sleeve gastrectomy patients. Gastric bypass was also associated with greater and longer-maintained weight loss, though both procedures resulted in considerable weight loss.
The results of the study suggest that, for individuals considered to have a lower preoperative probability of Type 2 diabetes remission, those who undergo gastric bypass could be more likely to achieve remission than those undergoing sleeve gastrectomy.
Co-principal investigator Kathleen McTigue (University of Pittsburgh; PA, USA) pointed out how patients need to balance these findings with other considerations, deciding which factors are most important for them: "As with many health care options, no one weight-loss surgical procedure is the best choice for every patient because tradeoffs are associated with each...The choice requires personalized decision making that involves weighing the evidence about the pros and cons along with each person's individual circumstances and preferences."
Patients might opt for Roux-en-Y gastric bypass for greater weight loss or the lower chance of relapse, especially in cases of more advanced Type 2 diabetes where remission is less likely. Alternatively, for Type 2 diabetic patients in whom both surgeries offer similar outcomes, sleeve gastrectomy might be preferable due to the lower risk or other considerations, such as the lessened likelihood of dumping syndrome (when eating foods high in sugar, calories and fat can cause discomfort, nausea and overall weakness each time).
"Taken together, the evidence from the PCORnet Bariatric Study is vital to enabling patients and their health care providers to weigh the tradeoffs of the procedures and make personalized decisions based on what matters most to each patient," commented PCORI Interim Executive Director Josephine Briggs. "This study is exemplary of how the comparative effectiveness research that PCORI funds can empower better-informed health care decision making."
McTigue KM, R Wellman, Nauman E et al. Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass – the national Patient-centered Clinical Research Network (PCORnet) Bariatric Study. JAMA Surg. doi:10.1001/jamasurg.2020.0087 (2020) (Epud ahead of print); www.pcori.org/news-release/helping-adults-with-severe-obesity-make-personalized-decisions-between-two-weight-loss-surgery-options.