HbA1c Reductions Following Sleeve Gastrectomy Versus Sleeve Gastrectomy With Proximal Jejunal Bypass: Significant Differences in Diabetic Patients

Abstract

Sleeve gastrectomy with proximal jejunal bypass (SG with PJB) is often preferred for patients with higher body mass index (BMI) and inadequate glycemic control. This study aimed to compare the outcomes of SG and SG with PJB, focusing on glycemic control and BMI in prediabetic and diabetic patients. Preoperative analysis revealed differences in age and hemoglobin A1c (HbA1c) levels between groups: SG with PJB patients were older (38.72±9.75 vs. 34.93±10.90 years, P=0.002) and had higher HbA1c levels (7.25±1.76 vs. 5.86±0.78%, P<0.001). Patients were stratified into prediabetic and diabetic groups. In the prediabetic group, no preoperative differences were observed between the surgical groups. However, in the diabetic group, patients in the SG with PJB had lower BMI (37.77±5.83 vs. 41.08±8.5 kg/m2, P=0.034) and higher HbA1c levels (7.88±1.72 vs. 6.51±1.37%, P<0.001) compared to the SG, despite stratification. Postoperatively, SG with PJB led to significantly lower BMI at 3 months compared to SG, but this difference was not sustained at 6 and 12 months in the prediabetic group. In diabetic patients, SG with PJB resulted in significantly greater reductions in HbA1c levels compared to SG, even when adjusted for BMI as a covariate. At the 12-month follow-up, although SG with PJB still showed higher HbA1c levels than SG (5.79±0.78 vs. 5.59±0.44%, P=0.031), the difference was smaller compared to the preoperative period, where SG with PJB had significantly higher levels (7.88±1.72 vs. 6.51±1.37%, P<0.001). These findings suggest that SG with PJB may offer superior glycemic control in morbidly obese diabetic patients.