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

Abstract 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 (RYGP), sleeve gastrectomy (SG) and biliopancreatic diversion (BPD). Setting Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Universita Cattolica del Sacro Cuore, Rome. Methods Consenting non-diabetic patients, matched for age, sex and pre-operative body mass index, who underwent SADI-S, RYGB, SG and BPD were recruited. A 75g OGTT was performed pre- and post-operatively. Plasma insulin (pIns-μUI/mL) and glucose (pGlu–mg/dL) were measured at baseline, and at +30, +60, +90, +120, +150, and +180minutes. Severe hypoglycemia was defined as pGlu concentration Results Thirty-five patients were recruited: 9 SADI-S, 11 RYGB, 7 SG, 8 BPD. Comparing preoperative and postoperative responses to OGTT, all procedures improved the glycemic control with better early results after SADI-S and BPD as compared with RYGB and SG. No patients showed severe hypoglycemia. Significantly more patients who underwent RYGB and SG showed asymptomatic pGlu Conclusions Similarly 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 to RYGB and SG.