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He YF, Hu XD, Liu JQ, Li HM, Lu SF. Bariatric surgery and diabetes: Current challenges and perspectives. World J Diabetes 2024; 15:1692-1703. [DOI: 10.4239/wjd.v15.i8.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024] Open
Abstract
Diabetes mellitus (DM) and obesity have become public issues of global concern. Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach; however, there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM. In this review, we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM. I believe that our insights will be of great help to clinicians in their daily practice.
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Affiliation(s)
- Yan-Fei He
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Xiao-Dong Hu
- Department of Endocrinology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Jun-Qiang Liu
- Department of Thoracic Surgery, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Hu-Ming Li
- Department of Respiratory Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Shuang-Feng Lu
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
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Innovative Bariatric Procedures and Ethics in Bariatric Surgery: the IFSO Position Statement. Obes Surg 2022; 32:3217-3230. [PMID: 35922610 DOI: 10.1007/s11695-022-06220-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/17/2022] [Accepted: 07/24/2022] [Indexed: 02/06/2023]
Abstract
With the rise in obesity and bariatric procedures worldwide, there has been a surge in new and innovative procedures that has been increasingly offered to patients. In this position statement, IFSO highlights the importance of surgical ethics in innovation and when offering new procedures. Furthermore, the task force reviewed the current literature to describe which procedures can be offered as mainstream outside research protocols versus those that are still investigational and need further data.
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Singh D, Baksi A, Ramana P, Singla V, Aggarwal S. Five-Year Outcomes of Sleeve Gastrectomy in Patients with Class I Obesity and Type 2 Diabetes Mellitus. Obes Surg 2021; 32:96-102. [PMID: 34669109 DOI: 10.1007/s11695-021-05718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies have reported short and medium-term outcomes of laparoscopic sleeve gastrectomy (LSG) in patients with class I obesity and type 2 diabetes mellitus (T2DM). However, literature on outcomes beyond three years is scarce. The present study discusses the 5-year results of a previously reported cohort of 20 patients with class I obesity and T2DM, who had undergone LSG between March 2012 and March 2015. MATERIALS AND METHODS Patients were followed up in the bariatric clinic at yearly intervals as per institute protocol. Primary outcome was proportion of patients with a glycated haemoglobin (HbA1c) level of 6.5% or less, 5 years after LSG. Secondary outcomes were percentage total weight loss (%TWL), excess weight loss (EWL), weight regain and complications. RESULTS Out of 20 patients, 9 (45%) were male and 11 (55%) were female. Mean age was 41.6 ± 9.5 years. Mean pre-operative weight and BMI were 94.8 ± 14.4 kg and 33.4 ± 1.2 kg/m2, respectively. Median duration of diabetes was 42 months. Mean pre-operative fasting plasma glucose (FPG) and HbA1c were 171.1 ± 56.8 mg/dL and 8.7 ± 1.6%, respectively. Of the 17 patients available for follow-up at 5 years, 9 (52.9%) achieved HbA1c < 6.5% without medication, while 7 (41.2%) patients had improvement of their glycaemic status. One patient had recurrence of diabetes after initial remission. Mean %TWL and %EWL were 18% and 65.1%, respectively. CONCLUSION Laparoscopic sleeve gastrectomy is a reasonable option as a metabolic procedure for patients with T2DM and class I obesity.
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Affiliation(s)
- Devender Singh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Aditya Baksi
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Prasanna Ramana
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Vitish Singla
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India.
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Huang H, Lu J, Dai X, Li Z, Zhu L, Zhu S, Wu L. Improvement of Renal Function After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2021; 31:4470-4484. [PMID: 34355340 DOI: 10.1007/s11695-021-05630-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE The effect of bariatric surgery in renal function varies and the postoperative benefit time point remains unclear. We aim to assess the changes of renal function after bariatric surgery (BS) in different postoperative periods and subgroups. METHODS We searched the databases of PubMed and Cochrane from inception to December 14, 2020. Articles included in the study were drawn from all recipients of BS that provided assessments of renal function pre and post-surgery. Meta-analysis was performed to compare glomerular filtration rate (GFR), serum creatinine, albumin-to-creatinine ratio (ACR), and albuminuria before and after BS. RESULTS The study included 49 articles involving 8515 patients. Compared with pre-operative renal function, the overall analysis showed that bariatric surgery significantly reduced serum creatinine levels, ACR, and albuminuria. There was significant increase of GFR in the CKD subgroup, yet a noticeable decrease in the hyperfiltration subgroup. The most significant improvement in GFR was seen 6-12 months after BS, while ACR dropped most dramatically 12-24 months after BS. CONCLUSIONS Bariatric surgery can improve renal function in obese patients with kidney dysfunction, especially 1 year after surgery.
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Affiliation(s)
- Hongyan Huang
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510515, China
- UDM Medical Group, Guangzhou, 510515, China
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Jun Lu
- School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Xiaojiang Dai
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510515, China
- UDM Medical Group, Guangzhou, 510515, China
| | - Zhixin Li
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, 18 Grade, Changsha, 410013, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Liangping Wu
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510515, China.
- UDM Medical Group, Guangzhou, 510515, China.
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Bhandari M, Kosta S, Khurana M, Mathur W, Reddy MK, Fobi M. Emerging Procedures in Bariatric Metabolic Surgery. Surg Clin North Am 2021; 101:335-353. [PMID: 33743973 DOI: 10.1016/j.suc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand for bariatric/metabolic surgery worldwide. New procedures have been developed and changed the face of modern bariatric surgery. Gastrointestinal metabolic surgery is a new treatment modality for obesity-related type 2 diabetes mellitus for patients with body mass index greater than 35 kg/m2. Providing safe bariatric/metabolic surgery, training qualified bariatric surgeons, and developing better techniques are important issues. This article discusses emerging procedures; a multitude of bariatric metabolic procedures enables surgeons to tailor treatment to patients' needs.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India.
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Kumar Reddy
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
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Somogyi E, Hoornenborg CW, Bruggink JE, Nyakas C, van Beek AP, van Dijk G. Ileal transposition: A non-restrictive bariatric surgical procedure that reduces body fat and increases ingestion-related energy expenditure. Physiol Behav 2020; 219:112844. [PMID: 32081815 DOI: 10.1016/j.physbeh.2020.112844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ileal Transposition (IT) was developed as a model to study body weight reduction without the restrictive or malabsorptive aspects of other bariatric surgeries, but the exact mechanisms of the alterations in body weight after IT are not completely understood. OBJECTIVE To provide a detailed description of the surgical procedure of IT, and describe its effect on energy balance parameters. METHODS Adult male Lewis rats underwent either IT (IT+) or sham (IT-) surgery. Following surgery body weight and energy intake were monitored. After attaining weight stability (> 30 days), energy expenditure and its components were assessed using indirect calorimetry at a day of fasting, limited intake, and ad libitum intake. At the end of the study body composition analysis was performed. RESULTS IT+ resulted in transiently reduced energy intake, increased ingestion-related energy expenditure (IEE) and decreased body and adipose tissue weight when compared to IT-. At weight stability, neither energy budget (i.e., energy intake - energy expenditure), nor energy efficiency was different in IT+ rats compared to IT-. CONCLUSION Our data show that the primary cause of weight reduction following IT+ is a transient reduction in energy intake. If the increased IEE is related to a higher level of satiety, compensatory feeding to bridge body weight difference between IT+ and IT- rats is less likely to occur.
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Affiliation(s)
- E Somogyi
- School of Ph.D Studies, University of Physical Education, Budapest, Hungary; Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands; Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - C W Hoornenborg
- Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands; Department of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands
| | - J E Bruggink
- Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands
| | - C Nyakas
- School of Ph.D Studies, University of Physical Education, Budapest, Hungary; Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - A P van Beek
- Department of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands
| | - G van Dijk
- Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands.
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Ying LD, Breuer GA, Hubbard MO, Nadzam GS, Hwa J, Martin KA. Technical Feasibility of a Murine Model of Sleeve Gastrectomy with Ileal Transposition. Obes Surg 2019; 29:593-600. [PMID: 30353248 DOI: 10.1007/s11695-018-3555-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleeve gastrectomy with ileal transposition has been shown to be superior to sleeve gastrectomy alone for promoting weight loss in rat and porcine models. The absence of a mouse model for this procedure has impeded efforts to understand the molecular physiology underlying its efficacy. This study demonstrates the long-term survivability of sleeve gastrectomy with ileal transposition in mice. MATERIALS AND METHODS In this study of technical feasibility, a sleeve gastrectomy with ileal transposition (SGIT), sleeve gastrectomy (SG), or sham surgery (SH) was performed on 7- to 8-week-old C57Bl/6J mice (n = 8 for each). To evaluate long-term survivability, mice were placed on an obesogenic diet and weighed weekly for 10 weeks. The intestinal identity of the transposed segment was assessed with gene expression analysis of duodenal-, jejunal-, and ileal-specific hormones using quantitative polymerase chain reaction. RESULTS Overall, SGIT better prevented weight gain than the SG or sham procedures (10-week post-operative weight: SH 45.3 ± 1.0 g, SG 41.25 ± 1.6 g, SGIT 35.4 ± 0.8 g). Gene expression pattern analysis of three markers of intestinal identity (gastrin, cholecystokinin, and peptide YY) suggests that the ileal identity of the transposed segment is maintained 10 weeks after transposition. CONCLUSIONS We demonstrate for the first time a reproducible mouse model of sleeve gastrectomy with ileal transposition. Future studies utilizing this model will expand our understanding of the molecular pathways through which the hindgut regulates satiety.
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Affiliation(s)
- Lee D Ying
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Yale Cardiovascular Research Center, 300 George St, Room 759, New Haven, CT, 06511, USA
| | | | - Matthew O Hubbard
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Department of Gastrointestinal Surgery, Yale New Haven Health, New Haven, CT, 06511, USA
| | - Geoffrey S Nadzam
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Department of Gastrointestinal Surgery, Yale New Haven Health, New Haven, CT, 06511, USA
| | - John Hwa
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Yale Cardiovascular Research Center, 300 George St, Room 759, New Haven, CT, 06511, USA
| | - Kathleen A Martin
- Yale University School of Medicine, New Haven, CT, 06511, USA. .,Yale Cardiovascular Research Center, 300 George St, Room 759, New Haven, CT, 06511, USA.
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Early Results of Laparoscopic Sleeve Gastrectomy With Loop Bipartition. Surg Laparosc Endosc Percutan Tech 2019; 28:385-389. [PMID: 29782429 DOI: 10.1097/sle.0000000000000541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE We evaluated early results of this new procedure of transit loop bipartition with sleeve gastrectomy (TLB-SG), making a comparison with transit bipartition with sleeve gastrectomy. MATERIALS AND METHODS Between January 2017 and September 2017, 22 patients have undergone transit bipartition with sleeve gastrectomy or TLB-SG surgery in our clinic. Patients' body mass index, excess body mass index loss, and HOMA-IR were calculated before and after the surgical operation. The values of c-peptide, HgA1C, insulin, blood sugar, albumin, Hg, urea, creatinine, calcium, total cholesterol, 25-hydroxy vitamin D, and vitamin B12 were evaluated retrospectively. RESULTS Vitamin and mineral deficiency, malnutrition, and anemia were not observed in both groups during the follow-up process. The operation time was shorter in the TLB-SG operation. Both groups were found to be effective at the expected level in terms of weight loss, diabetes remission, and improvement. CONCLUSIONS TLB-SG is a more effective and simpler method, becoming a candidate for being the most frequently performed surgical operation, in the field of metabolic surgery.
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Ferraz ÁAB, de Sá VCT, Santa-Cruz F, Siqueira LT, Silva LB, Campos JM. Roux-en-Y gastric bypass for nonobese patients with uncontrolled type 2 diabetes: a long-term evaluation. Surg Obes Relat Dis 2019; 15:682-687. [PMID: 31005458 DOI: 10.1016/j.soard.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is growing evidence that the impact of Roux-en-Y gastric bypass (RYGB) on type 2 diabetes (T2D) occurs regardless of the amount of weight loss. Taking this background into consideration, it is plausible to study this procedure in individuals with lower body mass index (BMI) under clinical treatment failure for uncontrolled T2D. OBJECTIVES To elucidate the long-term impact of RYGB on T2D regression in a non-obese population. SETTING Hospital das Clínicas, Federal University of Pernambuco, Brazil. METHODS Twelve patients with BMI 25 to 30 kg/m2 and inadequately controlled T2D underwent RYGB and were followed up for 6 years. Fasting plasma glucose, glycated hemoglobin, BMI, and the use of insulin and/or oral hypoglycemic agents were assessed. Each variable was analyzed in 3 distinct moments: preoperative evaluation, 2-year postoperative follow-up (2-PO), and 6-year postoperative follow-up (6-PO). RESULTS There were no cases of early or late mortality. Mean BMI at preoperative evaluation, 2-PO, and 6-PO were 28.1 ± 1.2; 23.2 ± 2.4; and 24.7 ± 3.1, respectively. The lowest BMI at 6-PO was 19.1 kg/m2. Complete remission of T2D was achieved in 16.7%, partial remission in another 16.7%, glycemic control in 25%, and glycemic improvement in 25% of the sample at 6-PO; 16.7% did not present positive glycemic outcomes. Only 1 patient needed to resume insulin administration between 2-PO and 6-PO. CONCLUSIONS RYGB was found to be safe and effective in treating uncontrolled T2D in non-obese patients, providing improvements in the glycemic patterns in 83.4% of our sample.
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Affiliation(s)
- Álvaro A B Ferraz
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Vladimir C T de Sá
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Luciana T Siqueira
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | - Lyz B Silva
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | - Josemberg M Campos
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, 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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Abstract
Obesity prevalence continues to increase worldwide, as do the numerous chronic diseases associated with obesity, including diabetes, non-alcoholic fatty liver disease, dyslipidemia, and hypertension. The prevalence of bariatric surgery also continues to increase and remains the most effective and sustainable treatment for obesity. Over the last several years, numerous prospective and longitudinal studies have demonstrated the benefits of bariatric surgery on weight loss, mortality, and other chronic diseases. Even though the mechanisms underlying many of these beneficial effects remain poorly understood, surgical management of obesity continues to increase given its unmatched efficacy. In this commentary, we discuss recent clinical advancements as well as several areas needed for future research, including indications for bariatric and metabolic surgery, determination of responders and non-responders, metabolic surgery in non-obese individuals, and the evolving role of bariatric surgery in adolescents.
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Affiliation(s)
- Vance L Albaugh
- Department of Surgery, MCN CC-2308, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naji N Abumrad
- Department of Surgery, MCN CC-2308, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Yormaz S, Yılmaz H, Ece I, Sahin M. Laparoscopic Ileal Interposition with Diverted Sleeve Gastrectomy Versus Laparoscopic Transit Bipartition with Sleeve Gastrectomy for Better Glycemic Outcomes in T2DM Patients. Obes Surg 2018; 28:77-86. [PMID: 28681261 DOI: 10.1007/s11695-017-2803-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Metabolic procedures provide better outcomes for obese patients with type 2 diabetes mellitus. Our aim was to compare the glycemic regulation in patients that have undergone the laparoscopic ileal interposition with diverted sleeve gastrectomy (II-DSG), laparoscopic transit bipartition with sleeve gastrectomy (TB-SG), and laparoscopic sleeve gastrectomy (LSG) throughout a 12-month follow-up period retrospectively. METHODS This study considered patients with T2DM who underwent metabolic procedures. The postoperative changes in the glucose, C-peptide, HbA1c, HOMA-IR, insulin, cholesterol, body mass index, and total weight loss (TWL) were compared retrospectively. The intended outcome was to reach a long lasting fasting blood glucose (FBG) <126 mg/dl. A multivariate regression analysis was applied to define the predictive markers in glucose regulation. RESULTS Present study consisted of 83 patients with a mean age of 47.25 ± 6.58 years, mean preoperative BMI of 37.36 ± 2.71 kg/m2, and mean outcomes in the HbA1C and FBG of 9.05 ± 1.33% and 237 ± 15 mg/dl, respectively. There were similar correlations in BMI and total weight loss (TWL). At 12-month follow up period, compared to LSG group, TB-SG and II-DSG groups have higher remission proportions (35.3, 67.9, 54.7, respectively, p < 0.05) with similar TWL% (22.35, 27.14, 23.16%) outcomes. The II-DSG and TB-SG results drew closer together toward the end of this study interval unlike the LSG group. CONCLUSION Our results showed that II-DSG and TB-SG ensured significant regression rates during the follow-up period. Since the TB-SG achieved these outcomes by finite anastomoses and intervening segments, it was considered to be a superior procedure compared to II-DSG and LSG procedures.
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Affiliation(s)
- Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University Fakültesi Genel Cerrahi Polikliniği, 42075, Konya, Turkey.
| | - Huseyin Yılmaz
- Department of Surgery, Faculty of Medicine, Selcuk University Fakültesi Genel Cerrahi Polikliniği, 42075, Konya, Turkey
| | - Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University Fakültesi Genel Cerrahi Polikliniği, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University Fakültesi Genel Cerrahi Polikliniği, 42075, Konya, Turkey
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Gao Z, Wang B, Gong X, Yao C, Ren D, Shao L, Pang Y, Liu J. Effect of gastric bypass combined with ileal transportation on type 2 diabetes mellitus. Exp Ther Med 2018; 15:4571-4577. [PMID: 29725390 DOI: 10.3892/etm.2018.5928] [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: 04/08/2017] [Accepted: 12/08/2017] [Indexed: 01/14/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic progressive disease, which manifests as an endocrine disorder. Among the different methods of surgery available to treat patients with T2DM, Roux-en-Y gastric bypass (RYGBP) and ileal transposition (IT) are the most commonly performed. The aim of the present study was to investigate the effects of RYGBP combined with IT on rats with T2DM. A total of 8 healthy male rats were used as a control group and 40 GK rats were randomly divided into 5 groups: A diabetes mellitus (DM) group, a sham operative group (SO), a RYGBP group, an IT group and a RYGBP+IT group. The results demonstrated that fasting blood glucose, triglyceride, total cholesterol and gastric inhibitory polypeptide levels in all treatment groups were significantly lower than those of the SO and DM groups. Furthermore, levels TC and TG in the RYGBP+IT group were significantly lower than in the RYGBP and IT groups. Levels of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase mRNA and IRS-2 protein in all treatment groups were also significantly lower than those of the SO group; and they were significantly lower in the RYGBP+IT group compared with the RYGBP and IT groups. The expression of phosphorylated Akt in the treatment groups was significantly higher than the SO group and was significantly higher in the RYGBP+IT group compared with the RYGBP and IT groups. These results indicate that RYGBP and IT surgical treatment can induce T2DM remission by mediating the expression of insulin-related factors to reverse insulin resistance. The current study also indicated that the effect of RYGBP combined with IT may be developed as a novel first-line method of treating T2DM.
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Affiliation(s)
- Zhaoxia Gao
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Bin Wang
- Department of Ear-Nose-Throat, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Xiaojun Gong
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Chun Yao
- Department of Endocrinology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Defa Ren
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Liwei Shao
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Yan Pang
- Department of Clinical Laboratory, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Jinxiu Liu
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
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Kim YJ, Kim BH, Choi BM, Sun HJ, Lee SJ, Choi KS. Bariatric surgery is associated with less progression of diabetic retinopathy: A systematic review and meta-analysis. Surg Obes Relat Dis 2017; 13:352-360. [DOI: 10.1016/j.soard.2016.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 01/06/2023]
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Zhou X, Li L, Kwong JS, Yu J, Li Y, Sun X. Impact of bariatric surgery on renal functions in patients with type 2 diabetes: systematic review of randomized trials and observational studies. Surg Obes Relat Dis 2016; 12:1873-1882. [DOI: 10.1016/j.soard.2016.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/07/2016] [Accepted: 05/02/2016] [Indexed: 12/29/2022]
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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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Segal-Lieberman G, Segal P, Dicker D. Revisiting the Role of BMI in the Guidelines for Bariatric Surgery. Diabetes Care 2016; 39 Suppl 2:S268-73. [PMID: 27440842 DOI: 10.2337/dcs15-3018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Pesach Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Dicker
- Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Surgical cure for type 2 diabetes by foregut or hindgut operations: a myth or reality? A systematic review. Surg Endosc 2016; 31:25-37. [PMID: 27194257 DOI: 10.1007/s00464-016-4952-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery results in remission of type 2 diabetes mellitus in a significant proportion of patients. Animal research has proposed the foregut and hindgut hypotheses as possible mechanisms of remission of T2DM independent of weight loss. These hypotheses have formed the basis of investigational procedures designed to treat T2DM in non-obese (in addition to obese) patients. The aim of this study was to review the procedures that utilise the foregut and hindgut hypotheses to treat T2DM in humans. METHODS A systematic review was conducted to identify the investigational procedures performed in humans that are based on the foregut and hindgut hypotheses and then to assess their outcomes. RESULTS Twenty-four studies reported novel procedures to treat T2DM in humans; only ten utilised glycated haemoglobin A1c (HbA1c) in their definition of remission. Reported remission rates were 20-40 % for duodenal-jejunal bypass (DJB), 73-93 % for duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG), 62.5-100 % for duodenal-jejunal bypass sleeve (DJBS) and 47-95.7 % for ileal interposition with sleeve gastrectomy (II-SG). When using a predetermined level of HbA1c to define remission, the remission rates were lower (27, 63, 0 and 65 %) for DJB, DJB-SG, DJBS and II-SG. CONCLUSIONS The outcomes of the foregut- and hindgut-based procedures are not better than the outcomes of just one of their components, namely sleeve gastrectomy. The complexity of these procedures in addition to their comparable outcomes to a simpler operation questions their utility.
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Diverted sleeve gastrectomy with ileal transposition in overweight, obese, and morbidly obese patients with type 2 diabetes: results of 1-year follow-up. Surg Obes Relat Dis 2016; 12:541-549. [DOI: 10.1016/j.soard.2015.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/23/2015] [Accepted: 09/29/2015] [Indexed: 12/18/2022]
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Zhang P, Zhang H, Han X, DI J, Zhou Y, Li K, Zheng QI. Effectiveness and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus. Exp Ther Med 2016; 11:827-831. [PMID: 26997999 PMCID: PMC4774318 DOI: 10.3892/etm.2016.2973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/18/2015] [Indexed: 12/13/2022] Open
Abstract
Gastric bypass may be conducted to aid in glycemic control in adults with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the clinical results of diabetes remission and metabolic syndrome in individuals with T2DM after undergoing a gastric bypass. A total of 85 patients (39 men and 46 women) with T2DM underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). Data regarding patient demographics, body mass index (BMI), co-morbidities and details of diabetes mellitus, including disease duration, remission, β-cell function, blood lipid levels and nutritive status were prospectively collected and analyzed. The mean duration from the onset of T2DM was 7.79±4.84 years (range, 1 month to 22 years). The preoperative mean BMI was 31.60±4.10 (range, 28.53–48.10 kg/m2), mean percentage of body fat was 36.35±9.12% (range, 18–56%), and the mean HbA1c was 8.32±2.13% (range, 7–15.9%). Five patients (5.9%) developed complications without mortality. T2DM and β-cell function were significantly improved from by month 6 after surgery (P<0.05). Improvements in central obesity, blood pressure (BP; systolic and diastolic) control, blood lipid levels were observed, without malnutrition or severe anemia. Therefore, the present results indicate that laparoscopic RYGBP is a safe and effective procedure for improving glycemic control, obesity, body fat percentage and BP in patients with T2DM and obesity.
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Affiliation(s)
- Pin Zhang
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Hongwei Zhang
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Xiaodong Han
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Jianzhong DI
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Yulong Zhou
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Kun Li
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Q I Zheng
- Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
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Borges MDC, Terra GA, Takeuti TD, Ribeiro BM, Silva AA, Terra-Júnior JA, Rodrigues-Júnior V, Crema E. IMMUNOLOGICAL EVALUATION OF PATIENTS WITH TYPE 2 DIABETES MELLITUS SUBMITTED TO METABOLIC SURGERY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:266-9. [PMID: 26734798 PMCID: PMC4755180 DOI: 10.1590/s0102-6720201500040012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/31/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus. AIM To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells. METHODS Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient. RESULTS No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients. CONCLUSION These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.
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Affiliation(s)
| | | | - Tharsus Dias Takeuti
- Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | - Alex Augusto Silva
- Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | | | - Eduardo Crema
- Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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Laparoscopic Roux-en-Y gastric bypass with ileal transposition - an alternative surgical treatment for type 2 diabetes mellitus and gastroesophageal reflux. Wideochir Inne Tech Maloinwazyjne 2015; 10:481-5. [PMID: 26649100 PMCID: PMC4653271 DOI: 10.5114/wiitm.2015.54224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/05/2015] [Accepted: 08/19/2015] [Indexed: 12/02/2022] Open
Abstract
Currently, type 2 diabetes mellitus (T2DM) is considered as a gastrointestinal disease. Numerous studies have demonstrated that bariatric operations ameliorate T2DM significantly. The laparoscopic Roux-en-Y gastric bypass (L-RYGB) is considered as the gold standard procedure. We aimed to evaluate the feasibility and impact of L-RYGB with ileal transposition (or interposition) on diabetes resolution in a patient who has not benefited from any medical therapy, with its additional effect on the amelioration of gastroesophageal reflux disease. The patient was a 38-year-old diabetic woman with uncontrolled blood glucose despite medical treatment, with additional gastroesophageal reflux disease. Following the procedure, her biochemical parameters and reflux symptoms improved significantly within 10 months. We think that L-RYGB with ileal transposition may be easily employed to gain a maximum effect in diabetics with adverse prognosis. This technique may be an alternative in the treatment of type 2 diabetic patients with gastroesophageal reflux.
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Ileal interposition surgery for treatment of type 2 diabetes mellitus-pros and cons. J Diabetes Metab Disord 2015; 14:77. [PMID: 26451349 PMCID: PMC4597394 DOI: 10.1186/s40200-015-0202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/05/2015] [Indexed: 12/19/2022]
Abstract
Nowadays, the surgical techniques for treating type 2 diabetes (T2DM) include: Ileal Interposition (II), Ileal Interposition in combination with Sleeve Gastrectomy (IISG) and Diverted Sleeve Gastrectomy (IIDSG). These procedures are not only for obese subjects, but are also used for non-obese subjects. These types of surgical procedures can improve glycemic control, and lead to a significant reduction in oral hypoglycemic agents (OHAs) and insulin therapy. The results of various studies have shown the safety, feasibility, and efficacy of the surgical procedure for the treatment of T2DM. Although it is an effective treatment option, this procedure is not recommended for general use and long-term studies are needed to confirm these findings and potential side effects on a larger number of patients.
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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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Rao WS, Shan CX, Zhang W, Jiang DZ, Qiu M. A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI ≤ 35 kg/m2 undergoing Roux-en-Y gastric bypass. World J Surg 2015; 39:223-30. [PMID: 25159119 DOI: 10.1007/s00268-014-2751-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is effective for type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) >35 kg/m(2). It is unknown whether it benefits those with a BMI ≤ 35 kg/m(2). In the last decade, the effect of bariatric procedures on metabolic outcomes in individuals who underwent surgery outside National Institutes of Health (NIH) guidelines (BMI ≤ 35 kg/m(2)) was both interesting and controversial. OBJECTIVE We performed a systematic analysis evaluating the effect of RYGB for T2DM patients with a BMI ≤ 35 kg/m(2). METHODS We searched databases (Embase, Ovid, PubMed, China National Knowledge Infrastructure [CNKI], and Cochrane Library) and relevant journals between January 1980 and October 2013. Keywords used in electronic searching included 'diabetes', 'gastric bypass', 'BMI', and 'body mass index'. Inclusion criteria were as follows: (1) patients who underwent RYGB; (2) sample size ≥ 15; (3) patients with a BMI ≤ 35 kg/m(2); and (4) follow-up ≥ 12 months. Exclusion criteria were as follows: (1) data extracted from a database; (2) trials for sleeve gastrectomy; (3) trials for laparoscopic banding; (4) trials for bilio-pancreatic diversion; and (5) trials for duodenojejunal bypass. Participants and intervention type 2 diabetes patients with BMI ≤ 35 kg/m(2) who underwent RYGB. Two investigators reviewed all reported studies independently. Data were extracted according to previously defined endpoints. A meta-analysis was performed for these parameters, with homogeneity among different trials. RESULTS Nine articles fulfilled inclusion criteria. After 12 months, patients with T2DM had a significant decrease in their BMI postoperatively (p < 0.00001, weighted mean difference [WMD] -7.42, 95 % confidence interval [CI] -8.87 to -5.97), and remission of diabetes (glucose: p < 0.00001, WMD -59.87, 95 % CI -67.74 to -52.01; hemoglobin A1c p < 0.00001, WMD -2.76, 95 % CI -3.41 to -2.11). There were no deaths in all trials, and the complication rate was between 6.7 and 25.9 %. Mean length of hospital stay was 2.00 to 3.20 days, and mean operative time was from 72.8 to 112.0 min. In terms of study limitations, publication and selection bias were unavoidable. Trials with small sample sizes were excluded, which may lead to a selection bias. CONCLUSION RYGB was effective for T2DM patients with BMI ≤ 35 kg/m(2). Further clinical studies with long-term follow-up data are necessary to clarify this issue.
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Affiliation(s)
- Wen-Sheng Rao
- Department of General Surgery, Shanghai Changzheng Hospital, Affiliated to the Second Military Medical University, 415 FengYang Road, Huangpu District, Shanghai, 200003, China
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Baskota A, Li S, Dhakal N, Liu G, Tian H. Bariatric Surgery for Type 2 Diabetes Mellitus in Patients with BMI <30 kg/m2: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0132335. [PMID: 26167910 PMCID: PMC4500506 DOI: 10.1371/journal.pone.0132335] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/14/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The role of bariatric surgery in non-obese patients with type 2 diabetes (T2DM) remains unclear, and its use in clinical practice is controversial. We conducted a systemic review and meta-analysis to investigate the metabolic changes after surgical treatment in diabetic patients with body mass index (BMI) <30 kg/m2. METHODS We conducted a comprehensive search in MEDLINE (PubMed), EMBASE and the Cochrane Library of published articles from January 2000 to April 2013 reporting the clinical outcome changes in various metabolic outcomes in diabetic patients with BMI <30 kg/m2. RESULTS Ten prospective studies including 290 patients were included in the meta-analysis. Bariatric surgery led to an overall 2.79 kg/m2 [95%CI 2.05~3.53, P<0.00001] reduction in BMI, a 1.88%[95%CI 1.32~2.43, P<0.00001] reduction in glycosylated hemoglobin, a 3.70 mmol/L [95%CI, 1.93~5.47, P<0.00001] reduction in fasting blood glucose, a 6.69 mmol/L [95%CI, 2.29~11.08, P=0.003] reduction in postprandial glucose, anda 3.37 [95%CI 0.55~6.18, P=0.02] reduction in homeostasis model assessment of insulin resistance (HOMA-IR). After surgical treatment, 76.2% of the patients were insulin free, and 61.8% patients were off medication. In total, 90(42.4%), 10(37%) and 34(37.2%) patients had post-surgical HbA1c levels of <6%,<6.5% and<7%, respectively. No deaths were observed in the included studies, and the major complication rate was 6.2%. CONCLUSIONS Based on the currently available data, bariatric surgery might improve glycemic control and weight loss in a very limited range with a doubled surgical complication rate in drug-refractory T2DM patients with BMI <30 kg/m2. It remains too premature to suggest bariatric surgery for non-obese T2DM patients.
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Affiliation(s)
- Attit Baskota
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Niharika Dhakal
- Department of Anesthesiology and Pain management, West China Hospital, Sichuan University, Chengdu, China
| | - Guanjian Liu
- Chinese Evidence-Based Medicine/Cochrane Center, Chengdu, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- * E-mail:
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Ramakrishnapillai P, Pai M, Shams F, Kumar P, Shaji PS, Anithadevi TS, Sulfia PJ, Krishna V. Effectiveness of Minimally Invasive Hybrid Surgery for Ileal Interposition (MIHSII) for the Resolution of Type 2 Diabetes. Surg Innov 2015; 23:42-51. [PMID: 26056095 DOI: 10.1177/1553350615589523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the effectiveness of minimally invasive hybrid surgery for ileal interposition (MIHSII), a novel procedure for type 2 diabetes (T2DM) in patients with a body mass index (BMI) <30 kg⁄m(2). MATERIALS AND METHODS MIHSII is an innovative technique in which sleeve gastrectomy is performed laparoscopically, followed by extracorporeal ileal interposition performed through a 5-cm midline incision. The procedure was performed on 31 T2DM patients, 17 males and 14 females. Their BMI values ranged from 21.8 kg/m(2) to 29.8 kg/m(2), with a mean BMI of 26.61 ± 2.61 kg/m(2). The average duration of diabetes 8.14 ± 4.89 (range = 1-20) years. Most of the patients exhibited poorly controlled diabetes despite the use of oral hypoglycemic agents (OHAs) and/or insulin. RESULTS The mean preoperative glycosylated hemoglobin (HbA1c) for the population was 8.86%. The mean HbA1c 1 year after surgery was 6.80%. The difference between the mean preoperative and 1-year postoperative HbA1c values was significant, at P < .05 (group 1: BMI = 18.5-24.99 kg/m(2), t = 2.83, and P = .022; group 2: BMI = 25-29.99 kg/m(2), t = 4.23, and P = .001). The resolution rate of diabetes was 80.48%; 48.57% experienced complete resolution, and 31.91% experienced partial resolution. The remaining 19.52% of patients exhibited a significant reduction in HbA1c, although the HbA1c levels did not fall below 6.5%, even with medications. CONCLUSION MIHSII is an innovative technique of metabolic surgery and is a cost-effective and minimal procedure for the resolution of T2DM in patients with BMI <30 kg/m(2).
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Affiliation(s)
| | | | | | | | - P S Shaji
- Sunrise Hospital, Kakkanad, Kochi, India
| | | | - P J Sulfia
- Sunrise Hospital, Kakkanad, Kochi, India
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Surgical Versus Medical Treatment of Type 2 Diabetes Mellitus in Nonseverely Obese Patients. Ann Surg 2015; 261:421-9. [DOI: 10.1097/sla.0000000000001014] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Influence of peri-duodenal non-constrictive cuff on the body weight of rats. Obes Surg 2014; 25:366-72. [PMID: 25479833 PMCID: PMC4297289 DOI: 10.1007/s11695-014-1519-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Weight loss has been found to improve or resolve cardiovascular comorbidities. There is a significant need for reversible device approaches to weight loss. METHODS Non-constrictive cuff (NCC) is made of implantable silicone rubber with an internal diameter greater than the duodenum. Ten or 11 NCC were individually mounted along the duodenum from the pyloric sphincter toward the distal duodenum to cover ~22 mm in the length. Twelve Wistar rats were implanted with NCC, and six served as sham, and both groups were observed over 4 months. Six rats with implant had their NCC removed and were observed for additional 4 weeks. RESULTS The food intake decreased from 40.1 to 28.1 g/day after 4 months of NCC implant. The body weight gain decreased from 1.76 to 0.46 g/day after 4 months of NCC implant. The fasting glucose decreased from 87.7 to 75.3 mg/dl at terminal day. The duodenal muscle layer covered by the NCC increased from 0.133 to 0.334 mm. After 4 weeks of NCC removal, the food intake, body weight gain, and fasting glucose recovered to 36.2, 2.51 g/day, and 83.9 mg/dl. The duodenal muscle layer covered by the NCC decreased to 0.217 mm. CONCLUSION The NCC implant placed on the proximal duodenum is safe in rats for a 4-month period. The efficacy of the NCC implant is significant for decrease in food intake, body weight gain, and fasting glucose in a normal rat model. The removal of NCC implant confirmed a cause-effect relation with food intake and hence body weight.
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Campos JM, Lins DC, Silva LB, Araujo-Junior JGC, Zeve JLM, Ferraz ÁAB. Metabolic surgery, weight regain and diabetes re-emergence. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26 Suppl 1:57-62. [PMID: 24463901 DOI: 10.1590/s0102-67202013000600013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/22/2013] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The poor success of clinical treatment of Type 2 Diabetes Mellitus (T2DM2) increased interest in metabolic surgery, which has been considered a promising alternative for the control of obese or non-obese diabetics. However, there is still no long-term follow-up to evaluate the duration of diabetes remission, and if weight regain would be associated to recurrence. AIM 1) To describe the results of diabetic patients with a BMI < 30 and < 35 kg/m² submitted to the following types of metabolic surgery: ileal interposition and sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), adjustable gastric banding, duodeno-jejunal exclusion and duodeno-jejunal bypass; 2) to evaluate the possible relapse of diabetes after occurrence of weight regain on long-term after bariatric surgery. METHOD An expositive and historical literature review about metabolic surgery in diabetic patients with BMI < 30 and < 35 kg/m² was conducted, and systematic review of the association between disease relapse and weight regain after bariatric surgery. RESULTS After analysis of 188 published papers on Medline until 2010, three papers were selected, which included 269 patients who underwent RYGB. Pre-operatory BMI was between 37 and 60 kg/m² and follow-up of three to 16 years. CONCLUSIONS 1) Two studies showed association between weight regain and recurrence of type 2 diabetes, while the third did not show this association when comparing groups with and without weight regain; 2) metabolic surgery has shown adequate control of T2DM2 in class I obese subjects; however, the non-obese group still need a long-term evaluation, considering the risk of diabetes recurrence when after weight regain.
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Abstract
To date, weight loss surgeries are the most effective treatment for obesity and glycemic control in patients with type 2 diabetes. Roux-en-Y gastric bypass surgery (RYGB) and sleeve gastrectomy (SG), two widely used bariatric procedures for the treatment of obesity, induce diabetes remission independent of weight loss while glucose improvement after adjustable gastric banding (AGB) is proportional to the amount of weight loss. The immediate, weight-loss independent glycemic effect of gastric bypass has been attributed to postprandial hyperinsulinemia and an enhanced incretin effect. The rapid passage of nutrients into the intestine likely accounts for significantly enhanced glucagon like-peptide 1 (GLP-1) secretion, and postprandial hyperinsulinemia after GB is typically attributed to the combined effects of elevated glucose and GLP-1. For this review we focus on the beneficial effects of the three most commonly performed bariatric procedures, RYGB, SG, and AGB, on glucose metabolism and diabetes remission. Central to this discussion will be the extent to which the effects of surgery are mediated by GLP-1. Better understanding of these mechanisms could provide insight to development of novel therapeutic strategies for treatment of diabetes as well as refinement of surgical techniques.
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Affiliation(s)
- Marzieh Salehi
- Department of Internal Medicine, Division of Endocrinology, Diabetes, & Metabolism, University of Cincinnati College of Medicine, 260 Stetson, Suite 4200, Cincinnati, OH 45219-0547 USA
| | - David A. D’Alessio
- Department of Internal Medicine, Division of Endocrinology, Diabetes, & Metabolism, University of Cincinnati College of Medicine, 260 Stetson, Suite 4200, Cincinnati, OH 45219-0547 USA
- Cincinnati VA Medical Center, Cincinnati, OH USA
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Wentworth JM, Playfair J, Laurie C, Ritchie ME, Brown WA, Burton P, Shaw JE, O'Brien PE. Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial. Lancet Diabetes Endocrinol 2014; 2:545-52. [PMID: 24731535 DOI: 10.1016/s2213-8587(14)70066-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Bariatric surgery improves glycaemia in obese people with type 2 diabetes, but its effects are uncertain in overweight people with this disease. We aimed to identify whether laparoscopic adjustable gastric band surgery can improve glucose control in people with type 2 diabetes who were overweight but not obese. METHODS We did an open-label, parallel-group, randomised controlled trial between Nov 1, 2009, and June 30, 2013, at one centre in Melbourne, Australia. Patients aged 18-65 years with type 2 diabetes and a BMI between 25 and 30 kg/m2 were randomly assigned (1:1), by computer-generated random sequence, to receive either multidisciplinary diabetes care plus laparoscopic adjustable gastric band surgery or multidisciplinary diabetes care alone. The primary outcome was diabetes remission 2 years after randomisation, defined as glucose concentrations of less than 7.0 mmol/L when fasting and less than 11.1 mmol/L 2 h after 75 g oral glucose, at least two days after stopping glucose-lowering drugs. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000286246. FINDINGS 51 patients were randomised to the multidisciplinary care plus gastric band group (n=25) or the multidisciplinary care only group (n=26), of whom 23 participants and 25 participants, respectively, completed follow-up to 2 years. 12 (52%) participants in the multidisciplinary care plus gastric band group and two (8%) participants in the multidisciplinary care only group achieved diabetes remission (difference in proportions 0.44, 95% CI 0.17-0.71; p=0.0012). One (4%) participant in the gastric band group needed revisional surgery and four others (17%) had a total of five episodes of food intolerance due to excessive adjustment of the band. INTERPRETATION When added to multidisciplinary care, laparoscopic adjustable gastric band surgery for overweight people with type 2 diabetes improves glycaemic control with an acceptable adverse event profile. Laparoscopic adjustable gastric band surgery is a reasonable treatment option for this population. FUNDING Monash University Centre for Obesity Research and Education and Allergan.
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Affiliation(s)
- John M Wentworth
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia; Molecular Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, Australia
| | - Julie Playfair
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia
| | - Cheryl Laurie
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia
| | - Matthew E Ritchie
- Molecular Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, Australia
| | - Wendy A Brown
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia
| | - Paul Burton
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul E O'Brien
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia.
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The better effect of Roux-en-Y gastrointestinal reconstruction on blood glucose of nonobese type 2 diabetes mellitus patients. Am J Surg 2014; 207:877-81. [DOI: 10.1016/j.amjsurg.2013.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 06/15/2013] [Accepted: 06/20/2013] [Indexed: 01/06/2023]
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Deitel M. A brief history of the surgery for obesity to the present, with an overview of nutritional implications. J Am Coll Nutr 2014; 32:136-42. [PMID: 24015720 DOI: 10.1080/07315724.2013.797854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Massive obesity results in serious diseases, which are a major public health problem. Surgery is frequently the only means to achieve and sustain significant weight loss. This historical overview is aimed at providing knowledge and appreciation of this surgery to scientists in other complex areas of nutrition. The development of these operations is provided, including their potential nutritional sequelae. Because type 2 diabetes frequently improves or resolves postoperatively, related operations are being investigated in patients with lower weights.
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Affiliation(s)
- Mervyn Deitel
- a Editor-in-Chief Emeritus and Founding Editor, Obesity Surgery , Toronto , Ontario , CANADA
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Patel JV, Alexander M, Flinders P. Diabetes mellitus: the Latin American paradox. Int J Clin Pract 2013; 67:1217-8. [PMID: 24246201 DOI: 10.1111/ijcp.12257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- J V Patel
- Academic Medicine Society, School of Medicine, University of Nottingham Medical School, Royal Derby Hospital, Derby, UK.
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Allen RE, Hughes TD, Ng JL, Ortiz RD, Ghantous MA, Bouhali O, Froguel P, Arredouani A. Mechanisms behind the immediate effects of Roux-en-Y gastric bypass surgery on type 2 diabetes. Theor Biol Med Model 2013; 10:45. [PMID: 23849268 PMCID: PMC3726422 DOI: 10.1186/1742-4682-10-45] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/10/2013] [Indexed: 02/08/2023] Open
Abstract
Background The most common bariatric surgery, Roux-en-Y gastric bypass, leads to glycemia normalization in most patients long before there is any appreciable weight loss. This effect is too large to be attributed purely to caloric restriction, so a number of other mechanisms have been proposed. The most popular hypothesis is enhanced production of an incretin, active glucagon-like peptide-1 (GLP-1), in the lower intestine. We therefore set out to test this hypothesis with a model which is simple enough to be robust and credible. Method Our method involves (1) setting up a set of time-dependent equations for the concentrations of the most relevant species, (2) considering an “adiabatic” (or quasi-equilibrium) state in which the concentrations are slowly varying compared to reaction rates (and which in the present case is a postprandial state), and (3) solving for the dependent concentrations (of e.g. insulin and glucose) as an independent concentration (of e.g. GLP-1) is varied. Results Even in the most favorable scenario, with maximal values for (i) the increase in active GLP-1 concentration and (ii) the effect of GLP-1 on insulin production, enhancement of GLP-1 alone cannot account for the observations. I.e., the largest possible decrease in glucose predicted by the model is smaller than reported decreases, and the model predicts no decrease whatsoever in glucose ×insulin, in contrast to large observed decreases in homeostatic model assessment insulin resistance (HOMA-IR). On the other hand, both effects can be accounted for if the surgery leads to a substantial increase in some substance that opens an alternative insulin-independent pathway for glucose transport into muscle cells, which perhaps uses the same intracellular pool of GLUT-4 that is employed in an established insulin-independent pathway stimulated by muscle contraction during exercise. Conclusions Glycemia normalization following Roux-en-Y gastric bypass is undoubtedly caused by a variety of mechanisms, which may include caloric restriction, enhanced GLP-1, and perhaps others proposed in earlier papers on this subject. However, the present results suggest that another possible mechanism should be added to the list of candidates: enhanced production in the lower intestine of a substance which opens an alternative insulin-independent pathway for glucose transport.
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Affiliation(s)
- Roland E Allen
- Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843, USA.
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Kim WS, Kim JW, Ahn CW, Choi SH. Resolution of type 2 diabetes after gastrectomy for gastric cancer with long limb Roux-en Y reconstruction: a prospective pilot study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:88-93. [PMID: 23396643 PMCID: PMC3566474 DOI: 10.4174/jkss.2013.84.2.88] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/14/2012] [Accepted: 12/04/2012] [Indexed: 01/06/2023]
Abstract
PURPOSE It is unclear whether metabolic surgery is effective in non obese type 2 diabetes mellitus (T2DM) and the result after gastrectomy and conventional reconstruction for gastric cancer with non obese T2DM are not satisfactory for improvement of T2DM. Prospective single-arm pilot study with long limb Roux-en Y reconstruction after gastrectomy was evaluated on its safety and efficacy as a potential cure for T2DM in patients with non obese gastric cancer. METHODS Fifteen patients with non obese T2DM and gastric cancer were enrolled. After gastrectomy, the gastrointestinal tract was reconstructed by Roux-en Y gastrojejunostomy or esophagojejunostomy. The biliopancreatic and Roux limb were 100 to 120 cm long each. RESULTS There was no surgery-related mortality, but four cases experienced complications (26.7%). Before surgery, the mean body mass index was 25.2 ± 3.4 kg/m(2) and mean glycated hemoglobin (HbA1c) was 7.7 ± 1.4% with antidiabetic medications. The mean BMI decreased to 21.7 ± 3.1 kg/m(2) (P < 0.05) and the mean HbA1c decreased to 6.3 ± 0.8% (P < 0.05) 6 months after surgery. At the end of the study (follow-up duration, 12.5 ± 5.5 months), HbA1c decreased to <6% in 11 patients (78.6%) without any antidiabetic medications. There were no patients who had anemia, and/or malnutrition after surgery except one patient who died due to recurrence four months after surgery. CONCLUSION Long limb Roux-en Y reconstruction after gastrectomy is feasible and has the potential to cure T2DM in non obese gastric cancer patients. A randomized controlled trial is needed to confirm this result.
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Affiliation(s)
- Whan Sik Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Ahn
- Department of Endocrinology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zhu L, Mo Z, Yang X, Liu S, Wang G, Li P, Tan J, Ye F, Strain J, Im I, Zhu S. Effect of laparoscopic Roux-en-Y gastroenterostomy with BMI<35 kg/m(2) in type 2 diabetes mellitus. Obes Surg 2013; 22:1562-7. [PMID: 22692669 DOI: 10.1007/s11695-012-0694-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RGB) has been endorsed by the "First World Congress on International Therapies for Type 2 diabetes" as a possible therapeutic option in patients with type 2 diabetes with a body mass index (BMI) of less than 35 kg/m(2). In the present study, we assessed the improvement in clinical indicators associated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with non-obese type 2 diabetes mellitus (T2DM). METHODS LRYGB was performed in 30 T2DM patients with a BMI <35 kg/m(2). The patients were followed up for 1 year. Pre- and postoperative changes in BMI, waist circumference, and biochemical indicators including fasting plasma glucose and glycosylated hemoglobin were recorded. RESULTS Significant reduction in glycosylated hemoglobin from 8.02 ± 1.77 to 5.59 ± 1.02 % (p < 0.05) at 12 months was noted. Diabetes was completely resolved in nine cases, resulting in discontinuation of diabetes-related medication. No significant surgical complications occurred. CONCLUSIONS LRYGB is beneficial for non-obese T2DM patients in China.
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Affiliation(s)
- Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China
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Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation. Obes Surg 2013; 22:1496-506. [PMID: 22926715 DOI: 10.1007/s11695-012-0679-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A systematic review and economic evaluation was commissioned to determine the effectiveness and cost-effectiveness of bariatric surgery for mild [class I, body mass index (BMI) 30 to 34.99] or moderate (class II, BMI 35 to 39.99) obesity. METHODS We searched 17 electronic resources (to February 2010) and other sources. Studies meeting predefined criteria were identified, data-extracted and assessed for risk of bias using standard methodology. A model was developed to estimate cost-effectiveness. RESULTS Two RCTs were included. Evidence from both indicated a statistically significant benefit from laparoscopic adjustable banding (LAGB) compared to a non-surgical comparator for weight loss and in obesity-related comorbidity. Both interventions were associated with adverse events. LAGB costs more than non-surgical management. For people with class I or II obesity and type 2 diabetes (T2D), the incremental cost-effectiveness ratio (ICER) at 2 years is £20,159, reducing to £4,969 at 5 years and £1,634 at 20 years. Resolution of T2D makes the greatest contribution to this reduction. In people with class I obesity, the ICER is £63,156 at 2 years, £17,158 at 5 years, and £13,701 at 20 years. Cost-effectiveness results are particularly sensitive to utility gain from reduction in BMI, factors associated with poorer surgical performance and diabetes health state costs. CONCLUSIONS Bariatric surgery appears to be a clinically effective and cost-effective intervention for people with class I or II obesity who also have T2D but is less likely to be cost-effective for people with class I obesity.
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Shrestha C, He H, Liu Y, Zhu S, Xiong J, Mo Z. Changes in Adipokines following Laparoscopic Roux-en-Y Gastric Bypass Surgery in Chinese Individuals with Type 2 Diabetes Mellitus and BMI of 22-30 kg·m(-2.). Int J Endocrinol 2013; 2013:240971. [PMID: 23690771 PMCID: PMC3652206 DOI: 10.1155/2013/240971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/17/2013] [Accepted: 03/19/2013] [Indexed: 01/16/2023] Open
Abstract
Aims. Although altered endocrine changes following bariatric surgery in morbidly obese patients with diabetes have been demonstrated by previous studies, little is known about their effects on low BMI patients of T2DM. We investigated the changes in adipokines and sICAM-1 in Chinese subjects with low BMI and T2DM after LRYGB and explored their relationship with postsurgical insulin sensitivity. Methods. Plasma levels of adiponectin, sICAM-1, fasting glucose, glycated hemoglobin, and fasting insulin and serum levels of visfatin were measured before and at three months after LRYGB in 33 T2DM patients with BMI of 22-30 kg·m(-2). Results. Significant reductions in anthropometric measurements and indicators of glucose and lipid metabolism and moderate reductions in insulin resistance and fasting insulin were observed at three months after LRYGB. Postoperative adiponectin level (P < 0.001) was increased compared to the preoperative level, whereas visfatin (P < 0.001) and sICAM-1 (P < 0.001) were lower than that before surgery. Serum adiponectin negatively correlated with HOMA-IR and FIns both preoperatively and at three months after surgery, and visfatin positively correlated with HOMA-IR and FIns both preoperatively and postoperatively. Conclusion. Changes in adipokines were related to an improvement in postsurgical insulin sensitivity, which was predicted by weight loss after LRYGB even in low BMI patients with T2DM.
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Affiliation(s)
- Chandrama Shrestha
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Honghui He
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Yiqun Liu
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Shaihong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Jing Xiong
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zhaohui Mo
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
- *Zhaohui Mo:
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Shrestha C, Zhao L, Chen K, He H, Mo Z. Enhanced healing of diabetic wounds by subcutaneous administration of human umbilical cord derived stem cells and their conditioned media. Int J Endocrinol 2013; 2013:592454. [PMID: 24089612 PMCID: PMC3781996 DOI: 10.1155/2013/592454] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/20/2013] [Indexed: 12/12/2022] Open
Abstract
Objective. Mesenchymal stem cells (MSCs) isolated from the umbilical cord and their conditioned media (CM) can be easily obtained and refined compared with stem cells from other sources. Here, we explore the possibility of the benefits of these cells in healing diabetic wounds. Methodology and Results. Delayed wound healing animal models were established by making a standard wound on the dorsum of eighteen db/db mice, which were divided into three groups with six mice in each: groups I, II, and III received PBS, UC-MSC, and CM, respectively. UC-MSC and their CM significantly accelerated wound closure compared to PBS-treated wounds, and it was most rapid in CM-injected wounds. In day-14 wounds, significant difference in capillary densities among the three groups was noted (n = 6; P < 0.05), and higher levels of VEGF, PDGF, and KGF expression in the CM- and UC-MSC-injected wounds compared to the PBS-treated wounds were seen. The expression levels of PDGF- β and KGF were higher in CM-treated wounds than those in UC-MSC-treated wounds. Conclusion. Both the transplantation of UC-MSC and their CM are beneficial to diabetic wound healing, and CM has been shown to be therapeutically better than UC-MSC, at least in the context of diabetic wound healing.
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Affiliation(s)
- Chandrama Shrestha
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Liling Zhao
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ke Chen
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Honghui He
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Zhaohui Mo
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital, Central South University, Changsha 410013, China
- *Zhaohui Mo:
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Ruiz-Tovar J, Oller I, Tomas A, Llavero C, Arroyo A, Calero A, Martinez-Blasco A, Calpena R. Midterm Impact of Sleeve Gastrectomy, Calibrated with a 50-Fr Bougie, on Weight Loss, Glucose Homeostasis, Lipid Profiles, and Comorbidities in Morbidly Obese Patients. Am Surg 2012. [DOI: 10.1177/000313481207800937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bariatric surgery has been shown to be effective in achieving and maintaining weight change and reducing obesity-related comorbidities. Recent reports have shown that sleeve gastrectomy could have similar resolution rates of the metabolic syndrome than Roux-Y bypass after a short-term follow-up of 1 year. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. There is little mid- and long-term information available about the evolution of these comorbidities with this procedure and with calibration of the sleeve with a 50-Fr bougie. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy, calibrated with a 50-Fr bougie, as bariatric procedure between October 2007 and September 2009 was performed. Mean excessive body mass index loss was 76.9 per cent after 1 year and 79.9 per cent after 2 years. After surgery, 83.3 per cent of patients with Type 2 diabetes mellitus discontinued their hypoglycemic medication at 1 month. All the patients with hypertension discontinued antihypertensive drugs at 6 months. One hundred per cent of patients with hypertriglyceridemia discontinued their hypolipidemic drugs at 3 months. Glucose levels decreased significantly 3 months after surgery (mean reduction of 24.7 mg/dL; 95% confidence interval [CI], 8.8 to 40.7; P = 0.003). Triglyceride levels decreased 3 months after surgery (mean reduction of 54.4 mg/dL; 95% CI, 22.8 to 86.1; P = 0.004). High-density lipoprotein (HDL) cholesterol increased significantly after 12 months (increase of 16.7 mg/dL; 95% CI, 11.7 to 21.7; P < 0.001). The changes observed were maintained 24 months after surgery. Sleeve gastrectomy, calibrated with a 50-Fr bougie, significantly reduced glucose and triglyceride levels and the cardiovascular risk predictor triglyceride/HDL ratio and increased HDL levels after surgery and maintained them under normal ranges for at least 2 years.
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Affiliation(s)
- Jaime Ruiz-Tovar
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Inmaculada Oller
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Andres Tomas
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Carolina Llavero
- Department of Surgical Nursery. Hospital del Sureste, Madrid, Spain
| | - Antonio Arroyo
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Alicia Calero
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Amparo Martinez-Blasco
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Rafael Calpena
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
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Saul D, Stephens D, Hofstätter RDC, Ahmed L, Langhoff E, Heimann TM. Preliminary outcomes of laparoscopic sleeve gastrectomy in a Veterans Affairs medical center. Am J Surg 2012; 204:e1-6. [PMID: 22902102 DOI: 10.1016/j.amjsurg.2012.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preliminary results of a new bariatric surgery program in a VA Medical Center using laparoscopic sleeve gastrectomy (LSG). METHODS Prospective review of the first 50 patients who underwent LSG. Percentage change in body mass index (BMI), comorbidities, serum glucose, glycosylated hemoglobin (HbA1c), lipid profiles, and medications were recorded. RESULTS Mean age was 52 years. Average BMI was 46 kg/m(2). There were no mortalities or staple line leaks. The percentage excess BMI loss was 47% and 54% at 6 and 12 months, respectively. After 6 months, fasting glucose level decreased from 127 to 93 mg/dL, and mean glycosylated hemoglobin decreased from 6.8% to 5.7%. At 1-year follow-up evaluation, serum cholesterol decreased from 182 to 168 mg/dL, mean triglycerides from 179 to 93 mg/dL, low-density lipoprotein from 110 to 94 mg/dL, and high-density lipoprotein increased from 42 to 50 mg/dL. CONCLUSIONS Laparoscopic sleeve gastrectomy is safe and effective for morbidly obese VA patients and resulted in significant discontinuation of medication for hypertension, diabetes and hyperlipidemia.
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Affiliation(s)
- Daniel Saul
- Department of Surgery, James J. Peters VA Medical Center, Bronx, NY 10468, USA
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Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr 2012; 6:125-131. [PMID: 23158974 DOI: 10.1016/j.dsx.2012.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of the present study was to prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of T2DM and related metabolic abnormalities. METHODS All patients underwent II +DSG. They had T2DM≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (HbA1C<6.5% without OHAs/insulin), and secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. RESULTS We report the preliminary postoperative follow-up data of 9.1±5.3 months (range: 3-21 months). There were 17 patients (male:female=12:5) with mean age of 50.7±8.1 (range, 34-66 years), duration of diabetes of 15.1±5.8 years (range, 5-30 years), and preoperative body mass index of 29.2±7.5 kg/m(2)(range, 22.4-37.5 kg/m(2)). Eight patients (45%) had hypertension, while dyslipidemia and microalbuminuria was present in 7 patients (39%) each. Twelve patients (70.5%) had diabetes remission. Seven/eight (87.5%) patients had remission in hypertension. All participants had weight loss ranging between 15% and 30%. Postoperatively statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (p<0.05). Two patients had vitamin B12 deficiency 1 year after surgery. CONCLUSION Ileal interposition combined with DSG addresses both foregut and hindgut theories and brings about remissions in T2DM patients with reasonable safety. Our preliminary observations demonstrated the feasibility and efficacy of this novel surgical procedure as a promising option in T2DM.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India.
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Donglei Z, Liesheng L, Xun J, Chenzhu Z, Weixing D. Effects and mechanism of duodenal-jejunal bypass and sleeve gastrectomy on GLUT2 and glucokinase in diabetic Goto-Kakizaki rats. Eur J Med Res 2012; 17:15. [PMID: 22686706 PMCID: PMC3431997 DOI: 10.1186/2047-783x-17-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/07/2012] [Indexed: 11/30/2022] Open
Abstract
Background The study investigated the effects and mechanism of duodenal-jejunal bypass (DJB) and sleeve gastrectomy (SG) on the expression of liver GLUT2 and glucokinase (GCK) in diabetic rats. Methods Animal models of Goto–Kakizaki (GK) rats were established for the investigation of DJB and SG. Results of weight, food intake, fasting plasma glucose level, oral glucose tolerance test and insulin were compared. Liver tissues were harvested 8 weeks postoperatively. Reverse transcription-PCR and western blot were used to detect liver GLUT2 and GCK mRNA and protein expression after operation. Results Fasting plasma glucose levels of DJB group and SG group in GK rats were markedly declined at 3 days and l, 2, 4, 6, and 8 weeks postoperatively (P <0.01), whereas the levels of the sham-operated group only dropped at 3 days and 1 week postoperatively, and there were no significant differences 2 weeks postoperatively (P >0.05). In the liver of GK rats, GLUT2 mRNA level and protein expression after DJB were higher than those in sham-operated group and control group. GLUT2 mRNA level and protein expression after SG were significantly lower than those in control group (P <0.01). GCK mRNA and protein experienced similar expression change. Conclusions Both DJB and SG can decrease the plasma glucose levels of GK rats, whereas they have different effects on the expression of liver GLUT2 and GCK.
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Affiliation(s)
- Zhou Donglei
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Shanghai Tongji University, #301 Yanchang Zhong Rd, Shanghai, 200073, China
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Yan Z, Chen W, Liu S, Zhang G, Sun D, Hu S. Myocardial insulin signaling and glucose transport are up-regulated in Goto-Kakizaki type 2 diabetic rats after ileal transposition. Obes Surg 2012; 22:493-501. [PMID: 22249887 DOI: 10.1007/s11695-012-0604-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Ileal transposition (IT) as one of the effective treatments for non-obese type 2 diabetes mellitus has been widely investigated. However, the mechanisms underlying profound improvements in glucose homeostasis are still uncertain. Our objective was to explore the myocardial insulin signal transduction and glucose disposal in non-obese type 2 diabetes mellitus rats after IT surgery. METHODS Adult male Goto-Kakizaki (GK) rats or Sprague-Dawley (SD) rats were randomly assigned to diabetic IT, diabetic sham-IT, and non-diabetic control SD groups. Food intake, body weight, fasting plasma glucose, insulin tolerance, and serum glucagon-like peptide-1 (GLP-1) were measured. Subsequently, the myocardial glucose uptake and the protein levels of insulin receptor-beta (IR-β), phosphorylated IR-β, insulin receptor substrate 1 (IRS-1), phosphorylated IRS-1, and IRS-1-associated phosphatidylinositol-3 kinase (PI3K) from myocardial cell lysates were evaluated. We also assessed the expression of glucose transporter 4 (GLUT4) in both skeletal muscle and myocardial cell lysates. RESULTS Compared to sham operations within 6 months, IT surgery for GK rats did (1) result in less food intake and reduced body weight gain over time, (2) improve plasma glucose homeostasis with increased serum GLP-1 secretion and myocardial glucose uptake, (3) increase protein expression of insulin signaling pathway, including IR-β, IRS-1 and their phosphorylation levels, and IRS-1-associated PI3K in the myocardium, and (4) enhance the protein levels of membrane GLUT4 in skeletal muscle and myocardium. CONCLUSIONS IT surgery ameliorates glucose disorder in GK type 2 diabetic rats. Meanwhile, IT surgery is effective in up-regulating both myocardial insulin signaling and glucose disposal within 6 months.
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Affiliation(s)
- Zhibo Yan
- Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
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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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Sleeve Gastrectomy with Jejunal Bypass for the Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index <35 kg/m2. A cohort study. Obes Surg 2012; 22:1097-103. [DOI: 10.1007/s11695-012-0652-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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