Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance

David Benaiges, Juana A. Flores Le-Roux, Juan Pedro-Botet, Juan J. Chillarón, Marine Renard, Alejandra Parri, José M. Ramón, Manuel Pera, Alberto Goday

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37 Citations (Scopus)


Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are associated with glucose metabolism improvement although data on insulin resistance remission rates after these procedures are lacking. Aims: Primary aim was to compare insulin resistance remission rates achieved after LRYGB and LSG, using population-specific HOMA-IR cut-off points. Secondary objectives were to analyze factors associated with type 2 diabetes mellitus (T2DM) complete remission according to the new American Diabetes Association criteria and to examine changes in HOMA-B during follow-up. Methods: Non-randomized, prospective cohort study of patients undergoing LRYGB or LSG with a minimal follow-up of 24 months. Patients on insulin therapy were excluded. Results: At baseline, 56 (48.7%) of the 115 LRYGB group and 48 (61.5%) of the 78 LSG group had insulin resistance, and 29 (25.2%) and 20 (25.6%) T2DM, respectively. No differences were detected in insulin resistance remission rate (92.9% LRYGB and 87.5% LSG, p = 0.355) nor in T2DM complete remission at 2 years (62.1 vs 60% respectively, p = 0.992). Factors independently associated with T2DM complete remission were diabetes treatment and a greater decrease in 3-month HOMA-IR index. The HOMA-B index showed a progressive decline during follow-up. Conclusion: Both surgical techniques are equally effective in achieving insulin resistance normalization in the majority of severely obese patients. Three-month HOMA-IR reduction after surgery was the main predictor of T2DM complete remission. © 2013 Surgical Associates Ltd.
Original languageEnglish
Pages (from-to)309-313
JournalInternational Journal of Surgery
Issue number4
Publication statusPublished - 15 Mar 2013


  • Diabetes mellitus
  • HOMA
  • Insulin resistance
  • Laparoscopic Roux-en-Y gastric bypass
  • Laparoscopic sleeve gastrectomy


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