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Duodenal Switch Beats Gastric Bypass For Blood Sugar Control

Fri, 10/04/2013 - 3:33pm
Kristina Fiore

When it comes to bariatric surgery, the duodenal switch procedure may offer a better glycemic profile than gastric bypass, researchers found.

In a small study comparing three forms of bariatric surgery, all patients had improved fasting blood sugar levels and insulin sensitivity -- but those who'd had gastric bypass had a much larger spike followed by a deeper trough in blood sugar on a glucose tolerance test, according to Mitchell Roslin, MD, of Lenox Hill Hospital in New York, and colleagues.

This pattern could contribute to hunger between meals, they wrote online in Surgical Endoscopy.

"In a world where the cornerstone of weight reduction is preventing insulin and glucose fluctuations, how can the perceived surgical gold standard -- gastric bypass -- actually promote fluctuations?" Roslin said in an email to MedPage Today. "The bypass actually promotes insulin release, which can result in hypoglycemia, and is what we believe the biggest reason for recidivism following bypass."

Richard Stahl, MD, a gastrointestinal surgeon at the University of Alabama at Birmingham, told MedPage Today that the findings confirm what’s been known in practice about the various bariatric procedures.

All three procedures “are known to improve glycemic control in type 2 diabetes. It is also known that duodenal switch is somewhat better at it than gastric bypass, and it is suspected that gastric bypass is better at it than sleeve gastrectomy.”

He cautioned, however, that duodenal switch is “more difficult and a higher-risk procedure than gastric bypass, with higher rates of short-term operative complications and longer-term metabolic complications.”

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