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Chagas TA, Dos Reis MA, Leivas G, Santos LP, Gossenheimer AN, Melo GB, Malerbi FK, Schaan BD. Prevalence of diabetic retinopathy in Brazil: a systematic review with meta-analysis. Diabetol Metab Syndr 2023; 15:34. [PMID: 36864478 PMCID: PMC9979496 DOI: 10.1186/s13098-023-01003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/19/2023] [Indexed: 03/04/2023] Open
Abstract
AIMS To evaluate the prevalence of diabetic retinopathy (DR) in Brazilian adults with diabetes mellitus via a systematic review with meta-analysis. METHODS A systematic review using PubMed, EMBASE, and Lilacs was conducted, searching for studies published up to February 2022. Random effect meta-analysis was performed to estimate the DR prevalence. RESULTS We included 72 studies (n = 29,527 individuals). Among individuals with diabetes in Brazil, DR prevalence was 36.28% (95% CI 32.66-39.97, I2 98%). Diabetic retinopathy prevalence was highest in patients with longer duration of diabetes and in patients from Southern Brazil. CONCLUSION This review shows a similar prevalence of DR as compared to other low- and middle-income countries. However, the high heterogeneity observed-expected in systematic reviews of prevalence-raises concerns about the interpretation of these results, suggesting the need for multicenter studies with representative samples and standardized methodology.
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Affiliation(s)
| | - Mateus Augusto Dos Reis
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Gabriel Leivas
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucas Porto Santos
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, RS, Brazil
| | - Agnes Nogueira Gossenheimer
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gustavo Barreto Melo
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fernando Korn Malerbi
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Beatriz D Schaan
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, RS, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Foschi D, Sorrentino L, Tubazio I, Vecchio C, Vago T, Bevilacqua M, Rizzi A, Corsi F. Ileal interposition coupled with duodenal diverted sleeve gastrectomy versus standard medical treatment in type 2 diabetes mellitus obese patients: long-term results of a case-control study. Surg Endosc 2018; 33:1553-1563. [PMID: 30225603 DOI: 10.1007/s00464-018-6443-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/05/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Randomized controlled trials have demonstrated that bariatric surgery is effective in obtaining remission of type 2 diabetes mellitus (T2DM) in obese patients, yet no data exist in the literature from prospective studies with ileal interposition with duodenal diversion sleeve gastrectomy (II-DD-SG). The aim of this case-control study is to investigate if II-DD-SG is superior to medical treatment in T2DM obese patients. METHODS Thirty obese patients (BMI > 30) affected by T2DM were recruited for surgery (II-DD-SG) between 2008 and 2011 and were matched with an equal control group which received standard medical treatment. Anthropometric measures, glucose metabolism, cardiovascular risk factors were determined baseline and during follow-up. The primary end point was T2DM remission; reduction of body weight, BMI, and cardiovascular risk factors were secondary end-points. RESULTS Shortly after II-DD-SG, normalization of glucose plasma levels and glycated hemoglobin was observed followed by a significant decrease in body weight and BMI. At one-year follow-up, insulin resistance strongly declined as did insulin plasma levels. Complete remission was observed in 26 patients (86%); 2 (6.6%) had partial remission, and two (6.6%) were still diabetic. After 5 years, 17 of 25 patients on follow-up (68%) showed complete remission of T2DM and 56% had remission of cardiovascular risk factors. Only two patients receiving medical treatment showed complete remission of T2DM (p < 0.0001 versus II-DD-SG). No significant changes of anthropometric parameters and lipid metabolism were recorded. CONCLUSIONS II-DD-SG is an effective surgical procedure, able to induce complete and prolonged remission of T2DM in obese patients as opposed to medical treatment.
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Affiliation(s)
- Diego Foschi
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy.
| | - Luca Sorrentino
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Igor Tubazio
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Consuelo Vecchio
- Unit of Dietetics, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy
| | - Tarcisio Vago
- Endocrine Laboratory Unit, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy
| | - Maurizio Bevilacqua
- Unit of Endocrinology, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy
| | - Andrea Rizzi
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Fabio Corsi
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
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Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review. Obes Surg 2018; 27:2410-2418. [PMID: 28353180 DOI: 10.1007/s11695-017-2651-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic management of leaks/fistulas after laparoscopic sleeve gastrectomy (LSG) is gaining popularity in the bariatric surgery. OBJECTIVES This study aimed to review the efficacy and safety of over-the-scope-clip (OTSC) system in endoscopic closure of post-LSG leak/fistula. METHODS PubMed/Medline and major journals of the field were systematically reviewed for studies on endoscopic closure of post-LSG leaks/fistula by means of the OTSC system. RESULTS A total of ten eligible studies including 195 patients with post-LSG leaks/fistula were identified. The time between LSG and leak/fistula ranged from 1 day to 803 days. Most of the leaks/fistula were located at the proximal staple line, and they sized from 3 to 20 mm. Time between leak diagnosis and OTSC clipping ranged from 0 to 271 days. Thirty-three out of 53 patients (63.5%) required one clip for closure of the lesion. Regarding the OTSC-related complications, a leak occurred in five patients (9.3%) and OTSC migration, stenosis, and tear each in one patient (1.8%). Of the 73 patients with post-LSG leak treated with OTSC, 63 patients had an overall successful closure (86.3%). CONCLUSION OTSC system is a promising endoscopic approach for management of post-LSG leaks in appropriately selected patients. Unfortunately, most studies are series with a small sample size, short-term follow-up, and mixed data of concomitant procedures with OTSC. Further studies should distinguish the net efficacy of the OTSC system from other concomitant procedures in treatment of post-LSG leak.
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El-Kadre LJ, de Almeida Tinoco ACA. Innovative Metabolic Operations. Surg Obes Relat Dis 2016; 13:368-369. [PMID: 27890343 DOI: 10.1016/j.soard.2016.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 09/25/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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Cohen R. Response to the letter to editor on innovative metabolic operations by El Kadre and Tinoco. Surg Obes Relat Dis 2016; 13:127. [PMID: 27865807 DOI: 10.1016/j.soard.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ricardo Cohen
- The Center for Obesity and Diabetes Oswaldo Cruz German Hospital, Sao Paulo, Brazil
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Celik A, Ugale S, Ofluoglu H, Asci M, Celik BO, Vural E, Aydin M. Technical feasibility and safety profile of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT). Obes Surg 2016; 25:1184-90. [PMID: 25445838 PMCID: PMC4460271 DOI: 10.1007/s11695-014-1518-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background In this study, we specifically aimed to analyze the technical and safety aspects of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in patients with type 2 diabetes (T2DM). Methods A total of 360 patients with type 2 diabetes who underwent a DSIT procedure within the past 2-year period (2011–2013) were analyzed. Operation time, length of hospital stay, perioperative and postoperative complications, and mortality were recorded and analyzed. Results The participants consisted of 229 males (63.6 %) and 131 females (36.4 %). Mean duration of follow-up was 12.4 months (range, 6–31). One early and two late mortalities occurred. Early mortality was due to an anastomotic leak, and late mortalities were related to myocardial infarction and a traffic accident. Leakage and bleeding were the most common surgical complications. The total number of surgical complications was 22 (6.1 %). Of those, 19 occurred within the first month (early) and 3 occurred after the first month (late). Among early complications, seven (1.94 %) required re-operation, two patients (0.55 %) required endoscopic treatment, and the remaining ten were managed conservatively. Late surgical complications (sleeve angulation) were noted in three patients (0.83) and were treated by endoscopic stents. Surgery-related non-surgical complications occurred in 19 cases (5.2 %), and neurological complications were noted in 11 patients (3.05 %). Additional surgical intervention was required in 26 patients (7.22 %). Of those, 15 (4.16 %) required cholecystectomy. Conclusions Our data demonstrate that DSIT is a technically feasible operation and can be safely performed in type 2 diabetic patients with acceptable complication and mortality rates.
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Affiliation(s)
- Alper Celik
- Metabolic Surgery Clinic, Taksim German Hospital, Istanbul, Turkey,
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Celik A, Asci M, Celik BO, Ugale S. The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs. SPRINGERPLUS 2015; 4:417. [PMID: 26295016 PMCID: PMC4534478 DOI: 10.1186/s40064-015-1216-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/04/2015] [Indexed: 01/06/2023]
Abstract
Background Type 2 diabetes mellitus (T2DM) has gained pandemic proportions becoming a global threat within the last few decades. In parallel to the increasing prevalence, healthcare costs have become a huge economic burden for the hospital and governments. Bariatric surgery has been proven to induce glycemic control in obese type 2 diabetics. However, the cost effectiveness of metabolic surgery in overweight, obese and morbidly obese individuals has not been documented. We aimed to demonstrate the efficacy and reduced diabetic-medication cost after diverted sleeve gastrectomy with ileal interposition (DSIT) in type 2 diabetic individuals followed more than 1 year. Methods Records of 116 type 2 diabetic patients operated by DSIT at a dedicated metabolic surgery clinic between October 2011 and April 2013 were retrospectively reviewed. A comparison was made between the annual diabetic medication cost before and after surgery using the paired t test. The alterations in BMI and HbA1c were recorded and analyzed. Results Diverted sleeve gastrectomy with ileal interposition led to a marked reduction in BMI and improved glycemic control after 1 year follow-up. Mean HbA1c levels decreased from a mean of 8.9 ± 1.7 to 6.6 ± 1.1 1 year after surgery (p < 0.001). Mean preoperative BMI declined from 32.9 ± 4.3 to 24.7 ± 2.7 kg/m2 (p < 0.001). Cost of diabetic medication decreased from a mean 660.08 USD/year to 65.12 USD 1 year after surgery (p < 0.001). Conclusion Our results have shown that DSIT operation leads to a significantly better glycemic control and lower diabetic medication costs at 1 year.
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Affiliation(s)
- Alper Celik
- Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Sokak Kent Pasaji No: 2/2, Sisli, Istanbul, Turkey
| | - Muharrem Asci
- Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Sokak Kent Pasaji No: 2/2, Sisli, Istanbul, Turkey
| | - Bahri Onur Celik
- Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Sokak Kent Pasaji No: 2/2, Sisli, Istanbul, Turkey
| | - Surendra Ugale
- Bariatric and Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India
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Busetto L, Dixon J, De Luca M, Shikora S, Pories W, Angrisani L. Bariatric surgery in class I obesity : a Position Statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2015; 24:487-519. [PMID: 24638958 DOI: 10.1007/s11695-014-1214-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Class I obesity conveys an increased risk of comorbidities, impairs physical and mental health-related quality of life, and it is associated to an increased psychosocial burden, particularly in women. The need for effective and safe therapies for class I obesity is great and not yet met by nonsurgical approaches. Eligibility to bariatric surgery has been largely based on body mass index (BMI) cut points and limited to patients with more severe obesity levels. However, obese patients belonging to the same BMI class may have very different levels of health, risk, and impact of obesity on quality of life. Individual patients in class I obesity may have a comorbidity burden similar to, or greater than, patients with more severe obesity. Therefore, the denial of bariatric surgery to a patient with class I obesity suffering from a significant obesity-related health burden and not achieving weight control with nonsurgical therapy simply on the basis of the BMI level does not appear to be clinically justified. A clinical decision should be based on a more comprehensive evaluation of the patient's current global health and on a more reliable prediction of future morbidity and mortality. After a careful review of available data about safety and efficacy of bariatric surgery in patients with class I obesity, this panel reached a consensus on ten clinical recommendations.
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Affiliation(s)
- Luca Busetto
- Department of Medicine, University of Padua, Padua, Italy,
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Ngiam KY, Lee WJ, Lee YC, Cheng A. Efficacy of metabolic surgery on HbA1c decrease in type 2 diabetes mellitus patients with BMI <35 kg/m2--a review. Obes Surg 2014; 24:148-58. [PMID: 24242843 DOI: 10.1007/s11695-013-1112-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
High glycated hemoglobin A1c (HbA1c) is strongly correlated with developing type 2 diabetes mellitus (T2DM) complications; this study reviews the efficacy of various types of metabolic surgeries in reducing HbA1c levels in type 2 diabetics with BMI <35 kg/m(2). An electronic search of MEDLINE databases using terms 'metabolic surgery', type 2 diabetes mellitus, BMI <35 kg/m(2), and related keywords for studies published between 1987 and 2013. Data from 53 articles with 2,258 patients were selected for this review. The weighted mean change in HbA1c was -2.8 % (95 % CI -2.8 to -2.7, p < 0.01) and weighted mean BMI change was -5.5 kg/m(2) (95 % CI -5.6 to -5.4, p < 0.01). There was a strong correlation between weighted percentage mean change in HbA1c and BMI. Adjustable gastric banding and duodenal jejunal bypass were inferior to other surgeries in reducing BMI and HbA1c in BMI <35 kg/m(2). Metabolic surgery significantly decreases HbA1c in T2DM patients with BMI <35 kg/m(2) and that the magnitude of HbA1c change may be a useful surrogate of DM control.
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Affiliation(s)
- Kee Yuan Ngiam
- Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828
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Johannessen H, Kodama Y, Zhao CM, Sousa MML, Slupphaug G, Kulseng B, Chen D. Eating Behavior and Glucagon-Like Peptide-1-Producing Cells in Interposed Ileum and Pancreatic Islets in Rats Subjected to Ileal Interposition Associated with Sleeve Gastrectomy. Obes Surg 2012; 23:39-49. [DOI: 10.1007/s11695-012-0750-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Bariatric surgery provides substantial, sustained weight loss and major improvements in glycaemic control in severely obese individuals with type 2 diabetes. However, uptake of surgery in eligible patients is poor, and the barriers are difficult to surmount. We examine the indications for and efficacy and safety of conventional bariatric surgical procedures and their effect on glycaemic control in type 2 diabetes. How surgical gastrointestinal interventions achieve these changes is of great research interest, and is evolving rapidly. Old classifications about restriction and malabsorption are inadequate, and we explore understanding of putative mechanisms. Some bariatric procedures improve glycaemic control in people with diabetes beyond that expected for weight loss, and understanding this additional effect could provide insights into the pathogenesis of type 2 diabetes and assist in the development of new procedures, devices, and drugs both for obese and non-obese patients.
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Affiliation(s)
- John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Dixon JB, Zimmet P, Alberti KG, Rubino F. Bariatric surgery: an IDF statement for obese Type 2 diabetes. ACTA ACUST UNITED AC 2012; 55:367-82. [PMID: 22011853 DOI: 10.1590/s0004-27302011000600003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 12/11/2022]
Abstract
The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m² or more.
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Affiliation(s)
- J B Dixon
- Baker IDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, Victoria 3004, Australia
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DePaula AL, Stival AR, DePaula CCL, Halpern A, Vencio S. Surgical treatment of type 2 diabetes in patients with BMI below 35: mid-term outcomes of the laparoscopic ileal interposition associated with a sleeve gastrectomy in 202 consecutive cases. J Gastrointest Surg 2012; 16:967-76. [PMID: 22350720 DOI: 10.1007/s11605-011-1807-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 11/01/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35. METHODS The procedures were performed on 202 consecutive patients. Mean age was 52.2 ± 7.5. Mean duration of T2DM was 9.8 ± 5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%. RESULTS Mean follow-up was 39.1 months (range, 25-61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m(2), mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A(1c) (HbA(1c)) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA(1c) below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications. CONCLUSION Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI <35. Beyond glycemic control, other benefits were achieved.
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Affiliation(s)
- Aureo L DePaula
- Department of Surgery, Hospital de Especialidades, Av. 136, no. 961, 14° andar, Setor Marista, 74.093-250, Goiânia, Goiás, Brazil.
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Reis CEG, Alvarez-Leite JI, Bressan J, Alfenas RC. Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index <35 kg/m2: a literature review. Diabetes Technol Ther 2012; 14:365-72. [PMID: 22176155 DOI: 10.1089/dia.2011.0127] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Bariatric surgery has been used to treat type 2 diabetes mellitus (T2DM); however, its efficacy is still debatable. This literature review analyzed articles that evaluated the effects of bariatric surgery in treatment of T2DM in obese patients with a body mass index (BMI) of <35 kg/m(2). A paired t test was applied for the analysis of pre- and postintervention mean BMI, fasting plasma glucose (FPG), and glycosylated hemoglobin (A1c) values. A significant (P<0.001) reduction in BMI (from 29.95±0.51 kg/m(2) to 24.83±0.44 kg/m(2)), FPG (from 207.86±8.51 mg/dL to 113.54±4.93 mg/dL), and A1c (from 8.89±0.15% to 6.35±0.18%) was observed in 29 articles (n=675). T2DM resolution (A1c <7% without antidiabetes medication) was achieved in 84.0% (n=567) of the subjects. T2DM remission, control, and improvement were observed in 55.41%, 28.59%, and 14.37%, respectively. Only 1.63% (n=11) of the subjects presented similar or worse glycemic control after the surgery. T2DM remission (A1c <6% without antidiabetes medication) was higher after mini-gastric bypass (72.22%) and laparoscopic/Roux-en-Y gastric bypass (70.43%). According to the Foregut and Hindgut Hypotheses, T2DM results from the imbalance between the incretins and diabetogenic signals. The procedures that remove the proximal intestine and do ileal transposition contribute to the increase of glucagon-like peptide-1 levels and improvement of insulin sensitivity. These findings provide preliminary evidence of the benefits of bariatric-metabolic surgery on glycemic control of T2DM obese subjects with a BMI of <35 kg/m(2). However, more clinical trials are needed to investigate the metabolic effects of bariatric surgery in T2DM remission on pre-obese and obese class I patients.
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Affiliation(s)
- Caio E G Reis
- School of Health Sciences, University of Brasília, Brasília, Brazil.
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Dixon JB, Straznicky NE, Lambert EA, Schlaich MP, Lambert GW. Surgical approaches to the treatment of obesity. Nat Rev Gastroenterol Hepatol 2011; 8:429-37. [PMID: 21727936 DOI: 10.1038/nrgastro.2011.112] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bariatric surgery, through its efficacy and improved safety, is emerging as an important and broadly available treatment for people with severe and complex obesity that has not responded adequately to other therapy. Established procedures, such as Roux-en-Y gastric bypass and adjustable gastric banding, account for more than 80% of bariatric surgical procedures globally. Sleeve gastrectomy has emerged as a stand-alone procedure. Truly malabsoptive procedures, such as biliopancreatic diversion and its duodenal switch variant, have a diminishing role as primary procedures, but remain an option for patients who do not respond adequately to less disruptive procedures. The procedures vary considerably in their postoperative morbidity and mortality; pattern and extent of weight loss; nature and severity of long-term complications; and nutritional requirements and risks. There is no perfect procedure--an informed risk and benefit assessment should be made by each patient. Gastroenterologists also need to be familiar with the risks and benefits of current and emerging procedures as they are likely to be increasingly involved in the integrated care of these patients.
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Affiliation(s)
- John B Dixon
- Baker IDI Heart & Diabetes Institute, PO Box 6492 St. Kilda Road Central, Melbourne, Vic 3004, Australia.
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Abstract
PURPOSE OF REVIEW To review the basic mechanisms of caloric intake reduction of bariatric surgery and its clinical and metabolic outcomes. To describe novel bariatric procedures, their effects on glucose homeostasis and insulin sensitivity and to explain the proposed mechanisms for type 2 diabetes mellitus (T2DM) resolution. RECENT FINDINGS The effects of surgically induced weight loss on T2DM have elucidated in part the role of proximal and distal gastrointestinal bypass on insulin sensitivity. A dual mechanism for improvement in glucose homeostasis after bariatric surgery has been proposed that appears to be weight loss independent. SUMMARY Bariatric surgery is the most effective therapy for obesity and obesity-related comorbidities today that provide high rates of resolution of T2DM with improvements in insulin resistance and β-cell function. Novel bariatric procedures offer a unique opportunity to understand the pathophysiology of T2DM and to identify potential pharmacologic targets for effective T2DM treatments and a potential cure.
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Affiliation(s)
- J Esteban Varela
- Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110, USA.
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Dixon J, Zimmet P, Alberti K, Rubino F. Bariatric surgery: An IDF statement for obese Type 2 diabetes. Obes Res Clin Pract 2011; 5:e169-266. [DOI: 10.1016/j.orcp.2011.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Laparoscopic sleeve gastrectomy with ileal interposition (SGIT): a modified duodenal switch for resolution of type 2 diabetes mellitus in lesser obese patients (BMI < 35). World J Surg 2011; 35:109-10. [PMID: 21052995 DOI: 10.1007/s00268-010-0845-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m(2) or more.
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Affiliation(s)
- J B Dixon
- Baker IDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, Victoria, Australia
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Dixon JB, Zimmet P, Alberti KG, Rubino F. Bariatric surgery: an IDF statement for obese Type 2 diabetes. Surg Obes Relat Dis 2011; 7:433-47. [PMID: 21782137 DOI: 10.1016/j.soard.2011.05.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2011] [Indexed: 01/06/2023]
Abstract
The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m(2) or more.
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Affiliation(s)
- J B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Affiliation(s)
- Andrei Keidar
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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