Long alimentary-limb versus long biliary-limb Roux-en-Y gastric bypass for diabetes remission

Impact of Long Alimentary Limb or Long Biliary Limb Roux-en-Y Gastric Bypass on Type 2 Diabetes Remission in Severely Obese Patients. A Prospective, Multicentric, Randomized, Controlled Trial.

This tests whether, for people with severe obesity and type 2 diabetes, two variants of Roux-en-Y gastric bypass with a short common limb—one with a long alimentary limb and one with a long biliary limb—lead to higher rates of diabetes remission.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 396 (estimated)
• Ages: 18 Years to 60 Years
• Sex: All
• Sponsor: University Hospital, Lille (other)
• Locations: 4 sites (Amiens and 3 other locations)
• Trial ID: NCT03821636 on ClinicalTrials.gov

What this trial studies

Roux-en-Y gastric bypass (RYGB) often improves blood sugar control rapidly and beyond what weight loss alone would predict, possibly because food is redirected away from the proximal intestine and glucose absorption shifts to the common limb. This study compares two RYGB configurations that both use a short common limb but differ in whether the alimentary limb or the biliary limb is lengthened. Eligible patients (BMI ≥35 kg/m2 with type 2 diabetes and suitable for bariatric surgery) will undergo one of the two surgical variants and be followed for metabolic outcomes including diabetes remission and postprandial glucose excursions. The trial aims to clarify whether limb-length configuration influences glycemic outcomes and could inform surgical planning.

Who should consider this trial

Good fit: Ideal candidates are adults with BMI ≥35 kg/m2 who have type 2 diabetes and are eligible for bariatric surgery under French guidelines, and who have not had prior obesity surgery.

Not a fit: Patients with prior bariatric surgery, severe non-stabilized psychiatric or eating disorders, active substance dependence, unstable life‑threatening disease, or contraindications to general anesthesia are unlikely to benefit from enrollment.

Why it matters

Potential benefit: If successful, the results could identify a surgical configuration that improves the chance of diabetes remission and better post-meal glucose control in severely obese patients.

How similar studies have performed: RYGB is well established to improve glycemic control, but high-quality evidence specifically comparing the metabolic effects of differing alimentary versus biliary limb lengths with a short common limb is limited and inconclusive.

Eligibility criteria

Inclusion Criteria:

* BMI ≥ 35 kg/m2
* All patient with type 2 diabetes
* Patients who were candidates for obesity surgery in accordance with French recommendation

Exclusion Criteria:

* Severe cognitive or mental disorders
* patient who have already undergone obesity surgery
* Severe and non-stabilised eating disorders
* The likely inability of the patient to participate in lifelong medical follow-up
* Alcohol or psychoactive substances dependence
* The absence of identified prior medical management of obesity
* Diseases that are life-threatening in the short and medium term;
* Contraindications to general anaesthesia.

Where this trial is running

Amiens and 3 other locations

• Chu Amiens Picardie — Amiens, France (RECRUITING)
• Ch Boulogne-Sur-Me — Boulogne-sur-Mer, France (RECRUITING)
• Hop Claude Huriez Chu Lille — Lille, France (RECRUITING)
• Ch de Valenciennes — Valenciennes, France (RECRUITING)

Study contacts

• Principal investigator: Grégory BAUD, MD — University Hospital, Lille
• Study coordinator: Grégory BAUD, MD

Conditions: Diabetes Mellitus Type 2 in Obese, Obesity, Diabetes Mellitus Type 2, Bariatric Surgery, Roux-en-Y, gastric bypass