1. Hippocrates Prize
Prof A. Kokkinos (Greece)

2. 15th Meeting of the Mediterranean Group for the Study of Diabetes
Comparison of Roux-en-Y gastric bypass and sleeve gastrectomy in the improvement of insulin sensitivity
Kokkinos A1, Liaskos C1, Liatis S1, Tentolouris N1, Alexiadou K1, Perrea D1, Diamantis T2, Katsilambros N1
1First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece; 2First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
15th Meeting of the Mediterranean Group for the Study of Diabetes
Athens, April, 2017

3. INTRODUCTION
● Bariatric surgery: the most effective method for the long-term treatment of morbid obesity
Sjöström L et al, N Engl J Med 2007;357:

4. THE SOS STUDY ● Reduction in mortality by 30%
● Important reduction in incidence and increase in recovery rate for all cardiovascular risk factors
● Impressive beneficial effects on T2DM
Sjöström L, Int J Obes (Lond) 2008;32:S93-S97

5. ● 150 overweight and obese T2DM patients randomized to:
- Intensive medical therapy
- Roux-en-Y gastric bypass (RYBG) or sleeve gastrectomy (SG)
● Primary endpoint: HbA1c ≤6% with or without medication
Schauer P et al, N Engl J Med 2017;376:

6. Schauer P et al, N Engl J Med 2017;376:641-651

7. INTRODUCTION ● Glycemia improvement a result of:
- Increase in insulin sensitivity (weight loss)
- Specific effects associated with distinct surgical modalities (incretin response)

8. STUDY AIM
To compare the effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on weight loss, insulin sensitivity, and postprandial glycemia and insulinemia

9. METHODS ● 12 morbidly obese patients undergoing RYGB, 15 undergoing SG
● No known T2DM, diabetes medications
● Matched for age and BMI
● Examined preoperatively, and at 3 and 6 months

10. METHODS (2) ● Test meal (200 ml ice-cream, 450 kcal)
● Blood samples at times 0’ and every 30 min until 180’ postprandially
● Glucose, insulin, HOMA-IR
● Area under the curve (AUC) for the postprandial response

11. Baseline characteristics
RESULTS
Baseline characteristics
RYGB SG P
Gender (♀/♂)
10/2
13/2
Age (years)
37.3 ± 8.1
40.7 ± 8.3 ns
Weight (kg)
137.3 ± 18.8
135.0 ± 20.8
BMI (kg/m2)
48.7 ± 6.1
50.8 ± 7.2
Waist (cm)
127.8 ± 10.2
128.4 ± 14.8
Hip (cm)
141.0 ± 13.7
143.5 ± 13.8
WHR
0.93 ± 0.12
0.90 ± 0.11
Glucose (mg/dl)
95.8 ± 9.5
118.6 ± 38.5
Insulin (mU/l)
29.3 ± 21.5
26.2 ± 12.4
HOMA-IR
6.7 ± 5.6
8.4 ± 6.6

13. 3 months
RYGB SG P
6 months
ΔBMI%
-19.0 ± 3.9
-17.8 ± 5.1 ns
-27.2 ± 4.6
-25.9 ± 5.1
Δglucose AUC%
-8.6 ± 12.3
-13.8 ± 20.8
-12.8 ± 12.9
-21.4 ± 17.4
Δinsulin AUC%
-51.5 ± 13.2
-39.2 ± 28.3
-57.1 ± 18.1
-54.3 ± 18.3
ΔHOMA-IR%
-53.1 ± 32.1
-62.1 ± 19.0
-60.2 ± 20.8
-64.6 ± 19.0

15. CONCLUSIONS
● Both RYGB and SG lead to substantial decreases in weight, postprandial glycemia, insulinemia and insulin resistance
● The main drive behind metabolic improvements seems to be weight loss per se, not differences between the two surgical modalities

16. Further directions ● More patients ● 12 months, 2 years
● Gut hormones (GLP-1, PYY, Ghrelin)

17. GUT PEPTIDE RESPONSES AFTER RYGB
● 16 RYGB patients, test meal during the early postoperative period
Le Roux CW et al, Ann Surg 2007;246:

19. Alamuddin N et al, Obes Surg 2016;Dec 21 [e-pub ahead of print]