Laparoscopic Roux-En-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Weight Loss, Type 2 Diabetes and Comorbidities

More and more U.S. citizens are obese, and many U.S. citizens have been diagnosed with type 2 diabetes. In general, bariatric surgery is used to treat obesity. However, some forms of bariatric surgery can lead to type 2 diabetes remission. Two types of bariatric surgical methods in use for weight loss are laparoscopic roux-en-y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). These two surgical methods are often considered to be treatment options for type 2 diabetes. And while LRYGB may be the most effective treatment for weight loss, a recent study indicates that LSG is as effective as LRYGB for type 2 diabetes treatment.

LRYGB and LSG are similar in some ways: For example, both surgeries "modify the upper gastrointestinal tract anatomy." And this characteristic may make LRYGB and LSG more effective at weight loss and type 2 diabetes management than some other forms of bariatric surgery. However, depending on the disease condition, there are differences in the outcomes associated with the two surgical methods.

The study, mentioned above, showed that both LRYGB and LSG were equally effective in type 2 diabetes remission, obstructive sleep apnoea and quality of life (QoL) improvement. However, LRYGB produced better remission in hypertension, but was associated with a higher complication rate.

Specifically, the researchers concluded that "Although LRYGB induced greater weight loss and better amelioration  of hypertension than LSG, there was no difference in remission of T2DM,  obstructive sleep apnoea, or QoL at 5 years. There were more complications after  LRYGB, but the individual burden for patients with complications was similar  after both operations."

It is also important to remember that there may be contraindications and other potential issues to consider when deciding on the appropriate form of bariatric surgery. The possibility of reintervention should be kept in mind, for example. Indeed, one study demonstrated that "[LSG] has significantly lower risk of reintervention in all categories studied when compared with RYGB at 5-year follow-up."

So, depending on the desired treatment outcome, the healthcare provider and the patient should work together to make the appropriate decision when it comes to bariatric surgery. 

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A Need for a More Restrictive Diabetes Prevention Program Inclusion Criteria

Prediabetes affects approximately 88 million adults in the U.S. And most of these people don’t know they have the condition. So, to some extent, there is a lack of treatment for prediabetes because of a lack of knowledge. Further, the inclusion criteria used to refer individuals to a National Diabetes Prevention Program (National DPP) may need some modification. The current National DPP inclusion criteria may not be restrictive enough to realize the optimum value from the prediabetes treatment.

A recent study, using simulation methods, looked at how placing restrictions in the National DPP inclusion criteria, similar to those used in the DPP trial, may improve the value of the DPP services.

The researchers, performing the study, concluded that the three-year risk of developing type 2 diabetes in the National DPP eligible population ranges from 1% to more than 90%. This means that the National DPP treats individuals who have very little risk of progressing to type 2 diabetes.

The researchers suggested that comparing the original DPP trial inclusion criteria with the National DPP inclusion criteria shows a loosening of National DPP restrictions. For example, in the DPP trial, the criteria did not include HbA1c measurements, whereas the National DPP does. The National DPP also allows participation from individuals starting at 18 years of age, where the DPP trial's starting age was 25. The National DPP allows participation by persons who had gestational diabetes, where the DPP trial did not.

To be included in the DPP trial, an individual had to have "Impaired glucose tolerance (fasting plasma glucose 95-125 mg/dL and 2hr plasma glucose 140-199 mg/dL)" These criteria are more restrictive than the criteria used by the National DPP.

The researchers determined that being more restrictive in the National DPP selection process would be more beneficial. Specifically, the researchers concluded that “Targeting active diabetes prevention to patients at highest risk could improve health outcomes and reduce costs compared to providing the same intervention to a similar number of patients with pre-diabetes without targeted selection."

Primary care organizations, offering Diabetes Prevention Programs, might want to place more restrictions on candidates for DPP programs. This might improve outcomes and lower cost.

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Tags: environmental scanning, balanced scorecard, business planning, strategic management, bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis