Effect of single anastomosis duodenal-ileal bypass with sleeve gastrectomy on glucose tolerance test: comparison with other bariatric procedures.

BACKGROUND

No data have been reported regarding the risk of hyperinsulinemic response and reactive hypoglycemia after single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S). Furthermore, comparative studies with other bariatric procedures are lacking.

OBJECTIVES

To compare response to oral glucose tolerance test (OGTT) in patients who underwent SADI-S, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion (BPD).

SETTING

Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome.

METHODS

Consenting, nondiabetic patients matched for age, sex, and preoperative body mass index, who underwent SADI-S, RYGB, SG, and BPD, were recruited. A 75 g OGTT was performed pre and postoperatively. Plasma insulin and glucose (pGlu-mg/dL) were measured at baseline, and at +30, +60, +90, +120, +150, and +180 minutes. Severe hypoglycemia was defined as pGlu concentration <55 mg/dL.

RESULTS

Thirty-five patients were recruited: 9 SADI-S, 11 RYGB, 7 SG, and 8 BPD. Comparing preoperative and postoperative responses to OGTT, all procedures improved the glycemic control with better early results after SADI-S and BPD compared with RYGB and SG. No patients showed severe hypoglycemia. Significantly more patients who underwent RYGB and SG showed asymptomatic pGlu <70 mg/dL during OGTT compared with SADI-S and BPD (63.6% and 57.1% vs 22.2% and 12.5%, respectively, P < .05).

CONCLUSIONS

Similar to BPD, SADI-S seems to be associated to insulin sensitivity and glucose homeostasis improvement, together with a reduced risk of hyperinsulinemia and, consequently, to hypoglycemia, often associated with RYGB and SG.