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Ferenc K, Marcinkowski M, Olszewski J, Kowalczyk P, Pilžys T, Garbicz D, Dib N, Świderska B, Matyba P, Gajewski Z, Grzesiuk E, Zabielski R. The proteomic profile is altered but not repaired after bariatric surgery in type 2 diabetes pigs. Sci Rep 2024; 14:10235. [PMID: 38702370 PMCID: PMC11068747 DOI: 10.1038/s41598-024-60022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
To reveal the sources of obesity and type 2 diabetes (T2D) in humans, animal models, mainly rodents, have been used. Here, we propose a pig model of T2D. Weaned piglets were fed high fat/high sugar diet suppling 150% of metabolizable energy. Measurements of weight gain, blood morphology, glucose plasma levels, cholesterol, and triglycerides, as well as glucose tolerance (oral glucose tolerance test, OGTT) were employed to observe T2D development. The histology and mass spectrometry analyses were made post mortem. Within 6 months, the high fat-high sugar (HFHS) fed pigs showed gradual and significant increase in plasma triglycerides and glucose levels in comparison to the controls. Using OGTT test, we found stable glucose intolerance in 10 out of 14 HFHS pigs. Mass spectrometry analysis indicated significant changes in 330 proteins in the intestine, liver, and pancreas of the HFHS pigs. These pigs showed also an increase in DNA base modifications and elevated level of the ALKBH proteins in the tissues. Six diabetic HFHS pigs underwent Scopinaro bariatric surgery restoring glycaemia one month after surgery. In conclusion, a high energy diet applied to piglets resulted in the development of hyperlipidaemia, hyperglycaemia, and type 2 diabetes being reversed by a bariatric procedure, excluding the proteomic profile utill one month after the surgery.
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Affiliation(s)
- Karolina Ferenc
- Center for Translational Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797, Warsaw, Poland
| | - Michał Marcinkowski
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawińskiego 5a, 02-106, Warsaw, Poland
| | - Jarosław Olszewski
- Center for Translational Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797, Warsaw, Poland
| | - Paweł Kowalczyk
- Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110, Jabłonna, Poland
| | - Tomaš Pilžys
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawińskiego 5a, 02-106, Warsaw, Poland
| | - Damian Garbicz
- Institute of Oncology, Maria Sklodowska-Curie National Research, W.K. Roentgena 5, 02-781, Warsaw, Poland
| | - Naser Dib
- European Health Centre Otwock (ECZ Otwock), The Fryderyk Chopin Hospital, Borowa 14/18, 05-400, Otwock, Poland
| | - Bianka Świderska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawińskiego 5a, 02-106, Warsaw, Poland
| | - Piotr Matyba
- Center for Translational Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797, Warsaw, Poland
| | - Zdzisław Gajewski
- Center for Translational Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797, Warsaw, Poland
| | - Elżbieta Grzesiuk
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawińskiego 5a, 02-106, Warsaw, Poland.
| | - Romuald Zabielski
- Center for Translational Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797, Warsaw, Poland.
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Hernández-Montoliu L, Rodríguez-Peña MM, Puig R, Astiarraga B, Guerrero-Pérez F, Virgili N, López-Urdiales R, Osorio J, Monseny R, Lazzara C, Sobrino L, Pérez-Maraver M, Pérez-Prieto M, Pellitero S, Fernández-Veledo S, Vendrell J, Vilarrasa N. A specific gut microbiota signature is associated with an enhanced GLP-1 and GLP-2 secretion and improved metabolic control in patients with type 2 diabetes after metabolic Roux-en-Y gastric bypass. Front Endocrinol (Lausanne) 2023; 14:1181744. [PMID: 37916149 PMCID: PMC10616869 DOI: 10.3389/fendo.2023.1181744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023] Open
Abstract
Objective To determine changes in incretins, systemic inflammation, intestinal permeability and microbiome modifications 12 months after metabolic RYGB (mRYGB) in patients with type 2 diabetes (T2D) and their relationship with metabolic improvement. Materials and methods Prospective single-center non-randomized controlled study, including patients with class II-III obesity and T2D undergoing mRYGB. At baseline and one year after surgery we performed body composition measurements, biochemical analysis, a meal tolerance test (MTT) and lipid test (LT) with determination of the area under the curve (AUC) for insulin, C-peptide, GLP-1, GLP-2, and fasting determinations of succinate, zonulin, IL-6 and study of gut microbiota. Results Thirteen patients aged 52.6 ± 6.5 years, BMI 39.3 ± 1.4 kg/m2, HbA1c 7.62 ± 1.5% were evaluated. After mRYGB, zonulin decreased and an increase in AUC after MTT was observed for GLP-1 (pre 9371 ± 5973 vs post 15788 ± 8021 pM, P<0.05), GLP-2 (pre 732 ± 182 vs post 1190 ± 447 ng/ml, P<0.001) and C- peptide, as well as after LT. Species belonging to Streptococaceae, Akkermansiacea, Rickenellaceae, Sutterellaceae, Enterobacteriaceae, Oscillospiraceae, Veillonellaceae, Enterobacterales_uc, and Fusobacteriaceae families increased after intervention and correlated positively with AUC of GLP-1 and GLP-2, and negatively with glucose, HbA1c, triglycerides and adiposity markers. Clostridium perfringens and Roseburia sp. 40_7 behaved similarly. In contrast, some species belonging to Lachnospiraceae, Erysipelotricaceae, and Rumnicocaceae families decreased and showed opposite correlations. Higher initial C-peptide was the only predictor for T2D remission, which was achieved in 69% of patients. Conclusions Patients with obesity and T2D submitted to mRYGB show an enhanced incretin response, a reduced gut permeability and a metabolic improvement, associated with a specific microbiota signature.
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Affiliation(s)
- Laura Hernández-Montoliu
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - M-Mar Rodríguez-Peña
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rocío Puig
- Department of Endocrinology and Nutrition Hospital de la Santa Creu i Sant Pau, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Brenno Astiarraga
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Osorio
- Department of General and Gastrointestinal Surgery. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Monseny
- Clinical Nutrition Unit. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Claudio Lazzara
- Department of General and Gastrointestinal Surgery. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Sobrino
- Department of General and Gastrointestinal Surgery. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Pérez-Maraver
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Pérez-Prieto
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Pellitero
- Department of Endocrinology and Nutrition and Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sonia Fernández-Veledo
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine and Surgery, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Pfefferkorn U, Hort S, Beluli M, La Vista M, Züger T. Weight Loss After Bariatric Surgery in Different Age Groups. Obes Surg 2023; 33:1154-1159. [PMID: 36757647 DOI: 10.1007/s11695-023-06488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Weight loss after bariatric operations may be reduced in older patients due to changes in metabolism. Some studies showed inferior weight loss in older patients compared to younger ones while others showed no such difference. In order to counsel patients about the expected weight loss after bariatric surgery, recommendations stratified by age are important. METHODS This study encompasses a retrospective analysis of 500 consecutive patients with RYGB or sleeve gastrectomies from a single institution with a mean follow-up time of 3.6 years. Patients were stratified into five groups according to age at the time point of the operation: < 30 years, 30-39 years, 40-49 years, 50-59 years, and ≥ 60 years. RESULTS Weight loss expressed in percent excessive body mass index loss (%EBMIL) at nadir were 86.6, 89.5, 84.0, 77.9, and 76.4% and 75.6, 78.4, 73.3, 68.0, and 69.0% at the time of last follow-up for the five groups, respectively. Weight loss was significantly higher in younger patients than in older patients for both time points. The total number of comorbidities that showed complete remission (normal values without treatment), was also significantly higher in the younger age groups. CONCLUSIONS Primary bariatric operations yield better weight loss results and remission rates of obesity related comorbidities in younger patients, but are still effective in older individuals.
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Affiliation(s)
- Urs Pfefferkorn
- Department of Surgery, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland.
| | - Sabrina Hort
- Department of Surgery, Kantonsspital Baden, 5404, Baden, Switzerland
| | - Melika Beluli
- Department of Surgery, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - Monica La Vista
- Department of Endocrinology, Diabetes and Metabolic Diseases, Kantonsspital Olten, 4600, Olten, Switzerland
| | - Thomas Züger
- Department of Endocrinology, Diabetes and Metabolic Diseases, Kantonsspital Olten, 4600, Olten, Switzerland
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Cigrovski Berkovic M, Bilic-Curcic I, Mrzljak A, Canecki Varzic S, Cigrovski V. Prehabilitation of overweight and obese patients with dysglycemia awaiting bariatric surgery: Predicting the success of obesity treatment. World J Diabetes 2022; 13:1096-1105. [PMID: 36578866 PMCID: PMC9791574 DOI: 10.4239/wjd.v13.i12.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 11/03/2022] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment. In cases with additional hyperglycemia, the burden of surgery can be even higher and alter both short-term and long-term outcomes. Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission, weight loss results are lower than for obese patients without diabetes. Different multimodal programs, usually including interventions related to patients’ performance, nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course. However, there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients’ health. In this minireview, we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.
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Affiliation(s)
- Maja Cigrovski Berkovic
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- Faculty of Kinesiology, University of Zagreb, Zagreb 10000, Croatia
| | - Ines Bilic-Curcic
- Faculty of Medicine University of Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Diabetes, Clinical Hospital Centre Osijek, Osijek 31000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Silvija Canecki Varzic
- Faculty of Medicine University of Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Diabetes, Clinical Hospital Centre Osijek, Osijek 31000, Croatia
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Choi YS, Yi JW, Shin WY, Heo Y. Oncometabolic surgery in gastric cancer patients with type 2 diabetes. Sci Rep 2022; 12:11853. [PMID: 35831319 PMCID: PMC9279435 DOI: 10.1038/s41598-022-15404-2] [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] [Received: 12/14/2021] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
The rates of early gastric cancer and type 2 diabetes mellitus(T2DM) are sharply increasing in Korea. Oncometabolic surgery in which metabolic surgery is conducted along with cancer surgery is a method used to treat gastric cancer and T2DM in one-stage operation. From 2011 to 2019, a total of 48 patients underwent long-limb Roux-en-Y gastrectomy (LRYG) in Inha University Hospital, and all data were reviewed retrospectively. A 75 g oral glucose tolerance test and serum insulin level test were performed before and 1 week and 1 year after surgery. One year after LRYG operation, 25 of 48 patients showed complete or partial remission and 23 patients showed non-remission of T2DM. The preoperative HbA1c level was significantly lower and the change in HbA1c was significantly greater in the T2DM remission group. Insulin secretion indices(insulinogenic index and disposition index) were increased significantly in the T2DM remission group. In contrast, the insulin resistance indices (homeostatic model assessment of insulin resistance (HOMA-IR) and Matsuda index) changed minimal. In the case of LRYG in T2DM patients, remnant β cell function is an important predictor of favorable glycemic control.
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Affiliation(s)
- Yun Suk Choi
- Department of Surgery, Inha University Hospital & College of Medicine, 27, Inhang-ro, Jung-gu, Inchon, 22332, Republic of Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital & College of Medicine, 27, Inhang-ro, Jung-gu, Inchon, 22332, Republic of Korea
| | - Woo Young Shin
- Department of Surgery, Inha University Hospital & College of Medicine, 27, Inhang-ro, Jung-gu, Inchon, 22332, Republic of Korea
| | - Yoonseok Heo
- Department of Surgery, Inha University Hospital & College of Medicine, 27, Inhang-ro, Jung-gu, Inchon, 22332, Republic of Korea.
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AbdAlla Salman M, Rabiee A, Salman A, Elewa A, Tourky M, Mahmoud AA, Moustafa A, El-Din Shaaban H, Ismail AA, Noureldin K, Issa M, Farah M, Barbary H, Elhaj MGF, Omar HS. Predictors of type-2 diabetes remission following bariatric surgery after a two-year follow up. Asian J Surg 2022; 45:2645-2650. [DOI: 10.1016/j.asjsur.2021.12.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/05/2021] [Accepted: 12/24/2021] [Indexed: 12/29/2022] Open
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Nomogram for Predicting 5-Year Diabetes Remission After Roux-en-Y Gastric Bypass Surgery in Chinese Patients with Obesity. Obes Surg 2022; 32:1556-1562. [PMID: 35178616 DOI: 10.1007/s11695-022-05952-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) is widely used as an effective treatment for type 2 diabetes (T2D) patients with obesity; long-term (> 5 years) diabetes remission (DR) rates have been less frequently reported. To date, there is no validated model to guide procedure selection based on long-term glucose control in patients with T2D. The purpose of this study is to establish a new tool for predicting long-term DR with a nomogram. MATERIALS AND METHODS One hundred five individuals with complete preoperative information and undergoing RYGB in a university hospital were enrolled in this retrospective study. DR criteria after bariatric surgery were defined according to the 2009 ADA guideline. Fifteen individuals were lost to 5-year follow-up. Thus, 90 individuals were available and seen at the end of follow-up. The baseline and 5-year data of these 90 individuals were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors for long-term DR, and these predictors were used to create a nomogram. RESULTS Preoperative glycated hemoglobin (A1C) and diabetes duration were identified as independent influential factors that could be combined for precise prediction of long-term complete DR. We created a nomogram by using these 2 factors. The area under the curve was 0.78 (95% confidence interval 0.67-0.89). The Hosmer-Lemeshow X2 value of nomogram was 3.86 (P = 0.87) and indicated consistency between predicted and observed remission. CONCLUSION Our nomogram was a novel and useful tool for accurate prediction of long-term DR after RYGB.
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Insenser M, Vilarrasa N, Vendrell J, Escobar-Morreale HF. Remission of Diabetes Following Bariatric Surgery: Plasma Proteomic Profiles. J Clin Med 2021; 10:jcm10173879. [PMID: 34501327 PMCID: PMC8432028 DOI: 10.3390/jcm10173879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/19/2022] Open
Abstract
Bariatric surgery restores glucose tolerance in many, but not all, severely obese subjects with type 2 diabetes (T2D). We aimed to evaluate the plasma protein profiles associated with the T2D remission after obesity surgery. We recruited seventeen women with severe obesity submitted to bariatric procedures, including six non-diabetic patients and eleven patients with T2D. After surgery, diabetes remitted in 7 of the 11 patients with T2D. Plasma protein profiles at baseline and 6 months after bariatric surgery were analyzed by two-dimensional differential gel electrophoresis (2D-DIGE) and matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight coupled to mass spectrometry (MALDI-TOF/TOF MS). Remission of T2D following bariatric procedures was associated with changes in alpha-1-antichymotrypsin (SERPINA 3, p < 0.05), alpha-2-macroglobulin (A2M, p < 0.005), ceruloplasmin (CP, p < 0.05), fibrinogen beta chain (FBG, p < 0.05), fibrinogen gamma chain (FGG, p < 0.05), gelsolin (GSN, p < 0.05), prothrombin (F2, p < 0.05), and serum amyloid p-component (APCS, p < 0.05). The resolution of diabetes after bariatric surgery is associated with specific changes in the plasma proteomic profiles of proteins involved in acute-phase response, fibrinolysis, platelet degranulation, and blood coagulation, providing a pathophysiological basis for the study of their potential use as biomarkers of the surgical remission of T2D in a larger series of severely obese patients.
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Affiliation(s)
- María Insenser
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Universidad de Alcalá, E-28034 Madrid, Spain;
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E-28029 Madrid, Spain; (N.V.); (J.V.)
| | - Nuria Vilarrasa
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E-28029 Madrid, Spain; (N.V.); (J.V.)
- Department of Endocrinology & Nutrition, Hospital Universitari Bellvitge, Hospitalet de Llobregat, E-08907 Barcelona, Spain
| | - Joan Vendrell
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E-28029 Madrid, Spain; (N.V.); (J.V.)
- Department of Endocrinology & Nutrition, Institut d’Investigació Sanitaria Pere Virgili, Hospital Universitari de Tarragona Joan XXIII, E-43005 Tarragona, Spain
| | - Héctor F. Escobar-Morreale
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Universidad de Alcalá, E-28034 Madrid, Spain;
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E-28029 Madrid, Spain; (N.V.); (J.V.)
- Correspondence:
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Yu Z, Li W, Sun X, Tang H, Li P, Ji G, Zhu L, Zhu S. Predictors of Type 2 Diabetes Mellitus Remission After Metabolic Surgery in Asian Patients with a BMI < 32.5 kg/m 2. Obes Surg 2021; 31:4125-4133. [PMID: 34227020 DOI: 10.1007/s11695-021-05544-1] [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: 02/11/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Metabolic surgery is an effective treatment for type 2 diabetes mellitus (T2DM) in patients with obesity. However, the efficacy in patients with body mass index (BMI) < 32.5 kg/m2, especially in Asian populations, has not been widely reported, and there are few studies on the prediction of diabetes remission. METHODS We evaluated 112 patients with T2DM who underwent metabolic surgery between October 2008 and November 2019. The basic data of the patients were collected, and clinical variables were measured at 6 months, 1 year, and 2 years after metabolic surgery. Four independent predictors of surgical outcomes were identified to construct the prediction score. RESULTS Diabetes remission occurred for 38 of the 112 patients. Ninety patients underwent Roux-en-Y gastric bypass, while the remaining 22 patients underwent sleeve gastrectomy. Weight, glucose, and lipid metabolism parameters were improved significantly after metabolic surgery. Age, BMI, insulin use, and duration were independent predictors of T2DM remission. The above four factors were defined with scores and developed ABID (age, BMI, insulin use, duration) scoring system. Patients with greater ABID scores had a greater probability of diabetes remission (from 0% at score 0 to 100% at score 4). CONCLUSIONS The ABID score is a simple and easy-to-implement prediction score system of diabetes remission after metabolic surgery for T2DM patients with a BMI < 32.5 kg/m2.
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Affiliation(s)
- Zhaomei Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guangnian Ji
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China. .,Department of Hepatobiliary & Pancreatic Surgery, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China.
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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Salman AA, Salman MA, Marie MA, Rabiee A, Helmy MY, Tourky MS, Qassem MG, Shaaban HED, Sarhan MD. Factors associated with resolution of type-2 diabetes mellitus after sleeve gastrectomy in obese adults. Sci Rep 2021; 11:6002. [PMID: 33727637 PMCID: PMC7966796 DOI: 10.1038/s41598-021-85450-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Many bariatric procedures are more effective for improving type-2 diabetes mellitus (T2DM) than conventional pharmacotherapy. The current research evaluated factors linked to complete and partial remission or improvement of T2DM after laparoscopic sleeve gastrectomy (LSG). The current prospective study included all diabetic patients who were submitted LSG between January 2015 and June 2018 and completed a 2-year follow-up period. Patients were assessed at baseline and 2 years after LSG. This work comprised of 226 diabetic cases. Two years after LSG, 86 patients (38.1%) achieved complete remission of DM, and 24 (10.6%) reached partial remission. Only 14 patients (6.2%) showed no change in their diabetic status. On univariate analysis, age ≤ 45 years, duration of diabetes ≤ 5 years, use of a single oral antidiabetic, HbA1c ≤ 6.5%, HOMA-IR ≤ 4.6, C-peptide > 2.72 ng/mL, and BMI ≤ 40 kg/m2 predicted complete remission. The independent predictors of complete remission were age ≤ 45 years, duration of diabetes ≤ 5 years, use of a single oral antidiabetic, HOMA-IR ≤ 4.6, and C-peptide > 2.72 ng/mL. A combined marker of young age, short duration of DM, and low HOMA-IR predicted complete remission with sensitivity 93% and specificity 82%. Independent predictors of complete remission of T2DM after LSG were younger age, shorter duration, single oral antidiabetic, lower HOMA-IR, and higher C-peptide.
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Affiliation(s)
| | | | - Mohamed A Marie
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Rabiee
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Youssry Helmy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Sabry Tourky
- Department of Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mohamed Gamal Qassem
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed D Sarhan
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study. Obes Surg 2020; 30:4834-4839. [PMID: 32578178 DOI: 10.1007/s11695-020-04782-z] [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: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a recommended treatment for type 2 diabetes mellitus (T2DM) in patients with obesity, with superiority over medical therapy. While diabetes remission is achieved initially in 60-90% of patients following surgery, many may experience relapse of diabetes on the long-term. Data on long-term follow-up of bariatric surgery is scarce. We report this 12-year follow-up study of glycaemic control following RYGB. METHODS Two hundred seventeen patients with obesity (109 diabetic, 108 matched nondiabetic) who underwent RYGB between 2000 and 2008 were identified. Data was recorded prospectively for these patients at baseline and 2 years postoperatively. The long-term data was obtained via direct contact with the patients cross-checked with our hospital/national patients' electronic databases. RESULTS The follow-up rate was 88% (initial age 44 ± 9 years, female 79%). The mean (± SD) percentage total weight loss was 28% (± 15%) and 27% (± 17%) at 2 years and 12 years, respectively. Diabetes remission rate was 69% at 2 years, but decreased to 36% at 12 years following surgery. The 12-year incidence of new-onset T2DM in the control group was 4.3%. On univariate analysis, age, preoperative duration of diabetes and use of insulin were associated with less chance of diabetes remission at long-term (p value 0.06, 0.01 and 0.03, respectively). However, on multivariate regression analysis, only the duration of diabetes preoperatively remained significant (p = 0.025). CONCLUSION This study shows a high relapse of diabetes 12-year post-RYGB despite the durability of weight loss. This affects preoperative counselling and indicates a need for a longer follow-up to detect relapse.
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12
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Chen KY, Liu YL, Shang JC, Su DW, Yao RR, Ke DZ, Tian H. Effect of roux-en Y gastric bypass surgery on patients with type 2 diabetes mellitus: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20382. [PMID: 32501984 PMCID: PMC7306338 DOI: 10.1097/md.0000000000020382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Previous studies have reported that roux-en Y gastric bypass surgery (RYGBS) can benefit patients with type 2 diabetes mellitus (T2DM). However, their conclusions are still inconsistent. Thus, this study will aim to assess the effect of RYGBS for patients with T2DM. METHODS In this study, the electronic databases of MEDLINE, EMBASE, CENTRAL, CINAHL, AMED, and CNKI from inceptions to the present without any limitations to language and publication status. All randomized controlled trials on assessing the effect of RYGBS for patients with T2DM will be included in this study. Two independent authors will carry out study search and selection according to the previous designed inclusion and exclusion criteria. At the same time, 2 authors will independently evaluate the risk of bias assessment by Cochrane risk of bias tool. Any disagreements between 2 authors will be solved by a third author through discussion. RevMan 5.3 software will be utilized for statistical analysis. RESULTS This study will summarize the most recent studies and will provide a deeper understanding about using the effect of RYGBS for patients with T2DM. CONCLUSIONS The findings of this study will present the existing evidence for the effect of RYGBS for patients with T2DM. SYSTEMATIC REVIEW REGISTRATION INPLASY202040127.
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Affiliation(s)
| | | | | | | | - Rong-Rong Yao
- Department of Interventional Radiology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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13
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Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy. Surg Obes Relat Dis 2020; 16:1521-1530. [PMID: 32680788 DOI: 10.1016/j.soard.2020.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown. OBJECTIVES We assessed patients' characteristics associated with T2D remission 1 year post SG. SETTING University hospital. METHODS Retrospective study of 230 T2D patients (18-64 yr) who underwent SG at our institution. We examined pre- and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre- and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve. RESULTS A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 ± 8.84 years. Mean preoperative weight and body mass index were 115.69 ± 20.76 kg and 43.53 ± 6.98 kg/m2, respectively. Approximately two thirds (64.4%) of the sample had diabetes for >5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on ≥2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 ± 6.09 kg/m2, percent excess weight loss (%EWL) was 62.29 ± 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration + pre-HbA1C + %EWL + insulin therapy + age + OHA (area under the curve = .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration). CONCLUSION SG results in significant weight reduction and various extents of T2D remission. HbA1C, %EWL, insulin therapy, age, and OHA were independent predictors of complete remission. Assessing these factors before bariatric surgery is important to identify any modifiable characteristics that can be altered to increase the likelihood of remission.
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Performance and improvement of the DiaRem score in diabetes remission prediction: a study with diverse procedure types. Surg Obes Relat Dis 2020; 16:1531-1542. [PMID: 32690456 DOI: 10.1016/j.soard.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The DiaRem score has proven to be a reliable predictor tool for diabetes remission in Roux-en-Y gastric bypass (RYGB), as well as laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG). To our knowledge there are no studies that analyze DiaRem in patients undergoing biliopancreatic diversion with duodenal switch (BPD/DS). OBJECTIVE To test the validity of the DiaRem score as a predictor of type 2 diabetes remission at 1 year post surgery in patients who underwent LABG, LSG, RYGB, and BPD/DS, as well as to develop and test a novel model that uses DiaRem to predict type 2 diabetes remission by procedure type (LABG, LSG, RYGB, and BPD/DS). SETTING University Medical Center, United States. METHODS A retrospective review of institutional records identified patients who underwent primary bariatric procedures (LAGB, LSG, RYGB, and BPD/DS) between January 1, 2000 to April 10, 2017, had a diagnosis of diabetes and had complete preoperative and 1-year postoperative follow-up information. A univariable logistic regression model was fit to assess the association between DiaRem score and diabetes remission. A multivariable logistic regression model was created, including procedure type and other preoperative characteristics. The area under the receiver operating curve (AUROC) was calculated to analyze the performance of both models for the entire cohort as well as a BPD/DS only subgroup. RESULTS A total study cohort of 602 was obtained. The majority of patients underwent RYGB (456; 75.7%), followed by LSG (84; 14.0%), BPD/DS (35; 5.8%), and LAGB (27; 4.5%). The multivariable regression model with RYGB as the reference procedure, showed that BPD/DS results in higher odds of type 2 diabetes remission at 1 year post surgery (adjusted odds ratio [OR] 3.29, 95% confidence interval [CI] 1.27, 8.51), while LSG (adjusted OR .52, 95%CI .29, .93) and LAGB resulted in lower odds (adjusted OR.23, 95% CI.09,.60). The univariable DiaRem model and the novel model were determined to be moderately strong in classifying diabetes remission in the entire cohort (AUROC: .79, 95% CI: .75, .83 and .82, 95% CI: .79, .85, respectively) as well as in the BPD/DS sub-group (AUROC: .85, 95% CI: .70, .99 and .84, 95% CI .69, .99, respectively). CONCLUSION Our study shows that the DiaRem score is a reliable tool to predict diabetes remission, amongst a wide variety of different procedures as well as specifically those receiving BPD/DS. Our novel model, which takes into account procedure type, not only shows that BPD/DS patients have the highest odds of diabetes remission than other procedures, but also that this model performs significantly better at predicting diabetes remission than DiaRem alone.
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15
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Yan W, Bai R, Li Y, Xu J, Zhong Z, Xing Y, Yan M, Lin Y, Song M. Analysis of Predictors of Type 2 Diabetes Mellitus Remission After Roux-en-Y Gastric Bypass in 101 Chinese Patients. Obes Surg 2020; 29:1867-1873. [PMID: 30798440 DOI: 10.1007/s11695-019-03783-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate prognostic factors for complete remission in type 2 diabetes mellitus (T2DM) patients who underwent gastric bypass (GBP) and to establish a prognostic model for risk stratification. METHODS We evaluated the baseline clinical features of patients with T2DM who received at Beijing Tian Tan Hospital from April 2012 to December 2015. Complete remission of T2DM was defined as meeting the following criteria: HbA1c < 6.5%, fasting plasma glucose (FPG) < 100 mg/dL, and absence of hypoglycemic drugs for 1 year following GBP. RESULTS A total of 101 patients were enrolled in our study, and the complete remission rate of T2DM was 70.3% (71/101). Compared with patients with incomplete remission, patients with complete remission of T2DM had higher C-peptide levels, lower HbA1c, shorter disease duration, better β cell function, and an absence of insulin therapy. HbA1c level, fasting C-peptide, duration of T2DM, and history of medical therapy were important prognostic factors for complete remission of T2DM (P = 0.001, 0.002, 0.01, 0.028, respectively). Patients with HbA1c lower than 7.5%, a history of T2DM shorter than 9.5 years, fasting C-peptide higher than 1.2 ng/mL, and absence of insulin therapy before GBP achieved a higher complete remission rate of T2DM after GBP (AUC of the model was 0.825, 95% CI, 0.741-0.910; P = 0.001). CONCLUSIONS The duration of T2DM, history of medical therapy, and levels of HbA1c and fasting C-peptide are independent predictors for the prognosis of T2DM patients undergoing GBP. Patients with HbA1c lower than 7.5%, a history of T2DM shorter than 9.5 years, a fasting C-peptide higher than 1.2 ng/mL, and an absence of insulin therapy may have a higher complete remission rate of T2DM after GBP.
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Affiliation(s)
- Wenmao Yan
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Rixing Bai
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.
| | - Youguo Li
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Jun Xu
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Zhiqiang Zhong
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ying Xing
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ming Yan
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Yi Lin
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
| | - Maomin Song
- Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China
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Ahmed SR, Bellamkonda S, Zilbermint M, Wang J, Kalyani RR. Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: experience from a community-based cohort. BMJ Open Diabetes Res Care 2020; 8:e000980. [PMID: 32193200 PMCID: PMC7103851 DOI: 10.1136/bmjdrc-2019-000980] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/11/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The optimal diet to improve glycemia in patients with type 2 diabetes remains unclear. Low carbohydrate, high fat (LCHF) diets can improve glycemic control, but have not been investigated in real-world settings. RESEARCH DESIGN AND METHODS We investigated effects of the LCHF diet compared with usual care in a community-based cohort of patients with type 2 diabetes by performing a retrospective study of 49 patients who followed the LCHF diet for ≥3 months, and compared glycemic outcomes with age-matched and body mass index (BMI)-matched controls who received usual care (n=75). The primary outcome was change in A1C from baseline to the end of follow-up. RESULTS Compared with the usual care group, the LCHF group showed a significantly greater reduction in A1C (-1.29% (95% CI -1.75 to -0.82; p<0.001)) and body weight (-12.8 kg (95% CI -14.7 to -10.8; p<0.001) at the end of follow-up after adjusting for age, sex, baseline A1C, BMI, baseline insulin dose. Of the patients initially taking insulin therapy in the LCHF group, 100% discontinued it or had a reduction in dose, compared with 23.1% in the usual care group (p<0.001). The LCHF group also had significantly greater reduction in fasting plasma glucose (-43.5 vs -8.5 mg/mL; p=0.03) compared with usual care. CONCLUSIONS In a community-based cohort of type 2 diabetes, the LCHF diet was associated with superior A1C reduction, greater weight loss and significantly more patients discontinuing or reducing antihyperglycemic therapies suggesting that the LCHF diet may be a metabolically favorable option in the dietary management of type 2 diabetes.
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Affiliation(s)
- Shabina Roohi Ahmed
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Endocrinology, Johns Hopkins Community Physicians, Bethesda, Maryland, USA
| | - Sridevi Bellamkonda
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Internal Medicine, Johns Hopkins Community Physicians, Germantown, Maryland, USA
| | - Mihail Zilbermint
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Endocrinology, Diabetes and Metabolism, Johns Hopkins Community Physicians Suburban Hospital, Suburban Hospital, Bethesda, Maryland, USA
| | - Jiangxia Wang
- Biostatistics Consulting Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rita Rastogi Kalyani
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jindal R, Gupta M, Ahuja A, Nain PS, Sharma P, Aggarwal A. Factors Determining Diabetic Remission after Sleeve Gastrectomy: A Prospective Study. Niger J Surg 2020; 26:66-71. [PMID: 32165840 PMCID: PMC7041342 DOI: 10.4103/njs.njs_9_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/08/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background An exponential rise in the prevalence of obesity and the associated type 2 diabetes mellitus (T2DM) has led to an explosion in the field of bariatric surgery worldwide. It has been proposed that laparoscopic sleeve gastrectomy (LSG) not only results in excess weight loss (EWL) but also leads to excellent glycemic control. Aims However, not every patient benefits from the bariatric surgery. Furthermore, bariatric surgery is currently indicated based on body mass index (BMI), but BMI solely does not predict diabetes remission after the surgery. We aimed to study the outcome of LSG on the diabetic status and the factors predicting the disease remission. Subjects and Methods This prospective study was conducted on 104 obese patients having T2DM who underwent LSG. Following surgery, the clinical outcome on weight loss, BMI, and glycemic control was studied for 6 months. Various positive and negative predictors of diabetic remission after the surgery were also determined. Student's t-test and Chi-square tests were applied. Results LSG resulted in significant weight loss (P < 0.05); the percentage of EWL was 60.75 ± 6.30 at 6 months. Furthermore, surgery resulted in 78.9% remission of diabetes with fasting blood glucose and glycated hemoglobin values at 6 months being 121.13 ± 15.25 mg/dl and 6.19% ± 0.31%, respectively. Younger and heavier patients, those with lesser disease severity and shorter duration had better chances of disease remission. Gender had no correlation with disease remission. Conclusion LSG is a successful treatment option for T2DM and is more beneficial if offered, not as a last option, but to younger, obese patients with mild disease severity and shorter disease duration after the failure of medical treatment.
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Affiliation(s)
- Rohit Jindal
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Mayank Gupta
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashish Ahuja
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Prabhdeep Singh Nain
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Pranjl Sharma
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aayushi Aggarwal
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Luo Y, Guo Z, He H, Yang Y, Zhao S, Mo Z. Predictive Model of Type 2 Diabetes Remission after Metabolic Surgery in Chinese Patients. Int J Endocrinol 2020; 2020:2965175. [PMID: 33488705 PMCID: PMC7787854 DOI: 10.1155/2020/2965175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Metabolic surgery is an effective treatment for type 2 diabetes (T2D). At present, there is no authoritative standard for predicting postoperative T2D remission in clinical use. In general, East Asian patients with T2D have a lower body mass index and worse islet function than westerners. We aimed to look for clinical predictors of T2D remission after metabolic surgery in Chinese patients, which may provide insights for patient selection. METHODS Patients with T2D who underwent metabolic surgery at the Third Xiangya Hospital between October 2008 and March 2017 were enrolled. T2D remission was defined as an HbA1c level below 6.5% and an FPG concentration below 7.1 mmol/L for at least one year in the absence of antidiabetic medications. RESULTS (1) Independent predictors of short-term T2D remission (1-2 years) were age and C-peptide area under the curve (C-peptide AUC); independent predictors of long-term T2D remission (4-6 years) were C-peptide AUC and fasting plasma glucose (FPG). (2) The optimal cutoff value for C-peptide AUC in predicting T2D remission was 30.93 ng/ml, with a specificity of 67.3% and sensitivity of 75.8% in the short term and with a specificity of 61.9% and sensitivity of 81.5% in the long term, respectively. The areas under the ROC curves are 0.674 and 0.623 in the short term and long term, respectively. (3) We used three variables (age, C-peptide AUC, and FPG) to construct a remission prediction score (ACF), a multidimensional 9-point scale, along which greater scores indicate a better chance of T2D remission. We compared our scoring system with other reported models (ABCD, DiaRem, and IMS). The ACF scoring system had the best distribution of patients and prognostic significance according to the ROC curves. CONCLUSION Presurgery age, C-peptide AUC, and FPG are independent predictors of T2D remission after metabolic surgery. Among these, C-peptide AUC plays a decisive role in both short- and long-term remission prediction, and the optimal cutoff value for C-peptide AUC in predicting T2D remission was 30.93 ng/ml, with moderate predictive values. The ACF score is a simple reliable system that can predict T2D remission among Chinese patients.
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Affiliation(s)
- Yufang Luo
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Zi Guo
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Honghui He
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Youbo Yang
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Shaoli Zhao
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Zhaohui Mo
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
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El Khoury L, Chouillard E, Chahine E, Saikaly E, Debs T, Kassir R. Metabolic Surgery and Diabesity: a Systematic Review. Obes Surg 2019; 28:2069-2077. [PMID: 29679334 DOI: 10.1007/s11695-018-3252-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is used to induce weight loss (baros = weight). Evidence has shown that bariatric surgery improves the comorbid conditions associated with obesity such as hypertension, hyperlipidemia, and type 2 diabetes mellitus T2DM. Hence, shifting towards using metabolic surgery instead of bariatric surgery is currently more appropriate in certain subset of patients. Endocrine changes resulting from operative manipulation of the gastrointestinal tract after metabolic surgery translate into metabolic benefits with respect to the comorbid conditions. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect. The aim of this systematic review is to examine clinical trials regarding long-term effects of bariatric and metabolic surgery on patients with T2DM and to evaluate the potential mechanisms leading to the improvement in the glycaemic control.
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Affiliation(s)
- Lionel El Khoury
- Department of Digestive and Minimally Invasive Surgery, Saint-Germain-en-Laye Medical Center, Poissy, France
| | - Elie Chouillard
- Department of Digestive and Minimally Invasive Surgery, Saint-Germain-en-Laye Medical Center, Poissy, France
| | - Elias Chahine
- Department of Digestive and Minimally Invasive Surgery, Saint-Germain-en-Laye Medical Center, Poissy, France
| | - Elias Saikaly
- Saint Georges Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Tarek Debs
- Department of General Surgery, CHU Archet, Nice, France
| | - Radwan Kassir
- Departement of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France.
- Department of Bariatric Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France.
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Dang JT, Sheppard C, Kim D, Switzer N, Shi X, Tian C, de Gara C, Karmali S, Birch DW. Predictive factors for diabetes remission after bariatric surgery. Can J Surg 2019; 62:315-319. [PMID: 31550092 PMCID: PMC7006352 DOI: 10.1503/cjs.014516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 12/19/2022] Open
Abstract
Background Bariatric surgery has been shown to induce type 2 diabetes mellitus (T2DM) remission in severely obese patients. After laparoscopic Roux-en-Y gastric bypass (LRYGB), diabetes remission occurs early and independently of weight loss. Previous research has identified preoperative factors for remission, such as duration of diabetes and HbA1c. Understanding factors that predict diabetes remission can help to select patients who will benefit most from bariatric surgery. Methods We retrospectively reviewed all T2DM patients who underwent laparoscopic sleeve gastrectomy (LSG) or LRYGB between January 2008 and July 2014. The primary outcome was diabetes remission, defined as the absence of hypoglycemic medications, fasting blood glucose < 7.0 mmol/L and HbA1c < 6.5%. Data were analyzed using multivariable logistic regression analysis to identify predictive factors of diabetes remission. Results We included 207 patients in this analysis; 84 (40.6%) had LSG and 123 (59.4%) had LRYGB. Half of the patients (49.8%) achieved diabetes remission at 1 year. Multivariable logistic analysis showed that LRYGB had higher odds of diabetes remission than LSG (odds ratio [OR] 6.58, 95% confidence interval [CI] 2.79–15.50, p < 0.001). Shorter duration of diabetes (OR 0.91, 95% CI 0.83–0.99, p = 0.032) and the absence of long-acting insulin (OR 0.0011, 95% CI < 0.000–0.236, p = 0.013) predicted remission. Conclusion Type of bariatric procedure (LRYGB v. LSG), shorter duration of diabetes and the absence of long-acting insulin were independent predictors of diabetes remission after bariatric surgery.
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Affiliation(s)
- Jerry T. Dang
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Caroline Sheppard
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - David Kim
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Noah Switzer
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Xinzhe Shi
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Chunhong Tian
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Christopher de Gara
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Shahzeer Karmali
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
| | - Daniel W. Birch
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Switzer); the Department of Surgery, University of British Columbia, Vancouver, BC (Kim); and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Shi, Tian, Karmali, Birch)
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21
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Ceperuelo-Mallafré V, Llauradó G, Keiran N, Benaiges E, Astiarraga B, Martínez L, Pellitero S, González-Clemente JM, Rodríguez A, Fernández-Real JM, Lecube A, Megía A, Vilarrasa N, Vendrell J, Fernández-Veledo S. Preoperative Circulating Succinate Levels as a Biomarker for Diabetes Remission After Bariatric Surgery. Diabetes Care 2019; 42:1956-1965. [PMID: 31375523 DOI: 10.2337/dc19-0114] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/11/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the potential use of baseline circulating succinate to predict type 2 diabetes remission after bariatric surgery. RESEARCH DESIGN AND METHODS Forty-five obese patients with diabetes were randomly assigned to Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or laparoscopic greater curvature plication. Anthropometric parameters were evaluated, and a complete biochemical analysis including circulating serum succinate concentrations was performed at baseline and 1 year after surgery. The results were externally validated in a second cohort including 88 obese patients with diabetes assigned to RYGB or SG based on clinical criteria. RESULTS Succinate baseline concentrations were an independent predictor of diabetes remission after bariatric surgery. Patients achieving remission after 1 year had lower levels of baseline succinate (47.8 [37.6-64.6] µmol/L vs. 64.1 [52.5-82.9] µmol/L; P = 0.018). Moreover, succinate concentrations were significantly decreased 1 year after surgery (58.9 [46.4-82.4] µmol/L vs. 46.0 [35.8-65.3] µmol/L, P = 0.005). In multivariate analysis, the best logistic regression model showed that baseline succinate (odds ratio [OR] 11.3, P = 0.031) and the type of surgery (OR 26.4, P = 0.010) were independently associated with remission. The C-statistic for this model was 0.899 (95% CI 0.809-0.989) in the derivation cohort, which significantly improved the prediction of remission compared with current available scores, and 0.729 (95% CI 0.612-0.846) in the validation cohort. Interestingly, patients had a different response to the type of surgery according to baseline succinate, with significant differences in remission rates. CONCLUSIONS Circulating succinate is reduced after bariatric surgery. Baseline succinate levels have predictive value for diabetes remission independently of previously described presurgical factors and improve upon the current available scores to predict remission.
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Affiliation(s)
- Victoria Ceperuelo-Mallafré
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Gemma Llauradó
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Noelia Keiran
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ester Benaiges
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Brenno Astiarraga
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona, CIBEROBN (CB06/03/010) and ISCIII, Girona, Spain
| | - Laia Martínez
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Silvia Pellitero
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Jose Miguel González-Clemente
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (Universitat Autònoma de Barcelona), Sabadell, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, CIBEROBN, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona, CIBEROBN (CB06/03/010) and ISCIII, Girona, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Ana Megía
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Nuria Vilarrasa
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Vendrell
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Rovira I Virgili University, Tarragona, Spain
| | - Sonia Fernández-Veledo
- Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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22
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Ahuja A, Tantia O, Chaudhuri T, Khanna S, Seetharamaiah S, Majumdar K, Goyal G. Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores. Obes Surg 2019; 28:2025-2031. [PMID: 29435812 DOI: 10.1007/s11695-018-3136-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is one of the major causes for development of T2DM. Metabolic surgery has been proved to be a successful and cost-effective treatment modality for managing the patients with obesity and T2DM. Many scoring systems and models have been described in literature to predict the outcome of T2DM after metabolic surgery. The aim of this study is to compare the efficacy of Diarem, DRS, and ABCD score in predicting the T2DM remission. METHODS A total number of 102 diabetic patients, who underwent LMGB/LOAGB, were selected for this study. A retrospective analysis of the three scoring systems when applied to these patients and their predictive abilities were analyzed. RESULTS At 1 year after surgery, 72 (70.59%) patients achieved remission of T2DM. Though the pairwise comparisons between AUC on ROC analysis of ABCD, Diarem, and DRS scores does not show statistically significant difference between them, Diarem score has the maximum relative area under ROC curves. By multivariate analysis, it was found that factors significantly associated with T2DM remission were duration of T2DM, C-peptide, and Pre-Op HbA1c. CONCLUSIONS Among the three scoring systems, though DiaRem score has the best sensitivity and specificity and maximum AUC, no statistically significant difference was found in their diabetes remission predicting abilities. A shorter duration of T2DM, a lower HbA1C, and higher levels of C-peptide were significantly associated with a higher chance of T2DM remission.
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Affiliation(s)
- Anmol Ahuja
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Om Tantia
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India.
| | - Tamonas Chaudhuri
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Shashi Khanna
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Shivakumar Seetharamaiah
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Kajari Majumdar
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Ghanshyam Goyal
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
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23
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Szczerbinski L, Taylor MA, Citko A, Gorska M, Larsen S, Hady HR, Kretowski A. Clusters of Glycemic Response to Oral Glucose Tolerance Tests Explain Multivariate Metabolic and Anthropometric Outcomes of Bariatric Surgery in Obese Patients. J Clin Med 2019; 8:E1091. [PMID: 31344893 PMCID: PMC6723855 DOI: 10.3390/jcm8081091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023] Open
Abstract
Glycemic responses to bariatric surgery are highly heterogeneous among patients and defining response types remains challenging. Recently developed data-driven clustering methods have uncovered subtle pathophysiologically informative patterns among patients without diabetes. This study aimed to explain responses among patients with and without diabetes to bariatric surgery with clusters of glucose concentration during oral glucose tolerance tests (OGTTs). We assessed 30 parameters at baseline and at four subsequent follow-up visits over one year on 154 participants in the Bialystok Bariatric Surgery Study. We applied latent trajectory classification to OGTTs and multinomial regression and generalized linear mixed models to explain differential responses among clusters. OGTT trajectories created four clusters representing increasing dysglycemias that were discordant from standard diabetes diagnosis criteria. The baseline OGTT cluster increased the predictive power of regression models by over 31% and aided in correctly predicting more than 83% of diabetes remissions. Principal component analysis showed that the glucose homeostasis response primarily occurred as improved insulin sensitivity concomitant with improved the OGTT cluster. In sum, OGTT clustering explained multiple, correlated responses to metabolic surgery. The OGTT is an intuitive and easy-to-implement index of improvement that stratifies patients into response types, a vital first step in personalizing diabetic care in obese subjects.
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Affiliation(s)
- Lukasz Szczerbinski
- Department of Endocrinology, Diabetology and Internal Medicine; Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
| | - Mark A Taylor
- School of Medicine, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA
| | - Anna Citko
- Clinical Research Centre; Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Maria Gorska
- Department of Endocrinology, Diabetology and Internal Medicine; Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Steen Larsen
- Department of Biomedical Sciences; University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark
| | - Hady Razak Hady
- 1st Clinical Department of General and Endocrine Surgery; Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Adam Kretowski
- Department of Endocrinology, Diabetology and Internal Medicine; Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
- Clinical Research Centre; Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
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24
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Page A, Etherton-Beer C. Undiagnosing to prevent overprescribing. Maturitas 2019; 123:67-72. [PMID: 31027680 DOI: 10.1016/j.maturitas.2019.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Health care focuses on controlling symptoms and managing risk factors to improve survival by avoiding future complications. Diagnoses describe a group of signs and symptoms, often implying specific aetiologies and underlying pathophysiological disease processes. The diagnosis provides a tool for the health professional to conceptualise and classify a presentation, and thus manage the condition, and can provide the patient with an explanation or validation of their experience. Not every diagnosis holds significant clinical implications. There are diagnosed conditions that do not require treatment and, moreover, where treatment has the potential for harm without the potential for benefit. Promoting investigations and diagnoses can lead to overdiagnosis related to vested interests in increased services, use of devices or therapeutics. Multiple factors drive this issue, including broadening disease definitions and cultural factors that encourage tests and treatments, as well as medicolegal factors. While the traditional medicine review process typically involved cross-referencing medicines used with current diagnoses, a more sophisticated version of this process critically reviews the medicines and associated diagnosis, giving less emphasis to diagnoses that are no longer relevant. Known as undiagnosis, this process facilitates the withdrawal of corresponding medicines used to manage those conditions. Systematically reviewing diagnoses regularly and the associated medicine management strategies could reduce prescribing. The novel ERASE process can help clinicians Evaluate diagnoses to consider Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and their corresponding medicines.
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Affiliation(s)
- Amy Page
- Alfred Health, 55 Commercial Rd, Australia; Monash University, Centre for Medicine Use and Safety, Melbourne, Australia; University of Western Australia, School of Allied Health, Centre for Medicines Optimisation, Perth, Australia.
| | - Christopher Etherton-Beer
- University of Western Australia, Western Australian Centre for Health and Ageing, Australia; Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
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25
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Xiaosong W, Chongyu S, Xuqi S, Peiwu Y, Yongliang Z. Risk Factors for Relapse of Hyperglycemia after Laparoscopic Roux-en-Y Gastric Bypass in T2DM Obese Patients: a 5-Year Follow-Up of 24 Cases. Obes Surg 2019; 29:1164-1168. [DOI: 10.1007/s11695-018-03656-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Jamal W, Zagzoog MM, Sait SH, Alamoudi AO, Abo'ouf S, Alghamdi AA, Bamashmous RO, Maghrabi AA. Initial outcomes of one anastomosis gastric bypass at a single institution. Diabetes Metab Syndr Obes 2019; 12:35-41. [PMID: 30613157 PMCID: PMC6307494 DOI: 10.2147/dmso.s180111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, which has been reported to be safe and effective. This study aims to evaluate the short-term outcome of OAGB and its midterm effects on weight loss and remission of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS A retrospective review of patients who had undergone OAGB between January 2013 and January 2017 in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, is presented here. Patients' perioperative characteristics, biochemical profile (fasting blood glucose, HbA1c and iron profile) and details on subsequent weight loss in terms of body mass index (BMI) and excess weight loss percentage (EWL%) along with early and late postoperative complications were evaluated. RESULTS Out of the 47 patients who underwent OAGB, 42 were included in this study and completed the 2-year follow-up. Average operative time was 107±21.3 minutes and average length of hospital stay was 2.5±0.53 days. Mean preoperative BMI was 47.6±9.1 kg/m2, and at 1 and 2 years of follow-up, it was 30.5±7.4 and 27.1±5.1, respectively. No mortality, anastomotic leak or bleeding were reported. Most common midterm complication was iron deficiency anemia (n=7/42). Remission of T2DM at 6 months was 80%. Patients with preoperative T2DM for less than 10 years showed better remission (P<0.001). CONCLUSION Our analysis suggests that OAGB is a safe and effective weight loss procedure that carries low perioperative risk and acceptable nutritional complications in the midterm, with a notable remission of T2DM. Preoperative duration of T2DM plays a major role in achieving remission after OAGB.
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Affiliation(s)
- Wisam Jamal
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammad M Zagzoog
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Salma H Sait
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ahmed O Alamoudi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Shaza Abo'ouf
- Beverly Medical Care Clinics for Obesity Management, Jeddah, Saudi Arabia
| | - Ayman A Alghamdi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ryan O Bamashmous
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ashraf A Maghrabi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
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The Effects of Duodenojejunal Omega Switch in Combination with High-Fat Diet and Control Diet on Incretins, Body Weight, and Glucose Tolerance in Sprague-Dawley Rats. Obes Surg 2018; 28:748-759. [PMID: 28840471 PMCID: PMC5803292 DOI: 10.1007/s11695-017-2883-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Despite excellent results of bariatric surgery in the treatment of type 2 diabetes and weight loss in human subjects, some patients do not obtain desired results. One of the reasons for this is that not all patients follow caloric intake recommendations. Aim The aim of this study was to investigate the effect of duodenojejunal omega switch (DJOS) surgery on body weight, glucose tolerance, and incretins in rats. Methods DJOS and SHAM surgery were performed on rats maintained for 8 weeks on high-fat diet (HF) and control diet (CD), respectively. After surgery, four groups were kept on the same diet as before the surgery, and four groups had a changed diet (CD vs. HF and HF vs. CD) for the next 8 weeks. Glucose tolerance, insulin tolerance, glucose-stimulated insulin, glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide/glucose-dependent insulinotropic polypeptide (GIP) secretion, food intake, and body weight were measured. Results A change of diet after surgery resulted in reduced glucose tolerance. Plasma insulin levels were lowered between DJOS and SHAM surgeries for the HF/HF and CD/HF groups. DJOS surgery did not reduce body weight in the studied groups, irrespective of diet. In the HF/HF group, ΔGLP-1 was lower for DJOS surgery in comparison with other groups. Differences of weight changes were observed for groups HF/HF and HF/CD. After DJOS surgery, ΔGIP was lower in the CD/HF group compared with HF/HF. Conclusions Our results show that applications of different types of diets, before and after surgery, is a sensitive method for studies of mechanism of glucose intolerance after DJOS surgery.
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Effectiveness of an Interprofessional Glycemic Optimization Clinic on Preoperative Glycated Hemoglobin Levels for Adult Patients With Type 2 Diabetes Undergoing Bariatric Surgery. Can J Diabetes 2018. [DOI: 10.1016/j.jcjd.2017.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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29
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Lee PC, Tan HC, Pasupathy S, Ganguly S, Eng AKH, Nadkarni N, Tham KW. Effectiveness of bariatric surgery in diabetes prevention in high-risk Asian individuals. Singapore Med J 2018; 59:472-475. [PMID: 30310918 PMCID: PMC6158137 DOI: 10.11622/smedj.2018110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Obesity is a key risk factor in the development of Type 2 diabetes mellitus (T2DM). Bariatric surgery causes a large amount of durable weight loss in those with clinically severe obesity. We reported the effect of weight loss via bariatric surgery on DM prevention in those at high risk of developing DM. METHODS This was a retrospective cohort study of 44 patients with obesity (mean body mass index 43.8 kg/m2) and pre-DM who underwent bariatric surgery and were followed up for up to three years. We also reviewed a non-surgical cohort of patients with obesity and pre-DM seen at the weight management clinic. RESULTS 91% of patients attained normal glycaemic status at one year after bariatric surgery. At the three-year follow-up, 87.5% of the patients maintained normoglycaemia. None of the patients developed T2DM after surgery. 26.9% of patients achieved absolute weight loss at one year after bariatric surgery and maintained this at two and three years post surgery (p < 0.001 vs. baseline). The homeostatic model assessment-insulin resistance index in patients also decreased from 5.50 at baseline to 1.20, 1.14 and 1.44 at one, two and three years, respectively (p < 0.001). CONCLUSION Bariatric surgery produces significant weight loss, and leads to reversion from the pre-diabetic state to normal glycaemic status and reduction of the incident DM rate in those with pre-DM and morbid obesity.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Alvin Kim Hock Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Nivedita Nadkarni
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Kwang Wei Tham
- Department of Endocrinology, Singapore General Hospital, Singapore
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Sohn SY, Lee EK, Han SS, Lee YJ, Hwangbo Y, Kang YH, Lee SD, Kim SH, Woo SM, Lee WJ, Hong EK, Park SJ. Favorable glycemic response after pancreatoduodenectomy in both patients with pancreatic cancer and patients with non-pancreatic cancer. Medicine (Baltimore) 2018; 97:e0590. [PMID: 29718860 PMCID: PMC6393016 DOI: 10.1097/md.0000000000010590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM) is prevalent in patients with pancreatic cancer and tends to improve after tumor resection. However, the glycemic response of non-pancreatic cancer patients after surgery has not been examined in detail. We aimed to investigate the changes in glucose metabolism in patients with pancreatic cancer or non-pancreatic cancer after pancreatoduodenectomy (PD).We prospectively enrolled 48 patients with pancreatic cancer and 56 patients with non-pancreatic cancer, who underwent PD. Glucose metabolism was assessed with fasting glucose, glycated hemoglobin (HbA1c), plasma C-peptide and insulin, quantitative insulin check index (QUICKI), and a homeostatic model assessment of insulin resistance (HOMA-IR) and β cell (HOMA-β) before surgery and 6 months after surgery. Patients were divided into 2 groups: "improved" and "worsened" postoperative glycemic response, according to the changes in HbA1c and anti-diabetic medication. New-onset DM was defined as diagnosis of DM ≤ 2 years before PD, and cases with DM diagnosis >2 years preceding PD were described as long-standing DM.After PD, insulin resistance (IR), as measured by insulin, HOMA-IR and QUICKI, improved significantly, although C-peptide and HOMA-β decreased. At 6 months after PD, new-onset DM patients showed improved glycemic control in both pancreatic cancer patients (75%) and non-pancreatic cancer patients (63%). Multivariate analysis showed that long-standing DM was a significant predictor for worsening glucose control (odds ratio = 4.01, P = .017).Favorable glycemic control was frequently observed in both pancreatic cancer and non-pancreatic cancer after PD. PD seems to contribute improved glucose control through the decreased IR. New-onset DM showed better glycemic control than long-standing DM.
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Affiliation(s)
- Seo Young Sohn
- Department of Internal Medicine, National Cancer Center
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center
| | | | - You Jin Lee
- Department of Internal Medicine, National Cancer Center
| | - Yul Hwangbo
- Department of Internal Medicine, National Cancer Center
| | | | | | | | | | - Woo Jin Lee
- Department of Internal Medicine, National Cancer Center
| | - Eun Kyung Hong
- Department of Pathology, National Cancer Center, Goyang, Gyeonggi, Korea
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Bariatric Surgery Resistance: Using Preoperative Lifestyle Medicine and/or Pharmacology for Metabolic Responsiveness. Obes Surg 2018; 27:3281-3291. [PMID: 29058238 DOI: 10.1007/s11695-017-2966-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is an effective and durable treatment for individuals with obesity and its associated comorbidities. However, not all patients meet weight loss and/or cardiometabolic goals following bariatric surgery, suggesting that some people are bariatric surgery resistant. The reason for this resistance is unclear, but potential factors, such as adiposity-derived inflammation, insulin resistance, hyperglycemia, and aerobic fitness prior to surgery, have been related to blunted surgery responsiveness. Exercise, diet, and/or pharmacology are effective at reducing inflammation and improving insulin action as well as physical function. Herein, we present data that supports the novel hypothesis that intervening prior to surgery can enhance disease resolution in people who are resistant to bariatric surgery.
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Kassir R, Le Moullec N, Coueffe X, Chouillard E, Amor IB, Gugenheim J. Comments on the Article: The Effects of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Japanese Patients with BMI < 35 kg/m 2 on Type 2 Diabetes Mellitus and the Prediction of Successful Glycemic Control. Obes Surg 2018; 28:2528-2529. [PMID: 29675636 DOI: 10.1007/s11695-018-3266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Radwan Kassir
- Departement of Digestive Surgery, CHU Félix Guyon, Saint-Denis, Réunion, France.
- Department of Bariatric Surgery, CHU Felix Guyon, Saint-Denis, Réunion, France.
| | - Nathalie Le Moullec
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU la réunion sud, Saint Pierre, France
| | - Xaviera Coueffe
- Department of Digestive Surgery, CHU la réunion sud, Saint Pierre, France
| | - Elie Chouillard
- Department of Digestive and Minimally Invasive Surgery, Saint-Germain-en-Laye Medical Center, Poissy, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Jean Gugenheim
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
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Salukhov VV, Ilinskii NS, Vasil'ev EV, Sardinov RT, Gladyshev DV. Possibilities of metabolic surgery for the treatment of type 2 diabetes mellitus in patients with grade 1 alimentary obesity. DIABETES MELLITUS 2018. [DOI: 10.14341/dm9292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Many studies have demonstrated the high effectiveness of bariatric surgery in patients with grade 23 obesity and type 2 diabetes mellitus. Currently, surgery is one of the most effective ways to decrease body mass, to maintain long-term weight loss and to manage type 2 diabetes mellitus. Particular interest has been generated by the strong influence of bariatric surgical interventions on the disruption of carbohydrate metabolism in patients who undergo surgery. This change leads to an improvement in the course of type 2 diabetes mellitus as well as its full remission. This review presents information on the mechanisms that are needed to improve glycaemic control in patients with obesity even after bariatric surgery. This review also contains a comparative analysis of how various surgical interventions influence the course of diabetes, the reasons for postbariatric glycaemia and predictors of the effectiveness of bariatric surgeries in terms of metabolic control in patients with type 2 diabetes mellitus.
Until recently, the primary focus of the studies by bariatric surgeons was on patients with grade 23 obesity and type 2 diabetes mellitus. However, in this review, special attention is given to the patients with a body mass index that ranges from 30 to 35 kg/m. Gained experience of the bariatric surgeons leads to high effectiveness with respect to the influence on the course of diabetes in patients with grade 1 obesity, which allows us to significantly expand the range of patients who should be recommended for this surgery. In addition, some information concerning surgical and metabolic complications of bariatric surgical intervention is provided, which allows us to seriously consider this treatment.
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Casajoana A, Pujol J, Garcia A, Elvira J, Virgili N, de Oca FJ, Duran X, Fernández-Veledo S, Vendrell J, Vilarrasa N. Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication. Obes Surg 2018; 27:2235-2245. [PMID: 28451931 DOI: 10.1007/s11695-017-2669-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our aim was to determine the predictive value of gut hormone changes for the improvement of type 2 diabetes (T2D) following metabolic Roux-en-Y gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP) in a randomized controlled trial. Contradictory results have been obtained regarding the role of gastrointestinal hormones (in particular GLP-1) in beneficial metabolic bariatric surgery outcomes. METHODS Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and area under the curve (AUC) of GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after surgery. RESULTS Twelve months after surgery, total weight loss percentage was higher and HbA1c lower in the mRYGB group than in the SG and GCP groups (-35.2 ± 8.1 and 5.1 ± 0.6% vs. -27.8 ± 5.4 and 6.2 ± 0.8% vs. -20.5 ± 6.8 and 6.6 ± 1.3%; p = 0.007 and p < 0.001, respectively). Moreover, GLP-1 AUC at months 1 and 12 was greater and T2D remission was higher in mRYGB (80 vs. 53.3 vs. 20%, p < 0.001). Insulin treatment (odds ratio (OR) 0.025, p = 0.018) and the increase in GLP-1 AUC from baseline to month 1 (OR 1.021, p = 0.013) were associated with T2D remission. CONCLUSIONS mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.
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Affiliation(s)
- Anna Casajoana
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Jordi Pujol
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Amador Garcia
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Jordi Elvira
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Francisco Javier de Oca
- Colorectal Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Xavier Duran
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Fernández-Veledo
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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Huang T, Fu J, Zhang Z, Zhang Y, Liang Y, Ge C, Qin X. Pancreatic islet regeneration through PDX-1/Notch-1/Ngn3 signaling after gastric bypass surgery in db/db mice. Exp Ther Med 2017; 14:2831-2838. [PMID: 28966671 PMCID: PMC5613180 DOI: 10.3892/etm.2017.4896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/11/2017] [Indexed: 01/27/2023] Open
Abstract
In view of the compelling anti-diabetic effects of gastric bypass surgery (GBS) in the treatment of morbid obesity, it is important to clarify its enhancing effect on pancreatic islets, which is closely linked with diabetes remission in obese patients, as well as the underlying mechanisms. The present study evaluated the effects of GBS on glycemic control and other pancreatic changes in db/db mice. The db/db mice were divided into Control, Sham and GBS group. A significant improvement in fasting plasma glucose levels and glucose intolerance were observed post-surgery. At 4 weeks after surgery, further noteworthy changes were observed in the GBS group, including improved islet structure (revealed by immunohistochemical analysis), enhanced insulin secretion, pancreatic hyperplasia and a marked increase in the ratio of β-cells to non-β endocrine cells. Furthermore, notable changes in the levels of Notch-1, pancreatic and duodenal homeobox 1 (PDX-1) and neurogenin 3 (Ngn3) were observed in the GBS group, indicating a potential role of Notch signaling in pancreatic islet regeneration after surgery. In addition, results obtained in PDX-1 knockout (KO), Notch-1 KO and Ngn3 KO mouse models with GBS suggested that elevated PDX-1 resulted in the inhibition of Notch-1, further facilitated Ngn3 and thus promoted pancreatic β-cell regeneration after GBS. The present findings demonstrated that GBS in db/db mice resulted in pancreatic islet regeneration through the PDX-1/Notch-1/Ngn3 signaling pathway, which also reflected the important role of the gastrointestinal system in metabolism control.
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Affiliation(s)
- Tao Huang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Jun Fu
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Zhijing Zhang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Yuhao Zhang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Yunjia Liang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Cuicui Ge
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Xianju Qin
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
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Predictors of Long-Term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass in Severely Obese Patients. Obes Surg 2017; 28:195-203. [DOI: 10.1007/s11695-017-2830-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Gastric Bypass Surgery Leads to Long-term Remission or Improvement of Type 2 Diabetes and Significant Decrease of Microvascular and Macrovascular Complications. Ann Surg 2017; 263:1138-42. [PMID: 26599565 DOI: 10.1097/sla.0000000000001509] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of the study was to compare long-term outcomes of 2 groups of morbidly obese patients with type 2 diabetes mellitus-1 managed by Roux-en-Y gastric bypass surgery and a comparable group managed medically. METHODS The present study was a single-institution retrospective study. Of the 173 obese patients with type 2 diabetes mellitus undergoing gastric bypass surgery between January 2000 and July 2004, 78 patients (45%) were followed for at least 10 years. The control group consisted of 80 diabetic obese patients from the same period with similar body mass index, age, race, and severity of diabetes. The median follow-up was 11 years for both the groups. RESULTS The group undergoing gastric bypass surgery had greater percentage of excess weight loss than the control group-66% versus -1.6%, respectively. Forty-one patients (52.6%) in the surgery group had complete remission of diabetes and 5 (6.4%) had partial remission. Twelve patients (15.4%) had diabetes recurrence after initial remission. No patient in the control group had remission of diabetes. Compared with the control group, the group undergoing gastric bypass surgery had a significantly reduced incidence of microvascular complications-46.3% versus 11.5%, and macrovascular complications-20.3% versus 5%, respectively (P < 0.01). CONCLUSIONS In this study, we demonstrated that after 10 years of follow-up, Roux-en-Y gastric bypass surgery, compared with nonsurgical medical management, resulted in significantly greater weight loss, reduction in hemoglobin A1c, and use of antidiabetic medications, and very importantly a lower incidence of both microvascular and macrovascular complications in obese patients with type 2 diabetes.
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Yan W, Bai R, Yan M, Song M. Preoperative Fasting Plasma C-Peptide Levels as Predictors of Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: A Systematic Review and Meta-Analysis. J INVEST SURG 2017; 30:383-393. [PMID: 28045566 DOI: 10.1080/08941939.2016.1259375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Wenmao Yan
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Rixing Bai
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Ming Yan
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Maomin Song
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, China
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Kassem MAM, Durda MA, Stoicea N, Cavus O, Sahin L, Rogers B. The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events. Front Endocrinol (Lausanne) 2017; 8:37. [PMID: 28298900 PMCID: PMC5331470 DOI: 10.3389/fendo.2017.00037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/14/2017] [Indexed: 01/10/2023] Open
Abstract
Recent studies discussed the benefit of bariatric surgery on obese patients diagnosed with type 2 diabetes mellitus (T2DM). Several factors play an essential role in predicting the impact of bariatric surgery on T2DM, such as ABCD score (age, BMI, C-peptide, and duration of the disease), HbA1c, and fasting blood glucose, incretins [glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP)]. DiaRem score known to include factors such as age, HbA1c, medication, and insulin usage used to predict the remission of T2DM, but it has some limitations. An extensive literature search was conducted on PubMed and Google Scholar using keywords such as gastric bypass, T2DM, bariatric surgery, GLP-1, GIP, and post bariatric hypoglycemia. Restrictive-malabsorptive procedures are most effective in treating T2DM patients based on changes induced in appetite through regulation of gastrointestinal hormones, with decreased hunger and increased satiation. We provide a review of bariatric surgery influence on T2DM and management of post-intervention hypoglycemic events. Post-bariatric surgery hypoglycemia is a serious complication especially when patients develop life-threatening neuroglycopenia with loss of consciousness and seizure. The avoidance of this adverse event may be achieved by strict dietary modification including a restriction on carbohydrates as well as foods with high glycemic index. Further research will provide more information on post-bariatric surgery hyperinsulinemic hypoglycemia pathophysiology and management.
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Affiliation(s)
- Mahmoud Attia Mohamed Kassem
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- *Correspondence: Mahmoud Attia Mohamed Kassem,
| | - Michael Andrew Durda
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omer Cavus
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Levent Sahin
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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White MG, Shaw JAM, Taylor R. Type 2 Diabetes: The Pathologic Basis of Reversible β-Cell Dysfunction. Diabetes Care 2016; 39:2080-2088. [PMID: 27926891 DOI: 10.2337/dc16-0619] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023]
Abstract
The reversible nature of early type 2 diabetes has been demonstrated in in vivo human studies. Recent in vivo and in vitro studies of β-cell biology have established that the β-cell loses differentiated characteristics, including glucose-mediated insulin secretion, under metabolic stress. Critically, the β-cell dedifferentiation produced by long-term excess nutrient supply is reversible. Weight loss in humans permits restoration of first-phase insulin secretion associated with the return to normal of the elevated intrapancreatic triglyceride content. However, in type 2 diabetes of duration greater than 10 years, the cellular changes appear to pass a point of no return. This review summarizes the evidence that early type 2 diabetes can be regarded as a reversible β-cell response to chronic positive calorie balance.
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Affiliation(s)
- Michael G White
- Regenerative Medicine for Diabetes Group and Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K
| | - James A M Shaw
- Regenerative Medicine for Diabetes Group and Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K
| | - Roy Taylor
- Regenerative Medicine for Diabetes Group and Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.
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Abstract
Type 2 diabetes causes major global health problems and has been believed to be a lifelong condition with inevitable worsening. Steadily increasing numbers of drugs appeared to be required to achieve even modest control. Early type 2 diabetes has now been shown to be reversed by substantial weight loss and this has allowed temporal tracking of the underlying pathophysiological changes. Areas covered: In early type 2 diabetes, negative calorie balance decreases liver fat within days, and allows return of normal control of hepatic glucose production. Over 8 weeks, the negative calorie balance allows the raised levels of intra-pancreatic fat and simultaneously first phase insulin secretion to normalise. These findings are consistent with the 2008 Twin Cycle Hypothesis of the etiology and pathogenesis of type 2 diabetes. Individuals develop type 2 diabetes when they exceed their personal fat threshold for safe storage of fat and there is no difference in pathophysiology between those with BMI above or below 30 kg/m2. Expert commentary: Type 2 diabetes can now be understood as a state of excess fat in liver and pancreas, and remains reversible for at least 10 years in most individuals.
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Affiliation(s)
- Roy Taylor
- a Magnetic Resonance Centre, Institute for Cellular Medicine , Newcastle University , Newcastle upon Tyne , UK
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Abstract
BACKGROUND Morbidly obese patients with type 2 diabetes have shown significant improvement in glycemic control after Roux-en-Y gastric bypass (RYGB). This study aimed to elucidate the predictors of diabetes remission. METHODS A retrospective review of a prospectively established database identified 134 type 2 diabetes patients who underwent laparoscopic RYGB between January 2011 and February 2014. Partial and complete remission of diabetes was defined as glycated hemoglobin (HbA1c) level <6.5 and <6.0%, respectively, without the use of antidiabetic medication. Pre- and postoperative clinical outcomes were compared between the remission and non-remission groups to identify the predictors of partial or complete remission of diabetes. RESULTS The mean duration of diabetes and preoperative HbA1c level were 4.6 years and 8.0%, respectively. The body mass index (BMI) of the enrolled patients decreased from 37.9 to 28.8 kg/m(2) during the mean follow-up of 12.3 months; 61.8% of the patients achieved partial or complete remission of diabetes. Multivariate analysis revealed that age at operation (odds ratio [OR] = 0.880; 95% confidence interval [CI] 0.807-0.960), HbA1c level (OR = 0.527; 95% CI 0.325-0.854), and C-peptide level (OR = 1.463; 95% CI 1.054-2.029) in the preoperative laboratory study, and the percentage of total weight loss (%TWL) (OR = 1.186; 95% CI 1.072-1.313) after RYGB were the independent predictors of partial or complete diabetes remission. CONCLUSION The predictive factors for diabetes remission after RYGB include age at operation, HbA1c and C-peptide levels, and the %TWL after surgery.
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Wang JL, Xu XH, Zhang XJ, Li WH. The role of obestatin in roux-en-Y gastric bypass-induced remission of type 2 diabetes mellitus. Diabetes Metab Res Rev 2016; 32:470-7. [PMID: 26445403 DOI: 10.1002/dmrr.2735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/31/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a complex and multifactorial disease that is generally characterized by insulin resistance and loss of β-cell function that develops in adulthood. To date, more than 6% of the world's population is affected by T2DM. The main treatments of T2DM are dietary and lifestyle changes. However, only dependent on behaviour modification and oral hypoglycemics, many patients are unable to maintain glycemic control. Emerging evidence indicates that up to 80% of patients with T2DM undergoing Roux-en-Y gastric bypass (RYGB) experience complete remission of their T2DM and the majority of remissions occur almost immediately following the operation. Obestatin is a 23-amino-acid peptide, which is not only thought to suppress food intake and decrease gastric emptying but also found to exert survival effects in pancreatic β cells, increase glucose-stimulated insulin secretion, and reduce insulin resistance and inflammation. In addition, some researchers demonstrated that obestatin is a nutritional marker reflecting body adiposity and insulin resistance. Although results from previous studies were conflicting, the peripheral blood concentrations of obestatin were changed after RYGB. Therefore, regulation of obestatin level may be another mechanism for RYGB-induced remission of T2DM. In this article, we review briefly the effect of RYGB on T2DM in humans and offer an overview of the published data on the effects of RYGB on obestatin level in patients with T2DM. Furthermore, the possible roles of obestatin in the remission of T2DM following RYGB are also reviewed. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jian-Li Wang
- Qingdao University, Qingdao, China
- Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China
| | - Xian-Hui Xu
- Department of General Surgery, No. 401 Hospital of People's Liberation Army, Qingdao, China
| | - Xue-Jun Zhang
- Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China
| | - Wei-Hua Li
- Department of General Surgery, No. 401 Hospital of People's Liberation Army, Qingdao, China
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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45
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Palmisano S, Silvestri M, Giuricin M, Baldini E, Albertario S, Capelli P, Marzano B, Fanti G, Zompicchiatti A, Millo P, Fabozzi M, Brachet Contul R, Ponte E, Allieta R, de Manzini N. Preoperative Predictive Factors of Successful Weight Loss and Glycaemic Control 1 Year After Gastric Bypass for Morbid Obesity. Obes Surg 2016; 25:2040-6. [PMID: 25845353 DOI: 10.1007/s11695-015-1662-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastric bypass (GBP) is one of the most effective surgical procedures to treat morbid obesity and the related comorbidities. This study aimed at identifying preoperative predictors of successful weight loss and type 2 diabetes mellitus (T2DM) remission 1 year after GBP. METHODS Prospective longitudinal study of 771 patients who underwent GBP was performed at four Italian centres between November 2011 and May 2013 with 1-year follow-up. Preoperative anthropometric, metabolic and social parameters, the surgical technique and the previous failed bariatric procedures were analyzed. Weight, the body mass index (BMI), the percentage of excess weight lost (% EWL), the percentage of excess BMI lost (% BMIL) and glycated haemoglobin (HbA1c) were recorded at follow-up. RESULTS Univariate and multivariate analysis showed that BMI <50 kg/m(2) (p = 0.006) and dyslipidaemia (p = 0.05) were predictive factors of successful weight loss. Multivariate analysis of surgical technique showed significant weight loss in patients with a small gastric pouch (p < 0.001); the lengths of alimentary and biliary loops showed no statistical significance. All diabetic patients had a significant reduction of HbA1c (p < 0.001) after surgery. BMI ≥ 50 kg/m(2) (p = 0.02) and low level of preoperative HbA1c (p < 0.01) were independent risk factors of T2DM remission after surgery. CONCLUSIONS This study provides a useful tool for making more accurate predictions of best results in terms of weight loss and metabolic improvement.
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Affiliation(s)
- Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Marta Silvestri
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Michela Giuricin
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Edoardo Baldini
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Simone Albertario
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Patrizio Capelli
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Bernardo Marzano
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Giovanni Fanti
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Aron Zompicchiatti
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Paolo Millo
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Massimiliano Fabozzi
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Riccardo Brachet Contul
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Elisa Ponte
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Rosaldo Allieta
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
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46
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Faucher P, Poitou C, Carette C, Tezenas du Montcel S, Barsamian C, Touati E, Bouillot JL, Torcivia A, Czernichow S, Oppert JM, Ciangura C. Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control. Obes Surg 2016; 26:2370-8. [DOI: 10.1007/s11695-016-2106-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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47
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Fang YL, Almulaifi AM, Lee WJ. Letter to "Predictive Factors of Type 2 Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis". Obes Surg 2016; 25:2424-5. [PMID: 26420762 DOI: 10.1007/s11695-015-1886-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Yue-Lin Fang
- Asia-Pacific Center of Bariatric and Diabetes Surgery, Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan, Republic of China
| | - Abdullah M Almulaifi
- Asia-Pacific Center of Bariatric and Diabetes Surgery, Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan
| | - Wei-Jei Lee
- Asia-Pacific Center of Bariatric and Diabetes Surgery, Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan.
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48
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Auclair A, Martin J, Bastien M, Bonneville N, Biertho L, Marceau S, Hould FS, Biron S, Lebel S, Lescelleur O, Després JP, Poirier P. Is There a Role for Visceral Adiposity in Inducing Type 2 Diabetes Remission in Severely Obese Patients Following Biliopancreatic Diversion with Duodenal Switch Surgery? Obes Surg 2015; 26:1717-27. [DOI: 10.1007/s11695-015-1973-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Pak J, Kwon Y, Lo Menzo E, Park S, Szomstein S, Rosenthal RJ. Impact of gastrointestinal bypass on nonmorbidly obese type 2 diabetes mellitus patients after gastrectomy. Surg Obes Relat Dis 2015; 11:1266-72. [DOI: 10.1016/j.soard.2014.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/08/2014] [Indexed: 12/19/2022]
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50
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Runkel M, Müller S, Brydniak R, Runkel N. Downgrading of type 2 diabetes mellitus (T2DM) after obesity surgery: duration and severity matter. Obes Surg 2015; 25:494-9. [PMID: 25209955 DOI: 10.1007/s11695-014-1419-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is overwhelming evidence for the antidiabetic effect of obesity surgery, but few reports involve objective longitudinal measurements of severity of type-2 diabetes mellitus (T2DM). This study applies a grading scheme and analyses the prognostic impact of routine clinical factors. MATERIAL AND METHODS This retrospective study includes 77 obese diabetic patients with a preoperative BMI of 48.9 ± 7.8 kg/m(2) who underwent gastric banding (n = 4), Roux-en-Y gastric bypass (n = 57), or sleeve gastrectomy (n = 16) between 2007 and 2013. A 6-point scoring system graded the level of antidiabetic therapy. Downgrading was calculated from the difference between pre- and postoperative grades. RESULTS Downgrading reached its maximum at 3 months well before maximal weight loss: one grade in 6 (8 %) patients, two grades in 36 (47 %) patients, and three or more grades in 20 (26 %) patients. Age, gender, and preoperative weight had no impact on downgrading. There were no significant differences between gastric banding (median 1; 0-2), gastric bypass (median 2; 0-5), and sleeve gastrectomy (median 2; 0-4). Preoperative duration of T2DM and its severity grade were independent prognostic factors in multivariate analysis. The rate of patients who could discontinue insulin was more than 80 % when the duration of preexisting T2DM was less than 5 years as compared to 62 % when the duration was more than 5 years. CONCLUSION The severity of T2DM downgrades in most patients within the initial period of postoperative weight loss. Downgrading increases with shorter duration and lower severity grade of pre-existing T2DM.
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Affiliation(s)
- Mira Runkel
- St George's Hospital Medical School, University of London, Cranmer Terrace, London, SW17 0RE, UK,
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