http://www.diabeteshealth.com/read/2009/06/09/6228/duodenal- switch-surgery-better-against-type-2-diabetes-than-gastric-b ypass/

Duodenal Switch Surgery Better Against Type 2 Diabetes Than Gastric Bypass

Jun 10, 2009

Over the years, gastric bypass surgery has proven an effective means of controlling-and even reversing-type 2 diabetes in
"super-obese" patients (those with a body mass index of 50 or above; usually more than 200 pounds above ideal body weight).

But now University of Chicago researchers have concluded that another type of surgery, called a duodenal switch, is even more effective at controlling such obesity-related conditions as diabetes, high cholesterol, and high blood pressure.

In gastric bypass surgery, surgeons create a small pouch that is separated from the rest of the stomach. Food bypasses the stomach, instead going through the pouch. The smaller size and capacity of the pouch lessens appetite and reduces the amount of food that the body can digest at any one time.

In contrast, duodenal switch surgery modifies the stomach itself, reshaping it into a long, narrow tube. At the same time, the small intestine is changed to reduce the amount of calories it can absorb.

Following either surgery, many obese patients are able to cease taking the medications used to treat their conditions. After tracking the results of the two types of surgery on 350 super-obese patients, however, the researchers noted that the duodenal switch had decisively better postoperative outcomes than the gastric bypass.

• One hundred percent of duodenal switch patients completely stopped taking their diabetes medications, versus 60 percent of gastric bypass patients.
• Sixty-eight percent of duodenal switch patients completely stopped taking their hypertension medications, versus 38.6 percent of gastric bypass patient
• Seventy-two percent of duodenal switch patients completely stopped taking their medications for high cholesterol, versus 26 percent of gastric bypass patients

However, one area in which the gastric bypass outperformed the duodenal switch was in the resolution of acid reflux disease. Almost 77 percent of gastric bypass patients enjoyed a cessation of the disease, versus 48.5 percent of patients undergoing duodenal switch.

One drawback to the duodenal switch is potential vitamin deficiencies or even malnutrition brought on by the modification of the small intestine's ability to absorb nutrients. Because obese people often already have pre-operative nutritional deficiencies, the University of Chicago researchers say that duodenal switch patients may routinely require vitamin supplementation. 

Results of the study were presented recently at Digestive Disease Week® 2009 in Chicago.

All the information you have provided is very true, I have been one of the exceptions to the rule. 3 months post op, I no longer need any diabetic meds. Prior to RNY surgery, I was running sugars of around 350, taking max dosages of 3 oral diabetes meds plus a large dose of lantus every night. Now my sugars run between 90-120, and I no longer take any diabetic meds.

Both surgery's reduce the intake of diabetes medications, and in allot of RNY patients it evens cures it. The DS so far is the only procedure with almost 100% guarantee of eliminating type 2 diabetes.

Thanks for the information, it is pleasure to see information shared across the boards

Doc

I know you are essentially agreeing with me, but the scientist in me is a stickler for accuracy.

One hundred percent of duodenal switch patients completely stopped taking their diabetes medications, versus 60 percent of gastric bypass patients.

You are not "one of the exceptions to the rule."  The 60% cure rate puts you square in the expected group where the odds are "more likely than not."  But you were lucky to not have ended up in the 40% group.

Moreover, what is NOT stated in this article is that even when DSer regain a significant amout of weight (it happens, though not very often), they almost never regain their diabetes.  The same is NOT true for the RNY, or VSG or Lapband.

And I would also like to point out that the cure rate for diabetes with the DS is not 100%, even if it was in that study.  People who have been type 2 diabetic (insulin resistent) so long that they have exhausted their pancreatic islet cells (making them churn out insulin at a higher and higher rate) have no "insulin reservoir" -- curing the insulin resistence by getting a DS is too late for them, because their islet cells are all dead, or too many of them are dead to make sufficient insulin.  It happens.

Diana,

  I love it when you talk technical!!!  

Great article,  thanks.

Peace,

William

I'd like to know more information than this excerpt provides ... such as:

1. How many of the 350 people were DS patients? How many were RNYers?
2. The percentages are one thing... but how many of the 350 in the study suffered from diabetes before surgery? and of that number, how many were DS and how many were RNY. It's easier to make 100% of 20 people than it is to make 100% of 100 people. It is unclear whether or not the 350 people all suffered from all three diseases (hypertension, high cholesterol, and diabetes) And if all of them didn't have all three diseases, the numbers for those who did suffer from each disease are not mentioned.
3. At what point did they test to see if the patients were or were not diabetic? A week after surgery?  a month?  a year? longer?

I could assume the patients studied were about equal in DSers and RNYers, and that the time they tested for diabetes was as far out as possible, but I wouldn't know from the article, and it's not good to assume. For a thorough review of a study those things are necessary. Methods is a huuuge part of believability, and this article only gives the bare minimum statistics aimed to prove its point. Not saying it's wrong, but from what it tells me I certainly don't know its right.

Remember 27.9% of statistics are made up on the spot!

I'm sure Diana will be along tomorrow to help you out, but in case you're an insomniac like I am, here's another study. Hope this helps some.

I'm not arguing the truth of the statement of the article originally presented, just that that particular source does NOT really prove the point to me. Whether true or not, it isn't reliable by my standards... Which I think are pretty darn low. No pictures or personal info for particular patients...  I just need a basic overview of the details of the methods so I can get a good feel for the sample etc. and how it was divided, since there was at least one or possibly two different divisions of that sample of 350 people mentioned. How many of the sample had each disease? How many of each disease had RNY or DS?

Buuut... I digress... II read a good bit of that article you posted, and.... this is what I think of it... :P

I'm not sure if you meant your article to support the OP's article or not, but my conclusion is that for me it doesn't really prove much more than that intestinal bypass cures diabetes in rats, and that the amount of intestine bypassed increases the likelihood of curing diabetes in rats. As for which surgery is better in humans, the article says the issue is of interest but needs further study.

Your article seems to be pretty much completely about the study of RNY and DS on rats with diabetes. It talks mostly about how either surgery can cure diabetes and makes a couple comparisons between the DS and RNY in rats with diabetes (favoring DS slightly). In the end, I thought it was kind of funny because in the questions for further study section, the author of this article says:

"Another question for future clinical trials is which of the various conventional bariatric operations is best suited to treat diabetes. It would require randomized clinical studies to properly answer this question; however, it seems clear that some procedures have greater potential efficacy (RYGB, BPD) than others. Future research may also help devise new surgical operations that could retain the benefit on diabetes without the potential drawbacks of current bariatric procedures."

which implies that the author didn't mean this article to answer the question "Is RNY or DS better at curing diabetes?" as the OP's article claims to answer.

If I ever get a diabetic rat I'll make sure he/she gets switched, hehe.

I don't think I can help you with methods but this was also in the study:

"A meta-analysis involving 136 studies for a total of 22,094 patients showed that type 2 diabetes was completely resolved in 76.8% and resolved or improved in 86.0% of patients who had undergone bariatric surgery (7). The same study showed that complete remission of diabetes occurs in 48% of patients after laparoscopic gastric banding, 84% after RYGB, and >95% after BPD (7). The remission of diabetes after RYGB and BPD is also durable, and recurrence of diabetes >10 years after surgery is rare (8). Intriguingly, whereas remission of diabetes after laparoscopic gastric banding typically occurs over several weeks to months (9), consistent with the consequences of weight loss, RYGB and BPD can cause complete remission of diabetes within days to weeks after surgery, long before substantial weight loss has occurred (4,5). "

"The meta-analysis of Buchwald et al. (7) showed that RYGB results in an average 50–60% long-term excess weight loss. Hence, RYGB, and likewise other bariatric operations, rarely return patients to an entirely normal condition. Losing 50–60% of the excess weight indeed means that, in many patients, the remaining 40–50% of the excess weight is not eliminated by the operation. Technically, many patients remain overweight or frankly obese and fail to achieve “complete remission" of obesity. This is in striking contrast with the evidence that >80% of patients who undergo RYGB and >90% of those who undergo BPD experience a complete sustained remission of type 2 diabetes. Therefore, if considered only in terms of ability to induce disease remission, RYGB (and BPD) seem to be even more effective in diabetes than in obesity itself."

Maybe this something you're looking for? This article wasn't meant to be DS v. RNY, but there are more people studied in the articles they site. Again HTH.

Not that it matters to you, as even the data you insisted upon receiving wasn't good enough for you on the MB thread, which you pooh-poohed anyway, but here is the abstract.  Oh, and for good measure, the link to the full text of the Buchwald meta-analysis:

http://jama.ama-assn.org/cgi/content/full/292/14/1724

Duodenal Switch Provides Superior Resolution of Metabolic Comorbidities Independent of Weight Loss in the Super-Obese (Bmi ≥ 50 Kg/M2) Compared with Gastric Bypass
Vivek N. Prachand^*1, Marc Ward², John C. Alverdy^1
1Surgery, University of Chicago, Chicago, IL; ²Pritzker School of Medicine, University of Chicago, Chicago, IL

OBJECTIVE(S): Increased BMI is associated with greater incidence and severity of obesity-related comorbidities and inadequate post-bariatric surgery weight loss. Accordingly, comorbidity resolution is an important measure of surgical outcome in super-obese individuals. We previously reported superior weight loss in super-obese patients following duodenal switch (DS) compared to Roux-en-Y Gastric Bypass (RYGB) in a large single institution series. We now report follow-up comparison of comorbidity resolution and correlation with weight loss.

METHODS: Data from patients undergoing DS and RYGB between August 2002 and October 2005 were prospectively collected and used to identify super-obese patients with diabetes, hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD). Ali-Wolfe scoring was used to describe comorbidity severity. Chi-square analysis was used to compare resolution and two-sample t-tests used to compare weight loss between patients whose comorbidities resolved and persisted.

RESULTS: 350 super-obese patients [DS (n=198), RYGB (n=152)] were identified. Incidence and severity of hypertension, dyslipidemia, and GERD was comparable in both groups while diabetes was less common but more severe in the DS group (24.2% vs. 35.5%, Ali-Wolfe 3.27 vs. 2.94, p<0.05). Diabetes, hypertension, and dyslipidemia resolution was greater at 36 months for DS (diabetes, 100% vs. 60%; hypertension, 68.0% vs. 38.6%; dyslipidemia, 72% vs. 26.3%), while GERD resolution was greater for RYGB (76.9% vs. 48.57%; p<0.05). There were no differences in weight loss between comorbidity “resolvers" and “persisters".

CONCLUSIONS: In comparison to RYGB, DS provides superior resolution of diabetes, hypertension, and dyslipidemia and inferior resolution of GERD in the super-obese independent of weight loss.

The buchwald study? I agreed with that study. Did you even read my post? I said it was valid and thorough as any study making such claims should be.

You just posted 2 different studies with huge differences in statistics.

Your OP study from the University of Chicago uses about 50 diabetic participants for each surgery and states the diabetes resolution statistics as: 60% RNY 100% DS

The Buchwald study uses over 300 diabetic participants from each surgery and states the resolution statistics as: 80% RNY 95% DS AND his study follows the patients a year longer then the University of Chigago study does.

The DS statistic is nearly the same in both studies, but the RNY statistic has a 20% difference Which one am I to believe? I choose to believe the Buchwald study because it uses a significant sample compared to the study originally posted allowing for much greater accuracy in percentages.

But yeah... keep posting the Chicago study, It'll probably convince most people DS is more reliable at curing diabetes, (TRUE) even with the lack of evidence it gives and it will also likely scare some prospective RNYers with diabetes with its inaccurate percentage (60%) for RNY diabetes resolution. I'm sure you'd prefer that to scientific accuracy and reliability. The shock value must be worth more than gold to the evangelical DSers like yourself.