Bariatric surgery has shown to be highly beneficial for people with obesity and type 2 diabetes, with a range of potential health benefits that include remission of diabetes or prediabetes — meaning that blood glucose levels are normal without taking any glucose-lowering medications. Not all forms of bariatric surgery carry the same benefits, though. Research has shown that gastric bypass surgery — which reduces the stomach to a small pouch, and also bypasses the upper part of the intestines — may be more effective than another form of surgery called sleeve gastrectomy when it comes to weight loss and cardiovascular benefits in people with type 2 diabetes. Gastric bypass has also been shown to be more effective for diabetes remission than gastric banding, in which a flexible band is placed around the stomach to reduce the size of the upper part to a small pouch. Gastric bypass may also be safer than sleeve gastrectomy when it comes to the risk of dying in the years following the surgery.
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For the latest study, researchers looked at hospitalizations related to alcohol use in 7,694 patients in the Veterans Health Administration system who underwent gastric bypass or sleeve gastrectomy or were referred to a weight-management program without any surgery. They were interested in finding out whether the risk for alcohol-related hospitalization was higher following any form of bariatric surgery — meaning that this surgery might not be appropriate for some people with alcohol use disorder. There were 1,854 participants who underwent gastric bypass, 4,211 who underwent sleeve gastrectomy, 265 who underwent gastric banding, and 1,364 who were referred to a weight-management program between 2008 and 2021. Participants who underwent gastric banding were excluded from the final analysis on alcohol-related hospitalizations due to their low numbers.
Gastric bypass linked to increased alcohol-related risks
During the follow-up period, participants who underwent gastric bypass lost the most weight, as noted in an article on the study at MedPage Today — about 29% of their body weight, compared with 22% for participants who underwent sleeve gastrectomy, 13% for those who underwent gastric banding, and less than 1% for those who took part in the weight-management program. After adjusting for participants’ body-mass index (BMI, a measure of body weight that takes height into account) and alcohol use, the researchers found that participants who underwent gastric bypass were 98% more likely to be hospitalized for alcohol-related reasons than those who underwent sleeve gastrectomy, and 70% more likely than those who took part in the weight-management program.
While the overall risk of dying was 37% lower among participants who underwent gastric bypass than those who took part in the weight-management program, this difference in death risk got smaller with greater alcohol consumption — indicating that gastric bypass, in particular, may not be the best option for certain people with alcohol use disorder. For these people, sleeve gastrectomy may be the better choice, despite the potentially greater benefits of gastric bypass among people without alcohol use disorder.
These results show “the importance of careful patient selection and alcohol-related counseling” for people who undergo gastric bypass surgery, the researchers wrote, noting that this form of bariatric surgery may alter alcohol metabolism in a way that sleeve gastrectomy does not.
Want to learn more about bariatric surgery and type 2 diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”
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