Gastric Bypass and Sleeve Gastrectomy Proposed to Outperform Medical Therapy for Type 2 Diabetes

Type 2 Diabetes Mellitus (T2DM) is a global health crisis, characterized by hyperglycemia, insulin resistance, and β-cell failure. Despite intensive medical treatment, less than 40% of patients achieve adequate metabolic control, leading to severe complications. Bariatric surgery, initially for morbid obesity, has emerged as a highly effective treatment for T2DM, often leading to remission. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) have shown significant metabolic impact, enhancing insulin secretion, insulin sensitivity, lipid metabolism, and blood pressure regulation, offering a potential paradigm shift beyond conventional pharmacotherapy.

Investigators propose a prospective randomized trial comparing Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), and the best available medical treatment for Type 2 Diabetes Mellitus (T2DM). The study will enroll poorly controlled T2DM patients. The primary endpoint is 36-month glycemic control, defined as achieving HbA1C < 6.5% with normal glucose levels, not requiring medication. This design aims to directly compare the long-term efficacy of surgical versus intensive medical approaches in achieving diabetes remission.