1
|
Yi X, Zhu L, Zhu S. Predictors of T2DM Remission after Bariatric Surgery in Patients with a BMI < 35 kg/m 2: a Meta-Analysis. Obes Surg 2023; 33:2342-2355. [PMID: 37328645 DOI: 10.1007/s11695-023-06671-7] [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: 01/10/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Although a few studies have reported the predictors of postoperative diabetes remission in patients with body mass index (BMI) < 35 kg/m2, the conclusions are still inconsistent. This meta-analysis aimed to evaluate the preoperative clinical factors of type 2 diabetes mellitus (T2DM) remission after bariatric surgery. MATERIALS AND METHODS The PubMed, Embase, and Cochrane Library databases were systematically searched until April 2022. The Newcastle-Ottawa Scale was used for quality assessment. Statistical heterogeneity was assessed with the I2 statistic, followed by subgroup and sensitivity analyses. RESULTS 16 studies involving 932 patients were selected. T2DM remission was negatively correlated with age, duration, insulin use, fasting plasma glucose, fasting insulin, and glycosylated hemoglobin levels. While BMI, body weight, waist circumference, and C-peptide levels were positive predictors of T2DM remission in patients with a BMI < 35 kg/m2. However, there was no significant association between gender, oral hypoglycemic agent, homeostasis model assessment, high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, and remission rate. CONCLUSION Patients with younger age, short diabetes duration, more obesity, better glucose control, and better β cell function were more likely to achieve T2DM remission in patients with a BMI < 35 kg/m2 after bariatric surgery.
Collapse
Affiliation(s)
- Xianhao Yi
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Liyong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
| | - Shaihong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
| |
Collapse
|
2
|
Papadia FS, Carlini F, Rubartelli A, Battistini M, Cordera R, Adami GF, Camerini G. Diabetes Resolution at 10 Years After Biliopancreatic Diversion in Overweight and Class 1 Obese Patients with Type 2 Diabetes. Obes Surg 2022; 32:845-851. [PMID: 35013895 PMCID: PMC8866270 DOI: 10.1007/s11695-021-05870-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients were investigated reporting the results at 10 years after BPD performed in severely non-obese T2DM patients. Material and Methods Thirty T2DM patients with BMI lower than 35 kg/m2 were investigated at 1, 5, and 10 years after BPD, and the results are compared with those of 30 T2DM patients followed for 10 years on pharmacological and/or behavioral conventional therapy. Results Mean levels of fasting blood glucose (FBG) and serum glycated hemoglobin (HbA1C) showed a marked reduction 1 year after BPD, values remaining slightly above the diabetic range throughout the entire follow-up. T2DM remission was observed in about 50% of the cases at 5 and 10 years after the operation. In 16 patients (53%), severe BPD-related complications developed, in ten cases requiring a surgical revision of the operation. In the BPD group, one patient died for malignant lymphoma and two patients after surgical revision. Within the control group, during the 10-year follow-up, no changes in the diabetic status were observed, being the FBG and HbA1C mean values higher than those recorded in the BPD patients at any follow-up time. All T2DM subjects of the control group were alive at the end of the 10-year follow-up. Conclusion Despite satisfactory long-term metabolic outcomes, these data indicate that BPD should be used with caution as a metabolic procedure in the treatment of T2DM in overweight or class 1obese patients. Graphical abstract ![]()
Collapse
Affiliation(s)
| | - Flavia Carlini
- Department of Surgery, University of Genova, Genova, Italy
| | | | - Micaela Battistini
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy
| | - Renzo Cordera
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy
| | - Gian Franco Adami
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy.
| | | |
Collapse
|
3
|
Du D, Wang L, Chen W, Sang Q, Zheng X, Lian D, Zhang N. Weight loss is the deciding factor to predict the outcome of RYGB in obese Chinese with a BMI < 35 kg/m 2. Asian J Surg 2021; 45:1682-1687. [PMID: 34642048 DOI: 10.1016/j.asjsur.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure for bariatric surgery that leads to sustained weight loss and amelioration of obesity-related comorbidities. OBJECTIVES To verify long-term efficacy and safety and to investigate the influence of early weight loss on post-RYGB long-term weight maintenance in obese Chinese with body mass index (BMI) < 35 kg/m2. METHODS All patients were followed up for evaluating the variations in their BMI, percentage of excess weight loss (%EWL), and total body percentage weight loss (%TWL). Linear regression models were applied to evaluate the effects of early weight loss on successful weight maintenance. Optimal cutoff values were analyzed via plotting the receiver operative characteristic (ROC) curve. RESULTS In the current study, 143 patients were recruited. Preoperative BMI and weight were recorded as 32.24 (29.39-33.12) kg/m2, and 88.90 ± 9.52 kg, respectively. At 1, 3, and 5 years, successful weight loss i.e., greater than 25% TWL was attained by 46.85%, 37.76%, and 37.06% of patients, respectively. The obtained data revealed that %TWL at 0.5 years was considerably associated with %TWL for up to 5 years (P-value <0.001). Based on the ROC curve, %TWL of 24.39% at 0.5 years best predicted effective weight loss at 5 years (sensitivity 71.70%, specificity 82.22%). CONCLUSION RYGB is a safe and effective approach for weight loss and %TWL at 6 months might be used for predicting weight maintenance up to 5 years post-RYGB in obese Chinese with a BMI <35 kg/m2.
Collapse
Affiliation(s)
- Dexiao Du
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Liang Wang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Weijian Chen
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Qing Sang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Xuejing Zheng
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Dongbo Lian
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Nengwei Zhang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Kim KH, Kim YH, Seo KW, Yoon KY, Shin YM, Choi YS, Kim BK. Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer. Methods A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC). Results The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery. Conclusions Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.
Collapse
|
6
|
Ji G, Li W, Li P, Tang H, Yu Z, Sun X, Li R, Zhu L, Zhu S. Effect of Roux-en-Y Gastric Bypass for Patients with Type 2 Diabetes Mellitus and a BMI < 32.5 kg/m2: a 6-Year Study in Chinese Patients. Obes Surg 2021; 30:2631-2636. [PMID: 32157520 DOI: 10.1007/s11695-020-04534-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbidly obese patients to improve type 2 diabetes mellitus (T2DM). Recently, T2DM patients with a lower body mass index (BMI) have been receiving more attention, and these patients could benefit from RYGB. METHODS Fifty-two patients with T2DM underwent RYGB between October 2008 and December 2012 in our hospital. Weight, BMI, oral glucose tolerance test (OGTT), insulin release test (IRT), C-peptide release test (CRT), glycosylated hemoglobin (HbA1c), and lipid metabolic parameters were measured at baseline and at 3 and 6 months and 1, 2, 3, 4, 5, and 6 years after surgery. RESULTS The mean age of the 52 patients was 46.8 ± 9.5 years, and 57.7% were male. The mean duration of T2DM was 6.5 ± 4.6 years. Compared with the baseline values, weight and BMI were significantly decreased at several time points after surgery. HbA1c decreased from 8.2 ± 1.7% at baseline to 6.5 ± 1.4% at 3 months, 6.5 ± 1.4% at 6 months, 7.2 ± 1.3% at 4 years, and 7.5 ± 1.2% at 6 years. OGTT, OGTT-IRT, and OGTT-CRT improved after surgery. There was a decrease in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein (LDL) and an increase in high-density lipoprotein (HDL). At 6 years after surgery, 16.7% of patients achieved complete remission of T2DM, and 66.7% achieved improvement in T2DM. CONCLUSION RYGB may be a safe and effective treatment for T2DM patients with a BMI < 32.5 kg/m2 in China. However, a long-term study without loss to follow-up is necessary for better evaluation.
Collapse
Affiliation(s)
- Guangnian Ji
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhaomei Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Rao Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| |
Collapse
|
7
|
Decreased serum betatrophin may correlate with the improvement of obstructive sleep apnea after Roux-en-Y Gastric Bypass surgery. Sci Rep 2021; 11:1808. [PMID: 33469084 PMCID: PMC7815868 DOI: 10.1038/s41598-021-81379-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Obesity is strongly correlated with obstructive sleep apnea (OSA), and bariatric surgery can effectively treat obesity and alleviate OSA. However, the contributing factors are still unclear. We aimed to explore the relationship between betatrophin and OSA in patients undergoing Roux-en-Y gastric bypass (RYGB) surgery. Our study consisted of thirty-seven individuals with OSA and type 2 diabetes (16 males, 21 females) undergoing RYGB surgery. The polysomnography test, anthropometric results, serum betatrophin, and abdominal magnetic resonance images were evaluated both before and 1 year after RYGB surgery. Factors that may correlate with the alleviation of OSA were investigated. In our study, RYGB surgery significantly decreased apnea hypopnea index (AHI) and serum betatrophin concentration (p < 0.001). The abdominal visceral fat area, subcutaneous fat area and HOMA-IR were also significantly decreased (p < 0.001). The preoperative AHI, postoperative AHI and the change in AHI were significantly correlated with the preoperative betatrophin, postoperative betatrophin and the change in betatrophin, respectively (p < 0.05). These correlations were still significant after adjustment for other risk factors. The change in betatrophin was also independently associated with the change in minimum oxygen saturation (p < 0.001). Our data might indicate that serum betatrophin was significantly independently correlated with the improvement of OSA after bariatric surgery.
Collapse
|
8
|
Wang L, Sang Q, Du D, Zheng X, Lian D, Zhang N. Early Weight Loss after Laparoscopic Sleeve Gastrectomy Predicts Sustained Weight Maintenance Among Chinese Individuals with a BMI < 35 kg/m 2. Obes Surg 2021; 31:1647-1655. [PMID: 33392996 DOI: 10.1007/s11695-020-05173-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study assessed the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) in Chinese individuals with a body mass index (BMI) under 35 kg/m2 and to explore the association between early weight loss and sustained weight maintenance. METHODS Patients whose BMI < 35 kg/m2 were recruited. Changes in BMI, total weight loss (%TWL), and excess weight loss (%EWL) were evaluated, with successful weight loss being a %EWL of > 50% and a %TWL of > 25%. Binary logistic regression was employed to assess relationships between %EWL and %TWL and to calculate a joint predictor. The association between early weight loss and sustained weight maintenance was assessed as a function of %EWL, %TWL, and this joint predictor, with receiver operating characteristic (ROC) curves being used for optimal cutoff threshold identification. RESULTS In total, 143 individuals with average preoperative weight and BMI values of 88 (82, 95) kg and 31.99 (29.41, 33.15) kg/m2, respectively, were enrolled in present study. At 5 years, 48.00% of patients achieved successful weight loss. Both 3-month %EWL and %TWL were significantly related to sustained weight loss at 5 years (P < 0.05). ROC curves were used to identify %TWL of 19.54% at 3 months as the most reliable predictor of weight loss at a 5-year follow-up (sensitivity: 61.11%, specificity: 76.92%). CONCLUSION LSG had long-term safety and efficacy, and %TWL at 3 months can predict sustained 5-year weight loss in Chinese individuals with BMI < 35 kg/m2.
Collapse
Affiliation(s)
- Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Dexiao Du
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Dongbo Lian
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China.
- Shijitan Hospital, Tieyi Road, Haidian District, Beijing, China.
| |
Collapse
|
9
|
Role of DiaRem Score in Preoperative Prediction of Type 2 Diabetes Mellitus Remission After Laparoscopic Roux-en-Y Gastric Bypass: Indian Perspective. Obes Surg 2020; 31:1265-1270. [PMID: 33196979 DOI: 10.1007/s11695-020-05129-4] [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: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has emerged as the most effective treatment in reversing insulin resistance in patients with type 2 diabetes mellitus (T2DM). A number of models and statistical tools have been proposed to predict patients likely to experience diabetes remission post-RYGB. The purpose of our study was to evaluate the preoperative accuracy of DiaRem score in predicting T2DM remission at 1 year of follow-up in a retrospective analysis of diabetic morbidly obese patients who underwent RYGB. METHODS One hundred and forty-three patients underwent RYGB between January 2018 and December 2018. We conducted a retrospective analysis in 55 patients (38.46%) with T2DM with 1 year of follow-up. DiaRem score was calculated, and patients were stratified in five groups. RESULT At a 1-year follow-up, we found a higher proportion of patients with T2DM remission in the lower score group compared to a lower proportion of patients with remission in the higher score group. We derived a DiaRem cut-off score of 6.5 that had high sensitivity and specificity to predict T2DM remission preoperatively. We found a significant decrease in BMI and HbA1C values post-operatively at 1 year following RYGB. CONCLUSION DiaRem score is an easy to determine score based on basic clinical parameters that could identify patients with T2DM who would achieve maximal benefit in terms of remission after bariatric surgery. The development of a suitable scoring tool would be clinically useful as it would enable clinicians to better triage patients for RYGB.
Collapse
|
10
|
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.
Collapse
|
11
|
Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
Collapse
Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
| |
Collapse
|
12
|
Wu T, Wong SKH, Law BTT, Grieve E, Wu O, Tong DKH, Leung DKW, Lam CLK, Wong CKH. Five-year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes: A population-based propensity score-matched cohort study. Diabetes Metab Res Rev 2020; 36:e3236. [PMID: 31912598 DOI: 10.1002/dmrr.3236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
Abstract
AIMS To compare disease remission rates, weight loss, and changes of metabolic parameters of patients after bariatric surgery with nonsurgical patients. METHODS Based on the 2006-2017 Hospital Authority database, a population-based retrospective cohort of obese type 2 diabetes mellitus (T2DM) patients with and without bariatric surgery were identified. Surgical patients were matched with nonsurgical patients on 1-to-5 propensity score. Remission rates of diabetes, hypertension, and dyslipidaemia were reported annually up to 60 months. Changes in weight loss measurements (Body Mass Index [BMI], percentage of total weight loss [%TWL], percentage of excess weight loss [%EWL], and percentage of rebound in excess weight loss [%REWL]) and metabolic parameters (haemoglobin A1c [HbA1c ], systolic blood pressure [SBP], diastolic blood pressure [DBP], and low-density lipoprotein cholesterol [LDL-C]) were measured for both groups. RESULTS Four hundred one surgical patients (310 restrictive surgeries; 91 bypass surgeries) and 1894 nonsurgical patients were included. Surgical patients had higher remission rates in diabetes and dyslipidaemia and better glycaemic control at 12 to 60 months (all Ps < .01). SBP and DBP were significantly lower for surgical group up to 12 months and similar between two groups after 12 months. Surgical patients had significantly lower BMI during follow-up period. %TWL and %EWL were higher in the surgery group (15.7% vs 3.7%; 48.8% vs 12.0%) at 60 months (P < .001); differences in %REWL between two groups were insignificant. The effectiveness of restrictive and bypass surgeries was similar at 60 months, although restrictive surgeries were slightly more effective in T2DM remission. CONCLUSIONS Bariatric surgery was effective in weight loss, remission of diabetes, and dyslipidaemia in 5-year post-surgery.
Collapse
Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | | | - Betty Tsz Ting Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Daniel King Hung Tong
- Surgery Centre, Hong Kong Sanatorium & Hospital, University of Glasgow, Hong Kong SAR, China
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Ha J, Kwon Y, Kim NH, Park S, Menzo EL, Rosenthal RJ. Discordance in prediction for prognosis of type 2 diabetes after metabolic surgery: comparison of the ABCD, DiaRem, and individualized metabolic surgery models. Ann Surg Treat Res 2019; 97:309-318. [PMID: 31824886 PMCID: PMC6893221 DOI: 10.4174/astr.2019.97.6.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Metabolic surgery has been performed as a treatment option for uncontrolled type 2 diabetes (T2D), and several scoring systems for predicting postoperative T2D remission have been proposed. This study was designed to assess consistency of 3 existing scoring systems in patients with T2D duration <1 year. METHODS This study included 186 patients with T2D enrolled in a university hospital prospective database between 2011 and 2013. Externally validated scoring systems for predicting T2D prognosis after metabolic surgery were identified and selected through systematic literature search. We assessed concordance between ABCD, DiaRem, and individualized metabolic surgery (IMS) scores in participants using kappa statistical analysis and 1-way analysis of variance. RESULTS Of the participants, 52 and 82 patients were expected to have favorable T2D remission after metabolic surgery with ABCD score of 10-5 and DiaRem score of 0-7, respectively, and a slight-to-fair concordance was shown between the 2 scoring systems (kappa measure, 0.07; standard error [SE], 0.05 and kappa measure, 0.25; SE, 0.19, respectively). The DiaRem score increased with T2D severity determined by IMS score (P < 0.001), while the ABCD score showed no significant association with IMS score. CONCLUSION ABCD and DiaRem scores showed significant discordance when applied to potential metabolic surgery candidates in whom postoperative T2D remission rate was highly expected. The IMS score showed a dose-response association with DiaRem score but had no significant association with the ABCD score.
Collapse
Affiliation(s)
- Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
| | - Yeongkeun Kwon
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Emanuele Lo Menzo
- Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Raul J. Rosenthal
- Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| |
Collapse
|
15
|
Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis 2019; 16:175-247. [PMID: 31917200 DOI: 10.1016/j.soard.2019.10.025] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Collapse
Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Caroline Apovian
- Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - W Timothy Garvey
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rachel Pessah-Pollack
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | | | - Stephanie Adams
- American Association of Clinical Endocrinologists, Jacksonville, Florida
| | - John B Cleek
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Karen Flanders
- Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Michael V Seger
- Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Lin S, Yang N, Guan W, Liang H. Can Chinese T2D patients with BMI 20–32.5 kg/m2 benefit from loop duodenojejunal bypass with sleeve gastrectomy? Surg Obes Relat Dis 2019; 15:1513-1519. [DOI: 10.1016/j.soard.2019.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/31/2019] [Accepted: 03/17/2019] [Indexed: 12/14/2022]
|
18
|
Navarrete Aulestia S, Leyba JL, Navarrete Llopis S, Pulgar V. One Anastomosis Gastric Bypass/Minigastric Bypass in Patients with BMI < 35 kg/m 2 and Type 2 Diabetes Mellitus: Preliminary Report. Obes Surg 2019; 29:3987-3991. [PMID: 31297740 DOI: 10.1007/s11695-019-04071-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Obesity in the world has been increasing, and the number of diabetic patients will increase by 114%, and the best treatment results are achieved through surgery. Several techniques have been described; the gastric bypass of an anastomosis (MGB/OAGB) has been gaining popularity for its simplicity and good results. We present a prospective study with this technique in 16 mild obesity patients with type 2 diabetes mellitus or peripheral insulin resistance. OBJECTIVE To evaluate weight loss as well as metabolic changes by measuring fasting glycemia and Hb A1c after 1 year of follow-up. MATERIAL AND METHODS Sixteen patients were operated on with the OAGB/MGB technique from September 2014 to January 2016, with some form of metabolic syndrome, whether DM2, RPI, HBP, or dyslipidemia, including patients in the study with a follow-up of at least 12 months. RESULTS There were 13 cases of female sex and 3 of male, average age of 42.9 years, with an average weight of 87.7 kg and BMI of 32.2 kg/m2. Metabolic values were fasting glycemia of 193.6 ± 52.9 mg/dl and HbA1c of 8.4% ± 1 (preop) and glycemia posop, 78.8 ± 7.6 mg/dl; HbA1c posop, 6.1 ± 0.2; preop weight, 87.7 ± 14 kg (69-116); weight posop, 66.8 ± 10.5 kg (49-90); BMI preop, 32.2 ± 1.8 (30-34.9); BMI posop, 25.4 ± 1.7 (21.7-27.6); percentage of excess weight lost, 87.6 ± 11.8 (70.9-100) % with 100% remission of diabetes. CONCLUSION The results show the benefits of MGB/OAGB in mild obese diabetic patients.
Collapse
|
19
|
Nor Hanipah Z, Hsin MC, Liu CC, Huang CK. Laparoscopic loop duodenaljejunal bypass with sleeve gastrectomy in type 2 diabetic patients. Surg Obes Relat Dis 2019; 15:696-702. [PMID: 30935839 DOI: 10.1016/j.soard.2019.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a new metabolic procedure. Our initial data on type 2 diabetes (T2D) remission after LDJB-SG were promising. OBJECTIVES The aim of this study was to look at our intermediate outcomes after LDJB-SG. SETTING An academic medical center. METHODS A prospective analysis of T2D patients who underwent LDJB-SG between October 2011 and October 2014 was performed. Data collected included baseline demographic, body mass index, fasting blood glucose, glycosylated hemoglobin, C-peptide, resolution of co-morbidities, and postoperative complications. RESULTS A total of 163 patients with minimum of follow-up >1 year were enrolled in this study (57 men and 106 women). The mean age and body mass index were 47.7 (±10.7) years and a 30.2 (±5.1) kg/m2, respectively. There were 119 patients on oral hypoglycemic agents only, 29 patients were on oral hypoglycemic agents and insulin, 3 patients were on insulin only, and the other 12 patients were not on diabetic medication. Mean operation time and length of hospital stay were 144.7 (± 45.1) minutes and 2.4 (± 1.0) days, respectively. Seven patients (3.6%) needed reoperation due to bleeding (n = 1), anastomotic leak (n = 2), sleeve strictures (n = 2), and incisional hernia (n = 2). At 2 years of follow-up, there were 56 patients. None of the patients were on insulin and only 20% of patients were on oral hypoglycemic agents. Mean body mass index significantly dropped to 22.9 (±5.6) kg/m2 at 2 years. The mean preoperative fasting blood glucose, glycosylated hemoglobin, and C-peptide levels were 174.7 mg/dL (± 61.0), 8.8% (±1.8), and 2.6 (±1.7) ng/mL, respectively. The mean fasting blood glucose, glycosylated hemoglobin, and C-peptide at 2 years were 112.5 (±60.7) mg/dL, 6.4% (±2.0), and 1.5 (±0.6) ng/mL, respectively. No patient needed revisional surgery because of dumping syndrome, marginal ulcer, or gastroesophageal reflux disease at the last follow up period. CONCLUSION At 2 years, LDJB-SG is a relatively safe and effective metabolic surgery with significant weight loss and resolution of co-morbidities.
Collapse
Affiliation(s)
- Zubaidah Nor Hanipah
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC); Department of General Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Ming-Che Hsin
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC)
| | - Chia-Chia Liu
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC)
| | - Chih-Kun Huang
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC).
| |
Collapse
|
20
|
Ferraz ÁAB, de Sá VCT, Santa-Cruz F, Siqueira LT, Silva LB, Campos JM. Roux-en-Y gastric bypass for nonobese patients with uncontrolled type 2 diabetes: a long-term evaluation. Surg Obes Relat Dis 2019; 15:682-687. [PMID: 31005458 DOI: 10.1016/j.soard.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is growing evidence that the impact of Roux-en-Y gastric bypass (RYGB) on type 2 diabetes (T2D) occurs regardless of the amount of weight loss. Taking this background into consideration, it is plausible to study this procedure in individuals with lower body mass index (BMI) under clinical treatment failure for uncontrolled T2D. OBJECTIVES To elucidate the long-term impact of RYGB on T2D regression in a non-obese population. SETTING Hospital das Clínicas, Federal University of Pernambuco, Brazil. METHODS Twelve patients with BMI 25 to 30 kg/m2 and inadequately controlled T2D underwent RYGB and were followed up for 6 years. Fasting plasma glucose, glycated hemoglobin, BMI, and the use of insulin and/or oral hypoglycemic agents were assessed. Each variable was analyzed in 3 distinct moments: preoperative evaluation, 2-year postoperative follow-up (2-PO), and 6-year postoperative follow-up (6-PO). RESULTS There were no cases of early or late mortality. Mean BMI at preoperative evaluation, 2-PO, and 6-PO were 28.1 ± 1.2; 23.2 ± 2.4; and 24.7 ± 3.1, respectively. The lowest BMI at 6-PO was 19.1 kg/m2. Complete remission of T2D was achieved in 16.7%, partial remission in another 16.7%, glycemic control in 25%, and glycemic improvement in 25% of the sample at 6-PO; 16.7% did not present positive glycemic outcomes. Only 1 patient needed to resume insulin administration between 2-PO and 6-PO. CONCLUSIONS RYGB was found to be safe and effective in treating uncontrolled T2D in non-obese patients, providing improvements in the glycemic patterns in 83.4% of our sample.
Collapse
Affiliation(s)
- Álvaro A B Ferraz
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Vladimir C T de Sá
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Luciana T Siqueira
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | - Lyz B Silva
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | - Josemberg M Campos
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| |
Collapse
|
21
|
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]
|
22
|
Dong Z, Islam SMS, Yu AM, Qu R, Guan B, Zhang J, Hong Z, Wang C. Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis. BMC Surg 2018; 18:73. [PMID: 30223815 PMCID: PMC6142391 DOI: 10.1186/s12893-018-0406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis. Methods We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis. Results In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m2 to < 35 kg/m2 in Asia. Conclusions Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m2, and that LSG is the most commonly performed surgical procedure for this in Asia.
Collapse
Affiliation(s)
- Zhiyong Dong
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | | | - Ashley M Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rui Qu
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Bingsheng Guan
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Junchang Zhang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Zhao Hong
- Robert H Lurie Medical Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Cunchuang Wang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China.
| |
Collapse
|
23
|
Li YX, Fang DH, Liu TX. Laparoscopic sleeve gastrectomy combined with single-anastomosis duodenal-jejunal bypass in the treatment of type 2 diabetes mellitus of patients with body mass index higher than 27.5 kg/m2 but lower than 32.5 kg/m2. Medicine (Baltimore) 2018; 97:e11537. [PMID: 30075520 PMCID: PMC6081088 DOI: 10.1097/md.0000000000011537] [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] [Received: 12/05/2017] [Accepted: 06/20/2018] [Indexed: 12/25/2022] Open
Abstract
This study aimed to introduce this surgical technique laparoscopic sleeve gastrectomy combined with single-anastomosis duodenal-jejunal bypass (LDJB-LSG), and to confirm this new surgical technique was safe in the treatment of type 2 diabetes mellitus (T2DM) of patients with body mass index (BMI) higher than 27.5 kg/m but lower than 32.5 kg/m.A total of 34 T2DM patients with (BMI) higher than 27.5 kg/m but lower than 32.5 kg/m were admitted to our department between January 2014 and October 2016, of whom 25 received laparoscopic gastric bypass surgery (LRYGB) and 9 received LDJB-LSG. The efficacy and safety were compared between the 2 groups.None in both groups died and had severe postoperative complications. All the surgeries were performed by laparoscopy, and none received switching to open surgery. Patients received regular follow-up after surgery and none were lost to follow-up.Our study indicates LDJB-LSG is similar to LRYGB in the improvements of the body weight, blood glucose, insulin resistance, islet β cell function, blood lipid profile and serum uric acid, and thus LDJB-LSG is applicable in T2DM patients with 27.5 kg/m ≤ BMI ≤ 32.5 kg/m and risk for gastric cancer. However, long-term therapeutic effects need to be evaluated by studies with multicenter, large sample size, and long-term follow-ups.
Collapse
|
24
|
Effects of Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI > 30 and < 30 kg/m 2. Obes Surg 2018; 27:3040-3047. [PMID: 28905292 PMCID: PMC5651707 DOI: 10.1007/s11695-017-2926-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recently, many studies focused on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) < 30 kg/m2 and suggested that those patients might benefit from Roux-en-Y gastric bypass (RYGB). However, evidence on its effectiveness to improve T2DM patients with BMI < 30 kg/m2 is still lacking. The aim of this study is to explore whether T2DM patients with BMI < 30 kg/m2 get similar surgical effect from RYGB compared with those patients with BMI > 30 kg/m2. Methodology Seventy patients with uncontrolled T2DM underwent laparoscopic RYGB from May 2010 to December 2015 in the GI Department of Daping Hospital. Weight, BMI, waist circumference, glucose, and lipid metabolic parameters were collected and evaluated at baseline and 1, 3, 6, 12, and 24 months postsurgery. Patients with BMI < 30 kg/m2 were compared with those with BMI > 30 kg/m2. Results Among the 70 patients, 47 (67.1%) BMI < 30 kg/m2, and 23 (32.9%) BMI > 30 kg/m2. Patients with BMI < 30 kg/m2 are significantly older; they are female predominant and have longer duration of diabetes. The complete remission of T2DM was 28.2% of the BMI < 30 kg/m2 group and 57.9% of the BMI > 30 kg/m2 group (p = 0.029). There was no significant difference in the change of glucose and lipid metabolic parameters of both groups. FPG, 2hPG, and HbA1c% levels were significantly improved after 1 month (p < 0.05), and then remained essentially stable from the sixth month in both groups. Conclusions The 2-year study has shown that RYGB is a safe and effective procedure in treating T2DM with BMI < 30 kg/m2, although the complete remission of T2DM in the BMI < 30 kg/m2 group is lower than the BMI > 30 kg/m2 group.
Collapse
|
25
|
Seki Y, Kasama K, Yasuda K, Yokoyama R, Porciuncula JP, Kurokawa Y. The Effects of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Japanese Patients with BMI < 35 kg/m2 on Type 2 Diabetes Mellitus and the Prediction of Successful Glycemic Control. Obes Surg 2018; 28:2429-2438. [DOI: 10.1007/s11695-018-3179-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
26
|
Coelho D, Godoy EPD, Marreiros I, Luz VFD, Oliveira AMGD, Campos JM, Caldas-Neto SDS, Freitas MPCD. DIABETES REMISSION RATE IN DIFFERENT BMI GRADES FOLLOWING ROUX-EN-Y GASTRIC BYPASS. ACTA ACUST UNITED AC 2018. [PMID: 29513804 PMCID: PMC5863997 DOI: 10.1590/0102-672020180001e1343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Type 2 diabetes mellitus has a high long-term remission rate after laparoscopic Roux-en-Y gastric bypass (LRYGB), but few studies have analyzed patients with BMI<35 kg/m2. Aim: To compare glycemic control after LRYGB between BMI 30-35 kg/m2 (intervention group or IG) and >35 kg/m2 patients (control group or CG) and to evaluate weight loss, comorbidities and surgical morbidity. Methods: Sixty-six diabetic patients (30 in IG group and 36 in CG group) were submitted to LRYGB. Data collected annually after surgery were analyzed with generalized estimating equations. Results: Average follow-up was 4.3 years. There was no statistical difference between groups using complete remission American Diabetes Association criteria (OR 2.214, 95%CI 0.800-5.637, p=0.13). There was significant difference between groups using partial remission American Diabetes Association criteria (p=0.002), favouring the CG group (OR 6.392, 95%CI 1.922-21.260). The higher BMI group also had lower HbA1c levels (-0.77%, 95%CI -1.26 to -0.29, p=0.002). There were no significant differences in remission of hypertension, dyslipidemia and surgical morbidity, while weight was better controlled in the IG group. Conclusion: No differences were found in diabetes complete remission, although greater partial remission and the lower levels of glycated hemoglobin in the BMI >35 kg/m2 group suggest a better response among more obese diabetic patients with LRYGB. In addition, both groups had important metabolic modifications at the expense of low morbidity.
Collapse
Affiliation(s)
- Daniel Coelho
- Service of Obesity and Related Diseases, University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, RN
| | - Eudes Paiva de Godoy
- Service of Obesity and Related Diseases, University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, RN
| | - Igor Marreiros
- Service of Obesity and Related Diseases, University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, RN
| | | | | | | | | | | |
Collapse
|
27
|
Praveen Raj P, Bhattacharya S, Saravana Kumar S, Sabnis SC, Parthasarathi R, Swamy PDK, Palanivelu C. Do Bariatric Surgery-Related Type 2 Diabetes Remission Predictors Add Clinical Value? A Study on Asian Indian Obese Diabetics. Obes Surg 2018; 27:2113-2119. [PMID: 28236254 DOI: 10.1007/s11695-017-2615-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bariatric surgery has emerged to be the most effective treatment strategy for the treatment of obesity and type 2 diabetes mellitus (T2DM) achieving high remission rates. Many factors have been evaluated with a potential to predict the improvement of glycemic control following bariatric procedures. This study aims to study the various predictive factors for T2DM and the ABCD score in obese diabetic patients undergoing bariatric surgery in a South Indian population. METHODS A total of 53 obese patients (BMI > 30 k/m2) with T2DM who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) from March 2014 to March 2015 were selected for the study. The patients were followed up to study the effects of various predictors of T2DM remission at 1 year. RESULTS Out of the 53 patients, 35 (66%) underwent LSG and 18 (34%) underwent LGB. Patients (81.1%) had T2DM remission. Mean HbA1c values decreased from 8.07 ± 1.98 to 6.0 ± 0.71. Only higher pre-operative body weight (p = 0.04) and lower HbA1c level (p = 0.04) were significantly associated with T2DM remission. Higher absolute weight loss (p = 0.03) after surgery was also significantly associated with T2DM remission. ABCD score was not significantly associated with T2DM remission although patients with ABCD score higher than 7 demonstrated 100% remission rate. CONCLUSION Among all the factors, only higher pre-operative weight and better glycaemic control along with better post-operative weight loss were significantly associated with the remission of T2DM. Although not significantly associated with remission of T2DM, higher ABCD scores had higher likelihood of remission.
Collapse
Affiliation(s)
- P Praveen Raj
- GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
| | | | | | | | - R Parthasarathi
- GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | | | - C Palanivelu
- GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| |
Collapse
|
28
|
Zhang H, Han X, Yu H, Di J, Zhang P, Jia W. Effect of Roux-en-Y Gastric Bypass on Remission of T2D: Medium-Term Follow-up in Chinese Patients with Different BMI Obesity Class. Obes Surg 2017; 27:134-142. [PMID: 27312346 DOI: 10.1007/s11695-016-2262-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes mellitus (T2D) with obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with different obesity classes. The purpose of this study is to evaluate the medium-term metabolic results of RYGB in T2D patients with body mass index (BMI) >25 kg/m2 compared by obesity class. METHODS We retrospectively divided 120 Chinese patients with T2D and BMI >25 kg/m2 into four groups from overweight to obesity class III and reviewed their medical records for metabolic outcomes 36 months after RYGB. T2D remission was defined as glycated hemoglobin <6.0 % and no current medications. Hypertension, dyslipidemia, cardiovascular risk, and medications were also evaluated. RESULTS Sixty-two patients (62/120, 51.6 %) were female. All surgeries were performed laparoscopically without mortality or major complications. Mean follow-up duration was 38.7 ± 9.1 months and follow-up compliance was 86.7 %. Patients with BMI ≥28 kg/m2 benefitted more from weight loss following RYGB. Medication and remission results for hypertension and dyslipidemia did not differ significantly between groups. There was a significant reduction in the need for oral medication or insulin in all four groups. T2D remission occurred in 44-66.7 % of all patients at 36 months with no significant difference between groups. Initial BMI was correlated with A1C 36 months after surgery (r = -0.217, P = 0.027). CONCLUSIONS RYGB effectively treated T2D patients in our study, even in low-BMI patients, and resulted in diabetes remission and metabolic disorder control, reducing cardiovascular risk.
Collapse
Affiliation(s)
- Hongwei Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Xiaodong Han
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jianzhong Di
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Pin Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| |
Collapse
|
29
|
Chen J, Yu H, Chen L, Wu L, Hu B, Bao Y, Jiang L. Effect of Roux-en-Y gastric bypass on carotid intima-media thickness in Chinese obese patients with type 2 diabetes. Surg Obes Relat Dis 2017; 13:1530-1535. [DOI: 10.1016/j.soard.2017.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/29/2016] [Accepted: 01/27/2017] [Indexed: 12/27/2022]
|
30
|
Amouyal C, Andreelli F. What is the evidence for metabolic surgery for type 2 diabetes? A critical perspective. DIABETES & METABOLISM 2017; 43:9-17. [DOI: 10.1016/j.diabet.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/24/2016] [Accepted: 06/13/2016] [Indexed: 02/05/2023]
|
31
|
Zhao L, Ni Y, Yu H, Zhang P, Zhao A, Bao Y, Liu J, Chen T, Xie G, Panee J, Chen W, Rajani C, Wei R, Su M, Jia W, Jia W. Serum stearic acid/palmitic acid ratio as a potential predictor of diabetes remission after Roux-en-Y gastric bypass in obesity. FASEB J 2016; 31:1449-1460. [PMID: 28007782 DOI: 10.1096/fj.201600927r] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/12/2016] [Indexed: 12/18/2022]
Abstract
Endogenous fatty acid metabolism that results in elongation and desaturation lipid products is thought to play a role in the development of type 2 diabetes mellitus (T2DM). In this study, we evaluated the potential of estimated elongase and desaturase activities for use as predictive markers for T2DM remission after Roux-en-Y gastric bypass (RYGB). The results of a targeted metabolomics approach from 2 independent studies were used to calculate 24 serum FA concentration ratios (product/precursor). Gene expression data from an open public data set was also analyzed. In a longitudinal study of 38 obese diabetic patients with RYGB, we found higher baseline stearic acid/palmitic acid (S/P) ratio. This ratio reflects an elovl6-encoded elongase enzyme activity that has been found to be associated with greater possibility for diabetes remission after RYGB [odds ratio, 2.16 (95% CI 1.10-4.26)], after adjustment for age, gender, body mass index, diabetes duration, glycosylated hemoglobin A1c, and fasting C-peptide. Our results were validated by examination of postsurgical elovl6 gene expression in morbidly obese patients. The association of S/P with the metabolic status of obese individuals was further validated in a cross-sectional cohort of 381 participants. In summary, higher baseline S/P was associated with greater probability of diabetes remission after RYGB and may serve as a diagnostic marker in preoperative patient assessment. - Zhao, L., Ni, Y., Yu, H., Zhang, P., Zhao, A., Bao, Y., Liu, J., Chen, T., Xie, G., Panee, J., Chen, W., Rajani, C., Wei, R., Su, M., Jia, W., Jia, W. Serum stearic acid/palmitic acid ratio as a potential predictor of diabetes remission after Roux-en-Y gastric bypass in obesity.
Collapse
Affiliation(s)
- Linjing Zhao
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai, China
| | - Yan Ni
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pin Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; and
| | - Aihua Zhao
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuqian Bao
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiajian Liu
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tianlu Chen
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Guoxiang Xie
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Jun Panee
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, Manoa, Hawaii, USA
| | - Wenlian Chen
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Cynthia Rajani
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Runmin Wei
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Mingming Su
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Weiping Jia
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; .,Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Jia
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; .,University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| |
Collapse
|
32
|
Lee WJ, Aung L. Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia. Diabetes Metab J 2016; 40:433-443. [PMID: 27990787 PMCID: PMC5167707 DOI: 10.4093/dmj.2016.40.6.433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/25/2016] [Indexed: 12/23/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m²). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m². Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.
Collapse
Affiliation(s)
- Wei Jei Lee
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taoyuan, Taiwan.
| | - Lwin Aung
- Department of Surgery, Ng Teng Fong General Hospital, Singapore
| |
Collapse
|
33
|
Zeng T, Cai Y, Chen L. The Effectiveness of Bariatric Surgery for Chinese Obesity in 2 Years: A Meta-Analysis and Systematic Review. J INVEST SURG 2016; 30:332-341. [PMID: 27806209 DOI: 10.1080/08941939.2016.1249442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Tianshu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuli Cai
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
34
|
Bradley D, Hsueh W. Type 2 Diabetes in the Elderly: Challenges in a Unique Patient Population. JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY 2016; 2:14. [PMID: 31692858 PMCID: PMC6831098 DOI: 10.23937/2469-5858/1510014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the older patient population, rates of Type 2 Diabetes (T2D) and obesity are reaching epidemic proportions. In fact, older patients will soon constitute the majority of patients with T2D in most developed countries. The higher prevalence of T2D in older individuals is seen in both men and women and across racial and ethnic groups. However, certain ethnic groups are disproportionately affected and successful strategies must account for these fundamental differences. T2D in old age is associated with traditional diabetes-associated complications including micro- and macro vascular disease, but is also closely related to numerous other comorbidities including cognitive impairment, urinary incontinence, sarcopenia, and increased fall risk. An overall state of chronic inflammation and dysregulated immune system may underlie these increased risks; yet our understanding of immunometabolism during the aging process remains incomplete. In addition, optimal recognition and treatment of diabetes in the elderly is hampered by a lack of relevant, high-quality studies, as the majority of clinical trial data establishing risk profiles, glycemic targets, and therapeutic interventions for T2D are not applicable for large segments of the older patient population. Simply acknowledging this gap is inadequate. We need strong evidence-based data upon which to successfully identify diabetic patients and then intervene in ways that are targeted to specific individuals within a heterogeneous group of elderly patients with T2D.
Collapse
Affiliation(s)
- David Bradley
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
| | - Willa Hsueh
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
| |
Collapse
|
35
|
Du X, Zhou HX, Zhang SQ, Tian HM, Zhou ZG, Cheng Z. A comparative study of the metabolic effects of LSG and LRYGB in Chinese diabetes patients with BMI<35 kg/m 2. Surg Obes Relat Dis 2016; 13:189-197. [PMID: 27720418 DOI: 10.1016/j.soard.2016.08.499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The metabolic effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in type 2 diabetes (T2D) patients who do not meet National Institutes of Health indications has not been well studied. OBJECTIVES To compare the effectiveness of LSG and LRYGB in Chinese T2D patients with body mass index (BMI)<35 kg/m2. SETTING University hospital, China. METHODS A nonrandomized cohort of patients who underwent LRYGB (n = 64) and LSG (n = 19) were followed up for 3 years and the outcomes (weight loss and remission of diabetes and other metabolic parameters) were compared. Univariate and multivariate analyses were applied to find associated parameters of T2D remission. RESULTS In total, 5 patients (6%) were lost to follow-up. No significant differences in mean percentage of excess weight loss and BMI were observed between the 2 groups at 2 years. At 3-year follow-up, the LRYGB group had significantly higher percentage of excess weight loss and lower BMI. The total (complete and partial) remission rate achieved with both bariatric procedures was 75.9% at 1 year and 56.4% at 3 years. Surgical safety, diabetes remission, and remission of other obesity-related co-morbidities were comparable between the 2 groups. Patients who achieved complete or partial remission had lower fasting plasma glucose, lower plasma glucose at 2 hours, lower glycated hemoglobin, and higher fasting C peptide than the other patients at baseline. High recurrence rates of hypertension and hyperuricemia were observed at 3 years postoperation. CONCLUSIONS Both LSG and LRYGB are safe and effective bariatric procedures for T2D in this Chinese population with diabetes and BMI<35 kg/m2.
Collapse
Affiliation(s)
- Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hong-Xu Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Si-Qin Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hao-Ming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
| |
Collapse
|
36
|
Guo K, Yu H, Lu J, Bao Y, Chen H, Jia W. Decreased serum betatrophin levels correlate with improved fasting plasma glucose and insulin secretion capacity after Roux-en-Y gastric bypass in obese Chinese patients with type 2 diabetes: a 1-year follow-up. Surg Obes Relat Dis 2016; 12:1343-1348. [DOI: 10.1016/j.soard.2016.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 11/28/2022]
|
37
|
Loop Duodenojejunal Bypass with Sleeve Gastrectomy: Comparative Study with Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients with a BMI <35 kg/m2, First Year Results. Obes Surg 2016; 26:2291-301. [DOI: 10.1007/s11695-016-2118-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
38
|
Yu H, Chen J, Lu J, Bao Y, Tu Y, Zhang L, Zhang P, Jia W. Decreased visceral fat area correlates with improved arterial stiffness after Roux-en-Y gastric bypass in Chinese obese patients with type 2 diabetes mellitus: a 12-month follow-up. Surg Obes Relat Dis 2016; 12:550-555. [DOI: 10.1016/j.soard.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/03/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022]
|
39
|
Chaudhry S, Bernardes M, Harris PE, Maffei A. Gastrointestinal dopamine as an anti-incretin and its possible role in bypass surgery as therapy for type 2 diabetes with associated obesity. MINERVA ENDOCRINOL 2016; 41:43-56. [PMID: 26505694 PMCID: PMC5079753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this review was to summarize and integrate specific clinical observations from the field of gastric bypass surgery and recent findings in beta cell biology. When considered together, these data sets suggest a previously unrecognized physiological mechanism which may explain how Roux-en-Y gastric bypass (RYGB) surgery mediates the early rapid reversal of hyperglycemia, observed before weight loss, in certain type 2 diabetes mellitus (T2DM) patients. The novel mechanism is based on a recently recognized inhibitory circuit of glucose stimulated insulin secretion driven by DA stored in β-cell vesicles and the gut. We propose that DA and glucagon-like peptide 1 (GLP-1) represent two opposing arms of a glucose stimulated insulin secretion (GSIS) regulatory system and hypothesize that dopamine represents the "anti-incretin" hypothesized to explain the beneficial effects of bariatric surgery on T2DM. These new hypotheses and the research driven by them may directly impact our understanding of: 1) the mechanisms underlying improved glucose homeostasis seen before weight loss following bariatric surgery; and 2) the regulation of glucose stimulated insulin secretion within islets. On a practical level, these studies may result in the development of novels drugs to modulate insulin secretion and/or methods to quantitatively asses in real time beta cell function and mass.
Collapse
Affiliation(s)
- Suleman Chaudhry
- Department of Surgery, Columbia University Medical Center, New York, NY, USA -
| | | | | | | |
Collapse
|
40
|
Xu B, Yan X, Shao Y, Shen Q, Hua R, Ding R, Yao Q. A Comparative Study of the Effect of Gastric Bypass, Sleeve Gastrectomy, and Duodenal-Jejunal Bypass on Type-2 Diabetes in non-Obese Rats. Obes Surg 2016; 25:1966-75. [PMID: 26254879 DOI: 10.1007/s11695-015-1835-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We compared the therapeutic effects of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and duodenal-jejunal bypass (DJB) on type-2 diabetes mellitus (T2DM) in non-obese rats using clamp testing. METHODS Goto-Kakizaki rats (non-obese rats with T2DM) underwent surgery: RYGB, SG, or DJB. Rats were observed for 8 weeks after surgery to evaluate weight changes. Levels of glucose, insulin, and glucagon-like peptide (GLP)-1 were determined 2, 4, 6, and 8 weeks after surgery. An oral glucose tolerance test (OGTT) and clamp test was used to evaluate glucose tolerance and insulin resistance. RESULTS Rats in RYGB, SG, and DJB groups weighed significantly less than sham-group rats 6 and 8 weeks after surgery. Fasting blood glucose levels of RYGB, SG, and DJB rats were significantly lower than preoperative levels. One month after surgery, the area under the curve of the OGTT (in mmol•h/L) for RYGB, SG, DJB, and sham surgery groups was 38.9 ± 5.9, 50.9 ± 2.9, 46.8 ± 3.3, and 67.4 ± 6.0, respectively; there was no significant difference in glucose levels of SG and DJB groups. Glucose infusion rates (in mg/(kg•min)) were 18.3 ± 2.7, 17.2 ± 2.1, and 16.8 ± 1.9 in hyperinsulinemic-euglycemic-clamped RYGB, DJB, and SG rats, respectively, 8 weeks after surgery. The rate in the sham surgery group was 6.3 ± 0.9. Area under plasma insulin curves 8 weeks after surgery in hyperglycemic-clamped RYGB, DJB, SG, and sham surgery rats (in mU•h/L) were 98.8 ± 7.0, 84.4 ± 6.1, 89.0 ± 7.1, and 22.6 ± 2.6, respectively. CONCLUSIONS The three surgical methods described alleviated T2DM and reduced insulin resistance in non-obese rats with T2DM.
Collapse
Affiliation(s)
- Bo Xu
- Department of General Surgery, Huashan Hospital, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China,
| | | | | | | | | | | | | |
Collapse
|
41
|
Di J, Zhang H, Yu H, Zhang P, Wang Z, Jia W. Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI <30 kg/m 2. Surg Obes Relat Dis 2016; 12:1357-1363. [PMID: 27387699 DOI: 10.1016/j.soard.2016.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 01/16/2016] [Accepted: 02/08/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes (T2D) and morbid obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with a body mass index (BMI)<30 kg/m2. OBJECTIVES The objective of this study was to evaluate the 3-year effect of RYGB among patients with T2D with a BMI<30 kg/m2 and elucidate the predictors of T2D remission. SETTING Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. METHODS Sixty-six Chinese patients with T2D and a BMI 25-30 kg/m2 were retrospectively examined for metabolic outcomes 3 years after RYGB. Remission was defined as glycated hemoglobin (HbA1C)<6.5% and no medications. Binary logistic regression analysis was used to identify preoperative parameters independently predictive of diabetes remission at 1 and 3 years postoperatively [variables: sex, age, BMI, T2D duration, plasma glucose 2 hours after meal, HbA1C, fasting C-peptide, visceral fat area, free triiodothyronine, and thyroid-stimulating hormone. There was no significant difference in fasting insulin or glucose between the remission and no remission groups. RESULTS Patients were a mean 50.4±11.4 years of age at baseline, and 57.6% were female. Mean T2D duration was 8.9±5.2 years, baseline HbA1C level was 8.3±1.9%, and baseline BMI was 28.2±1.2 kg/m2 (range: 25.5-30.0). BMI was 22.5±1.8 kg/m2 (range: 19.1-28.0) at 1 year and 23.0±1.76 kg/m2 (range: 19.7-28.0) at 3 years. Remission was achieved in 49 patients (74.2%) at 1 year and 38 patients (57.6%) at 3 years. There was a significant reduction in medication for diabetes, hypertension, and hyperlipidemia (P<.01). Compared with patients in the no remission group, patients in the remission group had higher fasting C-peptide levels (P<.01) and free triiodothyronine levels (P = .01) at 1 year. Multiple logistic regression analysis confirmed that fasting C-peptide (odds ratio = 3.795, P = .007) and free triiodothyronine (odds ratio = 4.661, P = .019) levels were predictors of T2D remission at 1 year. No significant difference was found between the 2 groups at 3 years. CONCLUSIONS RYGB resulted in significant clinical and biochemical improvements in Chinese patients with BMI 25-30 kg/m2 and T2D. Appropriate patient selection (better β-cell function) may produce better outcomes.
Collapse
Affiliation(s)
- Jianzhong Di
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongwei Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Pin Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhigang Wang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| |
Collapse
|
42
|
Chen Y, Zeng G, Tan J, Tang J, Ma J, Rao B. Impact of roux-en Y gastric bypass surgery on prognostic factors of type 2 diabetes mellitus: meta-analysis and systematic review. Diabetes Metab Res Rev 2015; 31:653-62. [PMID: 25387821 DOI: 10.1002/dmrr.2622] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 12/19/2022]
Abstract
Our aim is to clarify the features of complete type 2 diabetes mellitus (T2DM) remission in patients who undergo Roux-en Y gastric bypass surgery, to better determine factors affecting the outcome of T2DM surgery. A search was conducted for original studies on Medline, PubMed and Elsevier from inception until October 28, 2014. All of the articles included in this study were assessed with the application of predetermined selection criteria and were divided into two groups: Roux-en Y gastric bypass surgery for T2DM patients in remission or non-remission. The meta-analysis results demonstrated that fasting C-peptide values were significantly associated with increased remission (C-peptide: 95%CI = 0.2-1.0) whereas T2DM duration, patient age, preoperative insulin use, preoperative fasting blood glucose values and preoperative glycosylated haemoglobin values were significantly associated with reduced remission (T2DM duration: 95%CI = -1.2 - -0.7; age: 95%CI = -0.5 - -0.1; percentage of preoperative insulin users: odd ratio = 0.10, 95%CI = 0.07-0.15; preoperative fasting blood glucose: 95%CI = -0.9 - -0.5; preoperative glycosylated haemoglobin: 95%CI = -1.1 - -0.4). However, the results demonstrated that body mass index was not statistically different (body mass index: 95%CI = -0.2-0.6). The results of the systematic review demonstrated that smaller waist circumference; lower total cholesterol, triglycerides and low-density lipoprotein levels, increased higher high-density lipoprotein levels, shorter cardiovascular disease history and less preoperative prevalence of hypertension contribute to the increased postoperative remission rate. Better results are obtained in younger patients with less severe diabetes, a smaller waist circumference, higher preoperative high-density lipoprotein, lower preoperative total cholesterol, triglycerides and low-density lipoprotein levels and fewer other complications of shorter durations.
Collapse
Affiliation(s)
- Yali Chen
- The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Guangzheng Zeng
- Department of Gastrointestinal Anal Surgery and Institute of Gastroenterology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | | | - Jun Tang
- Jiangxi Provincial Tumor Hospital, Hospital Infection Branch, Nanchang, Jiangxi Province, China
| | - Jingsheng Ma
- Department of Gastrointestinal Anal Surgery and Institute of Gastroenterology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Benqiang Rao
- Department of Gastrointestinal Anal Surgery and Institute of Gastroenterology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| |
Collapse
|
43
|
Wang GF, Yan YX, Xu N, Yin D, Hui Y, Zhang JP, Han GJ, Ma N, Wu Y, Xu JZ, Yang T. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg 2015; 25:199-208. [PMID: 25103403 PMCID: PMC4297287 DOI: 10.1007/s11695-014-1391-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although a few studies have been reported on predictive factors of postoperative diabetes remission, the conclusions remain inconsistent. This meta-analysis aimed to assess the preoperative clinical factors for type 2 diabetes mellitus (T2DM) remission after bariatric surgery. METHODS The Cochrane Library, PubMed, MEDLINE, Embase, and CINAHL databases were searched. All human studies published in English between 1 January 1992 and 1 September 2013 reporting on the parameters of interest were included. RESULTS In total, 15 studies involving 1,753 bariatric surgery patients were selected. Analyses were performed separately for the parameters of interest. T2DM remission was observed to be negatively correlated with age, diabetes duration, insulin use, and HbA1c levels. Baseline body mass index (BMI) and C-peptide levels were positively associated with the remission rate in Asian patients. However, there was no significant association between gender and remission rate. CONCLUSIONS Patients with younger age, short diabetes duration, better glucose control, and better β cell function were more likely to achieve T2DM remission after bariatric surgery. However, further randomized controlled trials with uniform remission criteria should be conducted to provide more reliable evidence.
Collapse
Affiliation(s)
- Guo-Feng Wang
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Yong-Xin Yan
- Department of Gastrointestinal Surgery, Ianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Ning Xu
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Dong Yin
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Yuan Hui
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Ji-Ping Zhang
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Guan-Jun Han
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Ning Ma
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Yan Wu
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Jing-Zi Xu
- Department of Endocrinology Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical College, Tongguan North Road 182, Lianyungang City, Jiangsu Province 222000 China
| | - Tao Yang
- Department of Endocrinology Medicine, The Fist Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029 China
| |
Collapse
|
44
|
Ahluwalia JS, Chang PC, Tai CM, Tsai CC, Sun PL, Huang CK. Comparative Study Between Laparoscopic Adjustable Gastric Banded Plication and Sleeve Gastrectomy in Moderate Obesity—2 Year Results. Obes Surg 2015; 26:552-7. [DOI: 10.1007/s11695-015-1791-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Busetto L, Dixon J, De Luca M, Shikora S, Pories W, Angrisani L. Bariatric surgery in class I obesity : a Position Statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2015; 24:487-519. [PMID: 24638958 DOI: 10.1007/s11695-014-1214-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Class I obesity conveys an increased risk of comorbidities, impairs physical and mental health-related quality of life, and it is associated to an increased psychosocial burden, particularly in women. The need for effective and safe therapies for class I obesity is great and not yet met by nonsurgical approaches. Eligibility to bariatric surgery has been largely based on body mass index (BMI) cut points and limited to patients with more severe obesity levels. However, obese patients belonging to the same BMI class may have very different levels of health, risk, and impact of obesity on quality of life. Individual patients in class I obesity may have a comorbidity burden similar to, or greater than, patients with more severe obesity. Therefore, the denial of bariatric surgery to a patient with class I obesity suffering from a significant obesity-related health burden and not achieving weight control with nonsurgical therapy simply on the basis of the BMI level does not appear to be clinically justified. A clinical decision should be based on a more comprehensive evaluation of the patient's current global health and on a more reliable prediction of future morbidity and mortality. After a careful review of available data about safety and efficacy of bariatric surgery in patients with class I obesity, this panel reached a consensus on ten clinical recommendations.
Collapse
Affiliation(s)
- Luca Busetto
- Department of Medicine, University of Padua, Padua, Italy,
| | | | | | | | | | | |
Collapse
|
46
|
Rao WS, Shan CX, Zhang W, Jiang DZ, Qiu M. A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI ≤ 35 kg/m2 undergoing Roux-en-Y gastric bypass. World J Surg 2015; 39:223-30. [PMID: 25159119 DOI: 10.1007/s00268-014-2751-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is effective for type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) >35 kg/m(2). It is unknown whether it benefits those with a BMI ≤ 35 kg/m(2). In the last decade, the effect of bariatric procedures on metabolic outcomes in individuals who underwent surgery outside National Institutes of Health (NIH) guidelines (BMI ≤ 35 kg/m(2)) was both interesting and controversial. OBJECTIVE We performed a systematic analysis evaluating the effect of RYGB for T2DM patients with a BMI ≤ 35 kg/m(2). METHODS We searched databases (Embase, Ovid, PubMed, China National Knowledge Infrastructure [CNKI], and Cochrane Library) and relevant journals between January 1980 and October 2013. Keywords used in electronic searching included 'diabetes', 'gastric bypass', 'BMI', and 'body mass index'. Inclusion criteria were as follows: (1) patients who underwent RYGB; (2) sample size ≥ 15; (3) patients with a BMI ≤ 35 kg/m(2); and (4) follow-up ≥ 12 months. Exclusion criteria were as follows: (1) data extracted from a database; (2) trials for sleeve gastrectomy; (3) trials for laparoscopic banding; (4) trials for bilio-pancreatic diversion; and (5) trials for duodenojejunal bypass. Participants and intervention type 2 diabetes patients with BMI ≤ 35 kg/m(2) who underwent RYGB. Two investigators reviewed all reported studies independently. Data were extracted according to previously defined endpoints. A meta-analysis was performed for these parameters, with homogeneity among different trials. RESULTS Nine articles fulfilled inclusion criteria. After 12 months, patients with T2DM had a significant decrease in their BMI postoperatively (p < 0.00001, weighted mean difference [WMD] -7.42, 95 % confidence interval [CI] -8.87 to -5.97), and remission of diabetes (glucose: p < 0.00001, WMD -59.87, 95 % CI -67.74 to -52.01; hemoglobin A1c p < 0.00001, WMD -2.76, 95 % CI -3.41 to -2.11). There were no deaths in all trials, and the complication rate was between 6.7 and 25.9 %. Mean length of hospital stay was 2.00 to 3.20 days, and mean operative time was from 72.8 to 112.0 min. In terms of study limitations, publication and selection bias were unavoidable. Trials with small sample sizes were excluded, which may lead to a selection bias. CONCLUSION RYGB was effective for T2DM patients with BMI ≤ 35 kg/m(2). Further clinical studies with long-term follow-up data are necessary to clarify this issue.
Collapse
Affiliation(s)
- Wen-Sheng Rao
- Department of General Surgery, Shanghai Changzheng Hospital, Affiliated to the Second Military Medical University, 415 FengYang Road, Huangpu District, Shanghai, 200003, China
| | | | | | | | | |
Collapse
|
47
|
Chawla AS, Hsiao CW, Romney MC, Cohen R, Rubino F, Schauer P, Cremieux P. Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications. PHARMACOECONOMICS 2015; 33:629-641. [PMID: 26063335 DOI: 10.1007/s40273-015-0302-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite consistently supportive evidence of clinical effectiveness and economic advantages compared with currently available non-surgical obesity treatments, patient access to bariatric and metabolic surgery (BMS) is impeded. To address this gap and better understand the relationship between value and access, the objectives of this study were twofold: (i) identify the multidimensional barriers to adoption of BMS created by clinical guidelines, public policies, and health technology assessments; and, most importantly, (ii) develop recommendations for stakeholders to improve patient access to BMS. Updated public policies focused on treatment and clinical guidelines that reflect the demonstrated advantages of BMS, patient education on safety and effectiveness, updated reimbursement policies, and additional data on long-term BMS effectiveness are needed to improve patient access.
Collapse
Affiliation(s)
- Amarpreet S Chawla
- Quintiles Advisory Services, 4820, Emperor Blvd, Durham, NC, 27703, USA,
| | | | | | | | | | | | | |
Collapse
|
48
|
Boza C, Valderas P, Daroch DA, León FI, Salinas JP, Barros DA, Funke RA, Crovari FJ. Metabolic surgery: roux-en-Y gastric bypass and variables associated with diabetes remission in patients with BMI <35. Obes Surg 2015; 24:1391-7. [PMID: 24719226 DOI: 10.1007/s11695-014-1218-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35 kg/m(2) and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35 kg/m(2) who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient's demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3 years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60 %) were women; median age was 48 years old (interquartile range (IQR) 42-54), and median preoperative BMI was 32.7 kg/m(2) (IQR 31.6-34.1). Median preoperative duration of T2DM was 4 years (IQR 2-7), with 49, 30, 2, and 18 % on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93 % (IQR 67-121). A total of 53.2, 9.6, 25.5, and 11.7 % achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8-81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35 kg/m(2) at 3 years. T2DM remission's best results are observed in non-insulin diabetic patients.
Collapse
Affiliation(s)
- Camilo Boza
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Región Metropolitana, Santiago, Chile,
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Tu Y, Yu H, Bao Y, Zhang P, Di J, Han X, Jia W. Baseline of visceral fat area and decreased body weight correlate with improved pulmonary function after Roux-en-Y gastric bypass in Chinese obese patients with BMI 28-35 kg/m² and type 2 diabetes: a 6-month follow-up. BMC Endocr Disord 2015; 15:26. [PMID: 26054757 PMCID: PMC4460885 DOI: 10.1186/s12902-015-0027-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 06/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Associations between demographic data and pulmonary function have not been adequately examined in patients that underwent Roux-en-Y Gastric Bypass (RYGB). This study was designed to examine changes in body fat distribution and metabolic parameters after RYGB and whether these changes correlated with improved lung function. METHODS A retrospective review of 32 ethnic Chinese with obesity with body mass index (BMI) 28-35 kg/m(2) and type 2 diabetes (T2DM) was conducted, focusing on metabolic outcomes and pulmonary function 6 months after RYGB. RESULTS Forced expiratory volume during first second (FEV1), percentage of forced expiratory volume during first second (FEV1 [%pred]), forced vital capacity (FVC), and percentage of forced vital capacity (FVC [%pred]) all improved significantly after RYGB. These increases all were negatively correlated with decreases in body weight and visceral fat area (VFA). The improvements of FEV1, FEV1 [%pred] and FVC were also negatively correlated with baseline of body weight and VFA. Furthermore, increases in FEV1 and FVC were independently associated with baseline of VFA (β = -0.003, P = 0.000; β = -0.004, P = 0.002, respectively). CONCLUSIONS The baseline of VFA and weight loss induced by RYGB independently correlated with improved pulmonary function in Chinese patients.
Collapse
Affiliation(s)
- Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Yishan Road 600, Shanghai, China.
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Yishan Road 600, Shanghai, China.
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Yishan Road 600, Shanghai, China.
| | - Pin Zhang
- Department of General surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, China.
| | - Jianzhong Di
- Department of General surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, China.
| | - Xiaodong Han
- Department of General surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Yishan Road 600, Shanghai, China.
| |
Collapse
|
50
|
Preoperative use of incretins is associated with increased diabetes remission after RYGB surgery among patients taking insulin: a retrospective cohort analysis. Ann Surg 2015; 261:125-8. [PMID: 24646545 DOI: 10.1097/sla.0000000000000588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The main goal of this study was to determine the effects of incretins on type 2 diabetes (T2D) remission after Roux-en-Y gastric bypass (RYGB) surgery for patients taking insulin. BACKGROUND Type 2 diabetes is a chronic disease with potentially debilitating consequences. RYGB surgery is one of the few interventions that can remit T2D. Preoperative use of insulin, however, predisposes to significantly lower T2D remission rates. METHODS A retrospective cohort of 690 T2D patients with at least 12 months follow-up and available electronic medical records was used to identify 37 T2D patients who were actively using a Glucagon-like peptide 1 (GLP-1) agonist in addition to another antidiabetic medication, during the preoperative period. RESULTS Here, we report that use of insulin, along with other antidiabetic medications, significantly diminished overall T2D remission rates 14 months after RYGB surgery (9%) compared with patients not taking insulin (56%). Addition of the GLP-1 agonist, however, increased significantly T2D early remission rates (22%), compared with patients not taking the GLP-1 agonist (4%). Moreover, the 6-year remission rates were also significantly higher for the former group of patients. The GLP-1 agonist did not improve the remission rates of diabetic patients not taking insulin as part of their pharmacotherapy. CONCLUSIONS Preoperative use of antidiabetic medication, coupled with an incretin agonist, could significantly improve the odds of T2D remission after RYGB surgery in patients also using insulin.
Collapse
|