To evaluate the advantages of types of metabolic surgery for obese patients with type 2 diabetes (T2DM).

From January 2012 to February 2019, the clinical data of 64 cases of obesity with T2DM were retrospectively analyzed. According to the surgical intervention, 64 patients were divided into laparoscopic sleeve gastrectomy (LSG) group (n=30) and laparoscopic gastric bypass surgery (L-RYGB) group (n=34) . Statistical analysis were performed by using SPSS 17 software. Measurement data such as biochemical indicators were represented as (±s), and were examined by using independent t test. Postoperative complications and other count data were analyzed using χ² test and logistic regression (stepwise) model to analyze the risk factors of diabetes remission. A P value of <0.05 was considered as statistically significant difference.

Except for triglycerides, the blood lipid-related indexes in both two groups were not improved significantly one year after surgery. There were no significant difference in terms of BMI and blood glucose between two groups (P>0.05). In terms of remission rate of blood glucose, there was 88.2% in L-RYGB, which was better than76.7% in LSG group, with significant difference (P<0.05). One year after surgery, there were significant decrease in both groups in terms of HbA1c、systolic blood pressure and diastolic blood pressure (P=0.016; P=0.029 and P=0.017 respectively). Multivariate logistic regression analysis showed that BMI, fasting blood glucose and HbA1c could be used as independent risk factors for diabetes remission at 1 year (P=0.001; P=0.001; P=0.008). There was a higher remission rate in L-RYGB group than that in LSG group, with significant difference (OR=1.79, 95%CI: 1.133~2.829, P=0.013). There was no death or gastrointestinal fistula within 30 days in either group. There was a higher incidence of deep vein thrombosis in L-RYGB group than that in LSG group (11.8% vs.3.3%, P=0.022).

In terms of diabetes remission one year after surgery, gastric bypass surgery is superior to sleeve gastrectomy. However, follow-up studies are still needed for long-term remission outcome.