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Abi Mosleh K, Salameh Y, Ghusn W, Jawhar N, Mundi MS, Collazo-Clavell ML, Kendrick ML, Ghanem OM. Impact of metabolic and bariatric surgery on weight loss and insulin requirements in type 1 and insulin-treated type 2 diabetes. Clin Obes 2024:e12689. [PMID: 38934261 DOI: 10.1111/cob.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Metabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin-treated type 2 diabetes (T2D) patients over a 5-year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin-treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin-treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin-treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG.
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Affiliation(s)
| | - Yara Salameh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wissam Ghusn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria L Collazo-Clavell
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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2
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Kueh MTW, Chew NWS, Al-Ozairi E, le Roux CW. The emergence of obesity in type 1 diabetes. Int J Obes (Lond) 2024; 48:289-301. [PMID: 38092958 PMCID: PMC10896727 DOI: 10.1038/s41366-023-01429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 02/28/2024]
Abstract
Obesity, a chronic low-grade inflammatory disease represented by multifactorial metabolic dysfunctions, is a significant global health threat for adults and children. The once-held belief that type 1 diabetes is a disease of people who are lean no longer holds. The mounting epidemiological data now establishes the connection between type 1 diabetes and the subsequent development of obesity, or vice versa. Beyond the consequences of the influx of an obesogenic environment, type 1 diabetes-specific biopsychosocial burden further exacerbates obesity. In the course of obesity management discussions, recurring challenges surfaced. The interplay between weight gain and escalating insulin dependence creates a vicious cycle from which patients struggle to break free. In the absence of weight management guidelines and regulatory approval for this population, healthcare professionals must navigate the delicate balance between benefits and risks. The gravity of this circumstance highlights the importance of bringing these topics to the forefront. In this Review, we discuss the changing trends and the biopsychosocial aspects of the intersection between type 1 diabetes and obesity. We highlight the evidence supporting the therapeutic means (i.e., exercise therapy, nutritional therapy, adjunct pharmacotherapy, and bariatric surgery) and directions for establishing a more robust and safer evidence-based approach.
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Affiliation(s)
- Martin T W Kueh
- UCD School of Medicine and Medical Science, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, Dublin, Malaysia.
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Medicine, College of Medicine, Jabriya, Kuwait
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland.
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3
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Fehervari M, Fadel MG, Alghazawi LOK, Das B, Rodríguez-Luna MR, Perretta S, Wan A, Ashrafian H. Medium-Term Weight Loss and Remission of Comorbidities Following Endoscopic Sleeve Gastroplasty: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3527-3538. [PMID: 37700147 PMCID: PMC10602997 DOI: 10.1007/s11695-023-06778-x] [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: 03/07/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1-19.4%) in 23 studies (n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7-17.2%) in 10 studies (n = 4040). Diabetes resolution was 55.4% (95% CI 46-64%), hypertension resolution was 62.8% (95% CI 43-82%), dyslipidaemia resolution was 56.3% (95% CI 49-63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2-87.3%) in four studies (n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.
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Affiliation(s)
- Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Department of Upper Gastrointestinal and Bariatric Surgery, St. George's University Hospitals NHS Foundation Trust, London, UK.
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
| | - Michael G Fadel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Silvana Perretta
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
- Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
| | - Andrew Wan
- Department of Upper Gastrointestinal and Bariatric Surgery, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
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Chow E, Clement S, Garg R. Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors. BMJ Open Diabetes Res Care 2023; 11:e003666. [PMID: 37797963 PMCID: PMC10551972 DOI: 10.1136/bmjdrc-2023-003666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglycemia seen in diabetic ketoacidosis (DKA). The paper presents a classification system for the severity of EDKA, categorizing it into mild, moderate, and severe based on serum pH and bicarbonate levels. Another classification system is proposed to define stages of EDKA based on anion gap and ketones at the time of diagnosis and during the treatment period. A treatment algorithm is proposed to guide clinicians in managing EDKA. This treatment algorithm includes monitoring anion gap and ketones to guide insulin and fluid management, and slower transition to subcutaneous insulin to prevent a relapse. Increased awareness of EDKA is essential for a timely diagnosis because an early diagnosis and treatment can improve clinical outcomes.
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Affiliation(s)
- Erica Chow
- Division of Endocrinology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Stephen Clement
- Division of Endocrinology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Rajesh Garg
- Division of Endocrinology, Harbor-UCLA Medical Center, Torrance, California, USA
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Fadel MG, Fehervari M, Das B, Soleimani-Nouri P, Ashrafian H. Vagal Nerve Therapy in the Management of Obesity: A Systematic Review and Meta-Analysis. Eur Surg Res 2023; 64:365-375. [PMID: 37544303 DOI: 10.1159/000533358] [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: 04/24/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and meta-analysis assessed the effects of vagal nerve therapy on weight loss, body mass index (BMI), and obesity-related conditions. METHODS MEDLINE, EMBASE, and CINAHL databases were searched for studies up to April 2022 that reported on percentage excess weight loss (%EWL) or BMI at 12 months or remission of obesity-related conditions following vagal nerve therapy from January 2000 to April 2022. Weighted mean difference (WMD) was calculated, meta-analysis was performed using random-effects models, and between-study heterogeneity was assessed. RESULTS Fifteen studies, of which nine were randomised controlled trials, of 1,447 patients were included. Vagal nerve therapy led to some improvement in %EWL (WMD 17.19%; 95% confidence interval [CI]: 10.94-23.44; p < 0.001) and BMI (WMD -2.24 kg/m2; 95% CI: -4.07 to -0.42; p = 0.016). There was a general improvement found in HbA1c following vagal nerve therapy when compared to no treatment given. No major complications were reported. CONCLUSIONS Vagal nerve therapy can safely result in a mild-to-moderate improvement in weight loss. However, further clinical trials are required to confirm these results and investigate the possibility of the long-term benefit of vagal nerve therapy as a dual therapy combined with standard surgical bariatric interventions.
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Affiliation(s)
- Michael G Fadel
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
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Thaher O, Iaroshevych V, Driouch J, Hukauf M, Croner RS, Stroh C. Current status of metabolic surgery in patients with type I diabetes mellitus and obesity: a nationwide multicenter study. Langenbecks Arch Surg 2023; 408:46. [PMID: 36662321 DOI: 10.1007/s00423-023-02788-6] [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: 08/25/2022] [Accepted: 11/22/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE While obesity is prevalent among patients with type I diabetes mellitus (T1DM), the effects of metabolic surgery on patients with T1DM have not been adequately investigated. The study aims to investigate the perioperative outcomes and the improvement of comorbidity 1 year following metabolic surgery amongst this patient population. METHODS In this study, we evaluated the effects of sleeve gastrectomy (SG) and Roux-Y gastric bypass (RYGB) on patients with T1DM and insulin resistance. RESULTS One hundred forty-nine patients (SG n = 91 and RYGB n = 58) with obesity, T1DM, and insulin resistance were analyzed. There was no significant difference in BMI reduction and %EWL 1 year after surgery between the two groups. In the SG group, BMI reduction was 6.5 kg/m2 versus 5.9 kg/m2 in the RYGB group (p=0.406). The %EWL was 68.2 ± 25.2 in the RYGB group and 64.3 ± 21.5 in SG (p=0.332). There was also no significant difference in weight loss between the two groups (14.9 ± 5.4 kg in SG vs. 14.2 ± 7 kg in RYGB; p=0.548). In all patients, insulin requirements decreased after surgery, and in 22% of patients, insulin requirements were equivalent to those of normal-weight individuals. There was a significantly higher rate of remission of reflux in RYGB patients than in SG patients (94·44% vs 29·41; p<0.001). CONCLUSION Patients with obesity and T1DM may benefit from metabolic surgery. Both methods produce satisfactory results in this group of patients regarding daily insulin requirements and treatment of obesity-related diseases. However, the decision of which procedure should be carried out still depends on the patient's general condition and the surgeon's technical ability.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Volodymyr Iaroshevych
- Department of Surgery, SRH Hospital Naumburg, Humboldtstraße 31, 06618, Naumburg, Germany
| | - Jamal Driouch
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany
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Stroke and stroke risk factors in women of reproductive age with a history of metabolic or bariatric surgery. J Stroke Cerebrovasc Dis 2022; 31:106814. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
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Fadel MG, Fehervari M, Lairy A, Das B, Alyaqout K, Ashrafian H, Khwaja H, Efthimiou E. Clinical outcomes of single-stage versus two-stage laparoscopic Roux-en-y gastric bypass in the management of obesity (BMI ≥ 50 kg/m 2): a retrospective cohort study. Langenbecks Arch Surg 2022; 407:3349-3356. [PMID: 36050499 DOI: 10.1007/s00423-022-02664-9] [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: 05/09/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with obesity, BMI ≥ 50 kg/m2, can be a challenging operation. Weight loss with intra-gastric balloon (IGB) insertion prior to LRYGB may improve operative outcomes. METHODS Between June 2000 and June 2020, patients with a BMI ≥ 50 kg/m2 underwent either IGB insertion followed by LRYGB (two-stage group), or LRYGB as the definitive bariatric procedure (single-stage group) in our institution. The two-stage procedure was adopted for high risk individuals. Primary outcome measures were percentage total weight loss (%TWL) at 24 months, length of stay and postoperative morbidity. Propensity score analysis was used to account for differences between groups. RESULTS A total of 155 (mean age 42.9 years ± 10.60; mean BMI 54.6 kg/m2 ± 4.53) underwent either the two-stage (n = 30) or single-stage procedure (n = 125) depending on preoperative fitness. At 6 months following LRYGB, there was a significant difference in %TWL between the groups in a matched analysis (11.9% vs 23.7%, p < 0.001). At 24 months, there was no difference in %TWL (32.0% vs 34.7%, p = 0.13). Median hospital stay following LRYGB was 2.0 (1-4) days with the two-stage vs 2.0 (0-14) days for the single-stage approach (p = 0.75). There was also no significant difference in complication rates (p = 0.058) between the two groups. CONCLUSIONS There was no difference in weight loss after one or two-stage procedures in the treatment of patients with a BMI ≥ 50 kg/m2 super obesity in a propensity score weighted analysis at 24 months. Length of stay and perioperative complications were similar for high risk patients; however, the two-stage approach was associated with delayed weight loss. Single-stage management is recommended for moderate risk patients, particularly with significant metabolic disorders, whilst two-stage approach is a safe and feasible pathway for high risk individuals.
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Affiliation(s)
- Michael G Fadel
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK.
- Imperial College London, London, UK.
| | - Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Ali Lairy
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Khaled Alyaqout
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
| | - Hutan Ashrafian
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Evangelos Efthimiou
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Morey-Vargas OL, Aminian A, Steckner K, Zhou K, Kashyap S, Cetin D, Pantalone KM, Daigle C, Griebeler ML, Butsch WS, Zimmerman R, Kroh M, Saadi HF, Diemer CNP D, Burguera B, Rosenthal RJ, Lansang MC. Perioperative Management of Diabetes in Patients Undergoing Bariatric and Metabolic Surgery: A Narrative Review and The Cleveland Clinic Practical Recommendations. Surg Obes Relat Dis 2022; 18:1087-1101. [DOI: 10.1016/j.soard.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
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Dessify B, Wood C, Parker D, Carmichael D, Petrick A, Daouadi M. Is there a role for bariatric surgery in patients with severe obesity and type 1 diabetes? Surg Obes Relat Dis 2021; 18:177-181. [PMID: 34866016 DOI: 10.1016/j.soard.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of obesity in type 1 diabetes has been increasing over the past decades. Multiple studies have demonstrated suboptimal outcomes with dietary control and medical management for obesity and type 2 diabetes. This study's objective was to evaluate insulin and diabetic medication requirements in patients with type 1 diabetes 2 years after bariatric surgery. METHODS This was a retrospective medical-record review study from 2002 to 2019 at Geisinger Health System. Of 4549 total bariatric surgeries, 38 bariatric surgery patients were confirmed to have type 1 diabetes. Type 1 diabetes was confirmed by medical-record review and/or the presence of C-peptide <5 ng/mL. RESULTS The patient cohort had a mean age of 41 years, with 87% being female. The mean body mass index was 43.0 kg/m2, with a mean HbA1C of 8.4% before surgery. During follow-up, the insulin requirements improved from 114 units preoperatively to 60 units at 1 year postoperatively (SD = 54.5, P = .0018) and 60 units at 2 years postoperatively (SD = 60.3, P = .0033). Though not significant, the number of patients on more than 1 diabetic medication decreased from 66% preoperatively to 53% 1 year postoperatively (P = .343) and 52% at 2 years (P = .149). CONCLUSION This study demonstrated significant improvement in the insulin and total number of diabetic medication requirements after bariatric surgery, suggesting that bariatric surgery may be a viable treatment for patients with type 1 diabetes.
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Affiliation(s)
| | - Craig Wood
- Geisinger Medical Center, Danville, Pennsylvania
| | - David Parker
- Geisinger Medical Center, Danville, Pennsylvania
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Wang L, Lin M, Yu J, Fan Z, Zhang S, Lin Y, Chen X, Peng F. The Impact of Bariatric Surgery Versus Non-Surgical Treatment on Blood Pressure: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:4970-4984. [PMID: 34519991 DOI: 10.1007/s11695-021-05671-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to compare bariatric surgery versus non-surgical treatment on blood pressure for patients with obesity. Nineteen RCTs (1353 total patients) were included. In the pooled analyses, bariatric surgery reduces more systolic blood pressure (WMD: - 3.937 mmHg, CI95%: - 6.000 to - 1.875, p < 0.001, I2 = 0%), diastolic blood pressure (WMD: - 2.690 mmHg, CI95%: - 3.994 to - 1.385, P < 0.001, I2 = 0%) and more antihypertensives. In subgroup analyses, patients after Roux-en-Y gastric bypass, with poor control of hypertension (BP > 130/80 mmHg) and diabetes mellitus (HbA1C > 7.0%, FPG > 7.0 mmol/L), elder patients (> 45 years), non-severe obesity (BMI < 40 kg/cm2, body weight < 120 kg), less waist circumference (< 115 cm) tend to decrease more blood pressure. Besides, patients after surgery also lost more weight (p < 0.001), decreased more waist circumference (p < 0.001), fasting plasma glucose (p < 0.001), glycosylated hemoglobin (p < 0.001), triglycerides (p < 0.001), hsCRP (p = 0.001), increased more high-density lipoprotein cholesterol (p < 0.001), and had better remission of metabolic syndrome (p < 0.001). Changes in total cholesterol, low-density lipoprotein cholesterol, renal function, resting heart rate, and 6-min walking test were not significantly different. Therefore, bariatric surgery is more effective than non-surgical treatment in controlling patients' blood pressure.
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Affiliation(s)
- Laicheng Wang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Meihua Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Jianjian Yu
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Zongcheng Fan
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Shunpeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Yunchai Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Xin Chen
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China.
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Vendrame F, Calhoun P, Bocchino LE, Pratley RE, Casu A. Impact of bariatric surgery and weight loss medications in adults with type 1 diabetes in the T1D Exchange Clinic Registry. J Diabetes Complications 2021; 35:107884. [PMID: 33610436 DOI: 10.1016/j.jdiacomp.2021.107884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/15/2022]
Abstract
AIM To investigate the impact of bariatric surgery and weight loss medications in adults with type 1 diabetes. MATERIALS AND METHODS Subjects enrolled in the T1D Exchange (T1DX) Clinic Registry age ≥ 18 years with a diabetes duration of ≥1 year were included in the analysis (n = 13,501). Data for participants (n = 37) with bariatric surgery after diabetes onset were assessed before and after surgery and also compared to a matched control group. Data for participants who reported the use of FDA-approved weight loss medications (n = 483) were assessed before starting, during use, and after stopping the medications and also compared to a matched control group. Variables of interest included BMI, HbA1c, blood pressure, lipid profile, rates of acute complications. Data were analyzed using linear mixed models. RESULTS Bariatric surgery resulted in BMI reduction from 38.8 ± 9.1 kg/m2 to 33.3 ± 6.7 kg/m2 (P = 0.006) and HbA1c reduction from 8.8 ± 1.3% (73 ± 14.2 mmol/mol) to 8.1 ± 1.1% (65 ± 12.0 mmol/mol) (P = 0.05). Weight loss medications were not associated with weight loss or better glycemic control although stopping liraglutide favored weight gain. Both interventions were not associated with a significant change in blood pressure or lipid profile. There were no adverse events associated with the use of weight loss medications. CONCLUSIONS Bariatric surgery is effective for weight loss and may improve glycemic control in selected patients. Weight loss medications are not associated with diabetes improvement. A trial with liraglutide may be attempted for weight control, but weight loss medications in general do not show a significant effect.
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Affiliation(s)
- Francesco Vendrame
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami, Miami, FL, United States of America
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, FL, United States of America.
| | - Laura E Bocchino
- Jaeb Center for Health Research, Tampa, FL, United States of America
| | - Richard E Pratley
- AdventHealth Translational Research Institute, Orlando, FL, United States of America
| | - Anna Casu
- AdventHealth Translational Research Institute, Orlando, FL, United States of America
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Rudolph M, Galazra L, Greer M, Hemal K, Runyan C. The Impact of Perioperative Blood Pressure on Hematoma Development After Panniculectomy. Ann Plast Surg 2021; 86:S532-S537. [PMID: 34100811 DOI: 10.1097/sap.0000000000002912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Hematoma affects 10% to 13% of patients undergoing panniculectomy. Although elevated perioperative blood pressure has been associated with hematoma after rhytidectomy, this has not been established for panniculectomy. We sought to determine the impact of perioperative blood pressure on hematoma development in patients undergoing panniculectomy. METHODS A retrospective review was performed on patients undergoing isolated panniculectomy procedures. Blood pressure parameters recorded included systolic blood pressures (SBPs), diastolic blood pressures (DBPs), and mean arterial pressure. The mean, peak, and trough blood pressure values were recorded. Preoperative, intraoperative, and postoperative blood pressures were recorded, and differences between phases were calculated. Univariate and multivariate logistic regressions were performed. RESULTS One hundred forty-three patients were identified, which included 84% (n = 120) women and 17% (n = 23) men. A history of hypertension was present in 55% (n = 79) of patients, of which 91% (n = 72) were medically controlled. Preoperative antiplatelet or anticoagulation was used in 21% (n = 31) of patients. Seven patients (5%) developed a hematoma, of which 5 required operative drainage. Development of hematoma was not associated with patient, surgical, or postoperative pain variables. There was an association between hematoma and elevated postoperative blood pressures on univariate and multivariate analyses. The mean peak SBP in the hematoma group was 160 mm Hg in comparison to 141 mm Hg in the nonhematoma group. For each 10-mm Hg increase in postoperative peak SBP, the odds of a hematoma increased by 2.8 times. When comparing phases of care, hematoma patients had similar intraoperative and postoperative peak SBP, but their postoperative SBP was 19 mm Hg higher than preoperative baseline. Conversely, nonhematoma patients had a postoperative blood pressure that was similar to their preoperative baseline and 20 mm Hg lower than their intraoperative values. CONCLUSIONS Hematoma is associated with elevated postoperative blood pressures. A postoperative mean peak SBP of 160 mm Hg was associated with hematoma, and for each 10 mm Hg, the risk of hematomsa increased by 2.8 times. The risk of hematoma may be reduced by strict postoperative blood pressure control. We recommend a postoperative peak SBP goal of 140 mm Hg or less, with a value equal to or less than their preoperative baseline and 20 mm Hg lower than their intraoperative pressure.
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Affiliation(s)
- Megan Rudolph
- From the Department of Plastic Surgery, Wake Forest Baptist Medical Center
| | | | | | | | - Christopher Runyan
- From the Department of Plastic Surgery, Wake Forest Baptist Medical Center
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14
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Vangoitsenhoven R, Wilson R, Sharma G, Punchai S, Corcelles R, Froylich D, Mulya A, Schauer PR, Brethauer SA, Kirwan JP, Sangwan N, Brown JM, Aminian A. Metabolic effects of duodenojejunal bypass surgery in a rat model of type 1 diabetes. Surg Endosc 2021; 35:3104-3114. [PMID: 32607903 PMCID: PMC8633809 DOI: 10.1007/s00464-020-07741-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metabolic surgery has beneficial metabolic effects, including remission of type 2 diabetes. We hypothesized that duodenojejunal bypass (DJB) surgery can protect against development of type 1 diabetes (T1D) by enhancing regulation of cellular and molecular pathways that control glucose homeostasis. METHODS BBDP/Wor rats, which are prone to develop spontaneous autoimmune T1D, underwent loop DJB (n = 15) or sham (n = 15) surgery at a median age of 41 days, before development of diabetes. At T1D diagnosis, a subcutaneous insulin pellet was implanted, oral glucose tolerance test was performed 21 days later, and tissues were collected 25 days after onset of T1D. Pancreas and liver tissues were assessed by histology and RT-qPCR. Fecal microbiota composition was analyzed by 16S V4 sequencing. RESULTS Postoperatively, DJB rats weighed less than sham rats (287.8 vs 329.9 g, P = 0.04). In both groups, 14 of 15 rats developed T1D, at similar age of onset (87 days in DJB vs 81 days in sham, P = 0.17). There was no difference in oral glucose tolerance, fasting and stimulated plasma insulin and c-peptide levels, and immunohistochemical analysis of insulin-positive cells in the pancreas. DJB rats needed 1.3 ± 0.4 insulin implants vs 1.9 ± 0.5 in sham rats (P = 0.002). Fasting and glucose stimulated glucagon-like peptide 1 (GLP-1) secretion was elevated after DJB surgery. DJB rats had reduced markers of metabolic stress in liver. After DJB, the fecal microbiome changed significantly, including increases in Akkermansia and Ruminococcus, while the changes were minimal in sham rats. CONCLUSION DJB does not protect against autoimmune T1D in BBDP/Wor rats, but reduces the need for exogenous insulin and facilitates other metabolic benefits including weight loss, increased GLP-1 secretion, reduced hepatic stress, and altered gut microbiome.
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Affiliation(s)
- Roman Vangoitsenhoven
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Rickesha Wilson
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gautam Sharma
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suriya Punchai
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Ricard Corcelles
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dvir Froylich
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Carmel Medical Center, Haifa, Israel
| | - Anny Mulya
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Philip R Schauer
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Stacy A Brethauer
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John P Kirwan
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Naseer Sangwan
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - J Mark Brown
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.
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15
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Nasa P, Chaudhary S, Shrivastava PK, Singh A. Euglycemic diabetic ketoacidosis: A missed diagnosis. World J Diabetes 2021; 12:514-523. [PMID: 33995841 PMCID: PMC8107974 DOI: 10.4239/wjd.v12.i5.514] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023] Open
Abstract
Euglycemic diabetic ketoacidosis (DKA) is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose (less than 11 mmol/L). The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units; it may delay diagnosis and treatment causing worse outcomes. Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus. With the addition of sodium/ glucose cotransporter-2 inhibitors in diabetes mellitus management, euglycemic DKA incidence has increased. The other causes of euglycemic DKA include pregnancy, fasting, bariatric surgery, gastroparesis, insulin pump failure, cocaine intoxication, chronic liver disease and glycogen storage disease. The pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit, milder degree of insulin deficiency or resistance and increased glucagon/insulin ratio. Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones. The diagnostic workup includes arterial blood gas for metabolic acidosis, serum ketones and exclusion of other causes of high anion gap metabolic acidosis. Euglycemic DKA treatment is on the same principles as for DKA with correction of dehydration, electrolytes deficit and insulin replacement. The dextrose-containing fluids should accompany intravenous insulin to correct metabolic acidosis, ketonemia and to avoid hypoglycemia.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
| | - Sandeep Chaudhary
- Department of Endocrinology, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
| | | | - Aanchal Singh
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
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Holter-Derived Autonomic Function, Arrhythmias and Carbohydrate Metabolism in Patients with Class III Obesity Treated with Laparoscopic Sleeve Gastrectomy. J Clin Med 2021; 10:jcm10102140. [PMID: 34063446 PMCID: PMC8156268 DOI: 10.3390/jcm10102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/05/2022] Open
Abstract
The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m2, aged 36.5 (18–56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, all subjects had 24-h Holter monitoring with heart rate variability (HRV) and heart rate turbulence (HRT) evaluation. After a median of 15 months, BMI decreased from 43.9 to 29.7 kg/m2, the incidence of hypertension decreased from 54 to 32% (p = 0.04) and any carbohydrate disorders decreased from 24 to 6% (p = 0.02). Fasting insulin concentration and insulin resistance index improved significantly (p < 0.001). Improvements in HRV parameters related to the sympathetic autonomic division were also observed (p < 0.001), while HRT evaluation was not conclusive. The enhancement of autonomic tone indices was correlated with reduction of BMI (SDNN-I r = 0.281 p = 0.04; SDNN r = 0.267 p = 0.05), but not with reduction of waist circumference, and it was also associated with decrease of mean heart rate (OR 0.02, 95%CI 0.0–0.1, p < 0.001). The incidence of arrhythmias was low and similar before and after follow-up. In conclusion, improvement of homeostasis of carbohydrate metabolism and autonomic function is observed in relatively young patients after weight loss due to laparoscopic sleeve gastrectomy.
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Jiang Z, Zhang G, Huang J, Shen C, Cai Z, Yin X, Yin Y, Zhang B. A systematic review of body contouring surgery in post-bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers. Obes Rev 2021; 22:e13201. [PMID: 33565201 DOI: 10.1111/obr.13201] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
Many post-bariatric patients have impaired health-related quality of life (HRQoL) due to excess skin following weight loss; however, it is inconclusive whether body contouring surgery (BCS) improves this impairment. We aimed to comprehensively summarize existing evidence of the effect of BCS on the HRQoL (primary outcome) and determine the prevalence of, the desire for, and barriers to BCS (secondary outcomes). Randomized controlled trials, cohort, cross-sectional, case-control, and longitudinal studies were systematically searched in PubMed, Embase, the Cochrane Central, and Web of Science. After screening 1923 potential records, 24 studies (representing 6867 participants) were deemed eligible. Only 18.5% of respondents from cross-sectional studies underwent BCS, with abdominal BCS as the most common procedure. Most participants desired BCS but listed "cost" and "lacking reimbursement" as the main barriers. Results suggest that most post-bariatric patients who underwent BCS experienced improvements in their HRQoL, which could be seen in almost every dimension evaluated, including body image and physical and psychosocial functions. Therefore, both bariatric and plastic surgeons should regard BCS not only as an aesthetic supplement but also as a vital part of functional recovery in the surgery-mediated weight loss journey and, thus, provide it to more post-bariatric patients.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guixiang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jinming Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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18
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Stefater MA, Marks BE. Gastric Bypass in an Adolescent with Obesity, Insulin Resistance, and Type 1 Diabetes. Obes Surg 2021; 31:2298-2301. [PMID: 33454845 DOI: 10.1007/s11695-020-05190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Margaret A Stefater
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Brynn E Marks
- Division of Endocrinology, Department of Pediatrics, Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine, Washington, DC, USA
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Efficacy of laparoscopic sleeve gastrectomy for patient with morbid obesity and type 1 diabetes mellitus: a case report. Surg Case Rep 2021; 7:7. [PMID: 33409743 PMCID: PMC7788116 DOI: 10.1186/s40792-020-00989-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Bariatric surgery is effective for the treatment of patients with morbid obesity and type 2 diabetes mellitus (T2DM), for body weight loss and glycemic control. However, in Japan, there has been no previous report of the effectiveness bariatric surgery in a case of morbid obesity associated with acute onset type 1 diabetes mellitus (T1DM), in which pancreatic β-cells were destroyed and endogenous insulin was depleted. Case presentation A 36-year-old woman with morbid obesity and T1DM, diagnosed when she was 6 years, was admitted for bariatric surgery. At her first consultation, she had a body weight of 106.7 kg and a body mass index of 42.2 kg/m2. Her HbA1c level was 9.0%, with a required daily insulin dose of 75 units. She underwent laparoscopic sleeve gastrectomy. At 1 year after surgery, her body weight had decreased to 81.0 kg and her body mass index to 32.2 kg/m2. In addition, her daily required dose of insulin had decreased to 24 units, with an improvement in her HbA1c level to 7.7%. Conclusions Although further evidence needs to be accumulated, including long-term outcomes, laparoscopic sleeve gastrectomy may provide an effective treatment for patients with morbid obesity and T1DM for body weight loss, improvement in HbA1c level, and insulin dose reduction.
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Vilarrasa N, San Jose P, Rubio MÁ, Lecube A. Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges. Diabetes Metab Syndr Obes 2021; 14:2807-2827. [PMID: 34188505 PMCID: PMC8232956 DOI: 10.2147/dmso.s223618] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Obesity affects large numbers of patients with type 1 diabetes (T1D) across their lifetime, with rates ranging between 2.8% and 37.1%. Patients with T1D and obesity are characterized by the presence of insulin resistance, of high insulin requirements, have a greater cardiometabolic risk and an enhanced risk of developing chronic complications when compared to normal-weight persons with T1D. Dual treatment of obesity and T1D is challenging and no specific guidelines for improving outcomes of both glycemic control and weight management have been established for this population. Nevertheless, although evidence is scarce, a comprehensive approach based on a balanced hypocaloric diet, physical activity and cognitive behavioral therapy by a multidisciplinary team, expert in both obesity and diabetes, remains as the best clinical practice. However, weight loss responses with lifestyle changes alone are limited, so in the "roadmap" of the treatment of obesity in T1D, it will be helpful to include anti-obesity pharmacotherapy despite at present there is a lack of evidence since T1D patients have been excluded from anti-obesity drug clinical trials. In case of severe obesity, bariatric surgery has proven to be of benefit in obtaining a substantial and long-term weight loss and reduction in cardiovascular risk. The near future looks promising with the development of new and more effective anti-obesity treatments and strategies to improve insulin resistance and oxidative stress. Advances in precision medicine may help individualize and optimize the medical management and care of these patients. This review, by gathering current evidence, highlights the need of solid knowledge in all facets of the treatment of patients with obesity and T1D that can only be obtained through high quality well-designed studies.
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Affiliation(s)
- Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
- Correspondence: Nuria Vilarrasa Hospital Universitario de Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 L´Hospitalet de Llobregat, Barcelona, SpainTel +34 93-5338511Fax +34 933375248 Email
| | - Patricia San Jose
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Miguel Ángel Rubio
- Department of Endocrinology & Nutrition, Hospital Clínico San Carlos, IDISSC, Madrid, 28040, Spain
| | - Albert Lecube
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, 25198, Spain
- Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, Lleida, Spain
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Jiang Z, Zhang G, Du X, Chen Y, Shen C, Cai Z, Zhang B, Cheng Z. Experience of Excess Skin and Attitude to Body Contouring Surgery of a Chinese Post-Bariatric Population. Obes Facts 2021; 14:501-509. [PMID: 34365452 PMCID: PMC8546442 DOI: 10.1159/000517587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Western studies have explored post-bariatric patients concerning their views on excess skin and body contouring surgery (BCS), but Asian data were lacking. This study aims to investigate the experience of excess skin and attitude to BCS of a Chinese post-bariatric population. METHODS A total of 210 Chinese patients who underwent bariatric surgery from March 2015 to September 2018 were cross-sectional studied using the Sahlgrenska Excess Skin Questionnaire and a study-specific questionnaire. RESULTS The survey response rate was 61.4%. Most responders (78.2%) reported they had excess skin, and the most common sites were the abdomen (70.2%) and the upper arms (61.3%). Most responders (66.1%) reported being bothered by impaired health-related quality of life (HRQoL), and the most common problem was "the feeling of having unattractive body appearance" (42.7%). Many patients (37.9%) desired for BCS, and "the impact of excess skin is not serious enough" was the reason why not undergoing BCS being chosen most (28.1%), then "the cost is too high" (20.2%) and "worrying about the risk or complications of BCS" (18.4%). Younger age, female gender, higher weight loss, having full-time job, and earning higher income were independent factors increasing their desires for BCS. CONCLUSIONS Most Chinese post-bariatric patients have excess skin and are bothered by impaired HRQoL. The abdomen and upper arms are the sites where patients are most seriously affected and most eager for BCS. The conservative attitude toward BCS and the cost without reimbursement are the main barriers.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guixiang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Du
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, Ya'an People's Hospital, Ya'an, China
| | - Yi Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Cai
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Bo Zhang,
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- **Zhong Cheng,
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Jin H, Kim SH, Chung Y, Park DG, Kim YJ. Effect of Sleeve Gastrectomy on Morbid Obesity with Type 1 Diabetes Mellitus; Case Series, Literature Review and Meta-Analysis. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2020; 9:52-60. [PMID: 36688117 PMCID: PMC9847656 DOI: 10.17476/jmbs.2020.9.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Purpose The aim of this study was to report our experiences of sleeve gastrectomy (SG) in obese patients with type 1 diabetes mellitus (T1DM) and to assess its metabolic outcomes through a review of the literature and a meta-analysis. Materials and Methods We conducted a retrospective review of the electronic medical records of all patients who underwent bariatric surgery between January 2008 and February 2019 at a single institution. A literature search was performed using PubMed, Cochrane library, and Embase, and a meta-analysis for each direct comparison between pre- and postoperative groups was performed using the random effects DerSimonian-Laird method. Results We identified three obese patients with T1DM who underwent SG. The baseline body mass index (BMI), HbA1c, and total daily insulin dose was 40.8 (37-47.4) kg/m2, 7.1% (6%-7.7%), and 92.3 (54-113) units, respectively. After surgery, the BMI and total daily insulin dose reduced to 32.2 (30.2-37.6) kg/m2 and 22.3 (12-40) units, respectively. However, the HbA1c increased to 7.8% (5.4%-10.8%). In the meta-analysis, the weighted mean reduction in BMI, HbA1c, and total daily insulin dose were 10.69 kg/m2 (95% CI 7.01-14.37, P<0.00001, I2=0%), 0.3% (95% CI -0.10-0.71, P=0.1447, I2=0%), and 58.52 units (95% CI 15.96-101.08, P=0.07, I2=0%), respectively. Conclusion SG showed excellent weight-reducing effects during a short follow-up period in obese patients with T1DM and improved the glycemic control by reducing insulin requirement.
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Affiliation(s)
- Hana Jin
- Department of Surgery, Bariatric Surgery Center, Soonchunhyang University Hospital Seoul, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Sang Hyun Kim
- Department of Surgery, Bariatric Surgery Center, Soonchunhyang University Hospital Seoul, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Yoona Chung
- Department of Surgery, H plus Yangji Hospital, Seoul, Korea
| | - Dae Geun Park
- Department of Surgery, H plus Yangji Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Surgery, H plus Yangji Hospital, Seoul, Korea
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Optimizing Bariatric Surgery outcomes: the impact of preoperative elevated hemoglobin A1c levels on composite perioperative outcome measures. Surg Endosc 2020; 35:4618-4623. [PMID: 32789589 PMCID: PMC8823948 DOI: 10.1007/s00464-020-07887-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022]
Abstract
Introduction The use of bariatric surgery in the management of obesity and its related morbidity has significantly increased in the US over the past decade. There is a lack of data on the impact of optimal preoperative glycemic control on the morbidity and mortality following bariatric surgery. The aim of this study was to analyze the impact of hemoglobin (Hb) A1c > 7 on outcomes among patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Methods Data were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (2017) and limited to patients undergoing an elective laparoscopic RYGB or SG. Multivariable logistic regression was conducted to adjust for other preoperative variables. Results A total number of 31,060 (69.3%) patients underwent SG, while 13,754 (30.7%) received RYGB. Patients who were older, male, non-Hispanic, smokers, and those with a higher American Society of Anesthesiologist Classification (ASA) score were more likely to have elevated HbA1c levels. Compared to individuals with normal HbA1c levels, patients with elevated levels had no significant difference in mortality (p = 0.902) but did have a difference in composite morbidity and mortality (p < 0.001). On multivariable analysis, elevated HbA1c, older age, increasing body mass index (BMI), elevated creatinine, longer operations, African American race, receiving RYGB, and having a trainee as surgical assistant were found to increase the odds of having an adverse outcome. No significant difference was found within smoking status, sex, ASA Classification, robotic vs laparoscopic, or if a second attending surgeon was assisting. Conclusions HbA1c levels and presence of trainees in the OR are modifiable preoperative risk factors for adverse events following bariatric surgery. Improving preoperative glycemic control may be an effective and achievable quality improvement measure.
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Korakas E, Kountouri A, Raptis A, Kokkinos A, Lambadiari V. Bariatric Surgery and Type 1 Diabetes: Unanswered Questions. Front Endocrinol (Lausanne) 2020; 11:525909. [PMID: 33071965 PMCID: PMC7531037 DOI: 10.3389/fendo.2020.525909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/20/2020] [Indexed: 01/19/2023] Open
Abstract
In recent decades there has been an alarming increase in the prevalence of obesity in patients with type 1 diabetes leading to the development of insulin resistance and cardiometabolic complications, with mechanisms poorly clarified. While bariatric surgery has long been considered an effective treatment option for patients with type 2 diabetes, the evidence regarding its benefits on weight loss and the prevention of complications in T1DM patients is scarce, with controversial outcomes. Bariatric surgery has been associated with a significant reduction in daily insulin requirement, along with a considerable reduction in body mass index, results which were sustained in the long term. Furthermore, studies suggest that bariatric surgery in type 1 diabetes results in the improvement of comorbidities related to obesity including hypertension and dyslipidemia. However, regarding glycemic control, the reduction of mean glycosylated hemoglobin was modest or statistically insignificant in most studies. The reasons for these results are yet to be elucidated; possible explanations include preservation of beta cell mass and increased residual function post-surgery, improvement in insulin action, altered GLP-1 function, timing of surgery, and association with residual islet cell mass. A number of concerns regarding safety issues have arisen due to the reporting of peri-operative and post-operative adverse events. The most significant complications are metabolic and include diabetic ketoacidosis, severe hypoglycemia and glucose fluctuations. Further prospective clinical studies are required to provide evidence for the effect of bariatric surgery on T1DM patients. The results may offer a better knowledge for the selection of people living with diabetes who will benefit more from a metabolic surgery.
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Affiliation(s)
- Emmanouil Korakas
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Raptis
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Vaia Lambadiari
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Abstract
PURPOSE OF REVIEW The number of bariatric surgeries for patients with type 1 or type 2 diabetes continues to grow. Clinicians are challenged to choose therapies that reach glycemic targets without inducing adverse effects in post-bariatric patients without published guidelines. This review evaluates data supporting the best strategies for diabetes management in patients undergoing bariatric surgery. RECENT FINDINGS Though few clinical trials have evaluated the safety and effectiveness of different glucose-lowering therapies following bariatric surgery, remission of diabetes or reduced medications is an established benefit of bariatric surgery. Adverse events including diabetic ketoacidosis in post-bariatric patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors or inadequate insulin have been reported in patient's with both type 1 and type 2 diabetes. Metformin, glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, SGLT2 inhibitors, insulin, and sulfonylureas have been used successfully in the perioperative period for other surgeries and guidelines recommend adjusting the doses of these medications especially in the perioperative period. Clinicians should favor weight-neutral or weight-loss promoting therapies in post-bariatric surgery patients such as medical nutrition therapy, metformin, GLP-1 agonists, SGLT2 inhibitors, and DPP-4 inhibitors.
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Affiliation(s)
- Christopher M Mulla
- Division of Endocrinology, Landstuhl Regional Medical Center, US Army, Landstuhl, Germany.
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Harris M Baloch
- Division of Endocrinology, Landstuhl Regional Medical Center, US Army, Landstuhl, Germany
| | - Samar Hafida
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H. Does Body Contouring After Bariatric Weight Loss Enhance Quality of Life? A Systematic Review of QOL Studies. Obes Surg 2019; 28:3333-3341. [PMID: 30069862 PMCID: PMC6153583 DOI: 10.1007/s11695-018-3323-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Massive weight loss following bariatric surgery can result in excess tissue, manifesting as large areas of redundant skin that can be managed by body contouring surgery. This study aims to quantify the effects of body contouring surgery on indicators of quality of life in post-bariatric patients. A systematic review and meta-analysis of the literature revealed on indices of quality of life in post-bariatric patients, before and after body contouring surgery. Body contouring surgery resulted in statistically significant improvements in physical functioning, psychological wellbeing and social functioning, as well as a reduction in BMI. Body contouring surgery offers a strategy to improve quality of life in patients suffering from the functional and psychosocial consequences of excess skin after bariatric surgery.
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Affiliation(s)
- Tania Toma
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Leanne Harling
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Thanos Athanasiou
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Ara Darzi
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Hutan Ashrafian
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK.
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Yeung KTD, Reddy M, Purkayastha S. Surgical options for glycaemic control in Type 1 diabetes. Diabet Med 2019; 36:414-423. [PMID: 30575115 DOI: 10.1111/dme.13885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/14/2022]
Abstract
In recent years, bariatric surgery, also referred to as metabolic surgery, has become the most successful treatment option in those with Type 2 diabetes and obesity. There are some similarities in the pathological pathways in Type 1 and Type 2 diabetes, but the use of surgery in Type 1 diabetes remains unestablished and controversial. The treatment and management of Type 1 diabetes can be very challenging but recent advances in surgical interventions and technology has the potential to expand and optimize treatment options. This review discusses the current status of some surgical options available to people with Type 1 diabetes. These include implantable continuous glucose monitoring systems, continuous intraperitoneal insulin infusion pumps, closed-loop insulin delivery systems (also known as the artificial pancreas system) utilizing the latter two modalities of glucose monitoring and insulin delivery, and bariatric or metabolic surgery. Whole pancreas and islet transplantation are beyond the scope of this review but are briefly discussed.
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Affiliation(s)
- K T D Yeung
- Department of Surgery and Cancer, Imperial College, London, UK
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
| | - M Reddy
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK
| | - S Purkayastha
- Department of Surgery and Cancer, Imperial College, London, UK
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
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Hironaka JY, Kitahama S, Sato H, Inoue M, Takahashi T, Tamori Y. Sleeve Gastrectomy Induced Remission of Slowly Progressive Type 1 Diabetes in a Morbidly Obese Japanese Patient. Intern Med 2019; 58:675-678. [PMID: 30333397 PMCID: PMC6443562 DOI: 10.2169/internalmedicine.1217-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The effects of bariatric/metabolic surgery on glycemic control in obese type 1 diabetic patients are controversial. We herein report a case of a morbidly obese 35-year-old woman who completely recovered from slowly progressive type 1 diabetes (SPIDDM) following laparoscopic sleeve gastrectomy. Preoperatively, her body mass index (BMI) was 49.8 kg/m2 and hemoglobin A1c was 5.7% with intensive insulin therapy. Six months after bariatric/metabolic surgery, her BMI decreased to 33.2 kg/m2 and her glycemic control was normal despite the discontinuation of all diabetic medicine. This case demonstrates the usefulness of bariatric/metabolic surgery for achieving glycemic control in morbidly obese patients with SPIDDM in Japan.
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Affiliation(s)
- Jun-Ya Hironaka
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Chibune General Hospital, Japan
| | - Seiichi Kitahama
- Department of Bariatric and Metabolic Surgery, Chibune General Hospital, Japan
| | - Hiroyuki Sato
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Chibune General Hospital, Japan
| | - Maki Inoue
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Chibune General Hospital, Japan
| | - Tetsuya Takahashi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Chibune General Hospital, Japan
| | - Yoshikazu Tamori
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Chibune General Hospital, Japan
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Landau Z, Kowen-Sandbank G, Jakubowicz D, Raziel A, Sakran N, Zaslavsky-Paltiel I, Lerner-Geva L, Pinhas-Hamiel O. Bariatric surgery in patients with type 1 diabetes: special considerations are warranted. Ther Adv Endocrinol Metab 2019; 10:2042018818822207. [PMID: 30728940 PMCID: PMC6354304 DOI: 10.1177/2042018818822207] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/06/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM). METHODS We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years. RESULTS Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 (p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 (p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% (p = 0.09). CONCLUSIONS Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.
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Affiliation(s)
| | | | - Daniela Jakubowicz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel; Department of Surgery A, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Inna Zaslavsky-Paltiel
- Gertner Institute for Epidemiology and Health Policy Research, Women and Children’s Health Research, Tel Hashomer, Israel
| | - Liat Lerner-Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Gertner Institute for Epidemiology and Health Policy Research, Women and Children’s Health Research, Tel Hashomer, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Juvenile Diabetes Center, Raanana, Israel; Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
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Raveendran AV, Chacko EC, Pappachan JM. Non-pharmacological Treatment Options in the Management of Diabetes Mellitus. EUROPEAN ENDOCRINOLOGY 2018; 14:31-39. [PMID: 30349592 PMCID: PMC6182920 DOI: 10.17925/ee.2018.14.2.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 02/05/2023]
Abstract
The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.
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Affiliation(s)
| | - Elias C Chacko
- Department of Endocrinology, Jersey General Hospital, Jersey
| | - Joseph M Pappachan
- Department of Endocrinology, Diabetes & Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, UK
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Ashrafian H, Monnich M, Braby TS, Smellie J, Bonanomi G, Efthimiou E. Intragastric balloon outcomes in super-obesity: a 16-year city center hospital series. Surg Obes Relat Dis 2018; 14:1691-1699. [PMID: 30193905 DOI: 10.1016/j.soard.2018.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intragastric balloons represent an endoscopic therapy aimed at achieving weight loss by mechanical induction of satiety. Their exact role within the bariatric armamentarium remains uncertain. OBJECTIVE Our study aimed to evaluate the use of intragastric balloon therapy alone and before definitive bariatric surgery over a 16-year period. SETTING A large city academic bariatric center for super-obese patients. METHODS Between January 2000 and February 2016, 207 patients underwent ORBERA intragastric balloon placement at esophagogastroduodenoscopy. Four surgeons performed the procedures, and data were entered prospectively into a dedicated bariatric database. Patients' weight loss data were measured through body mass index (BMI) and excess weight loss and recorded at each clinic review for up to 5 years (60 mo). Treatment arms included intragastric balloon alone with lifestyle therapy or intragastric balloon and definitive bariatric surgery: gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass. An additional treatment arm of analysis included the overall results from intragastric balloon followed by stapled procedure. RESULTS One hundred twenty-nine female and 78 male patients had a mean age of 44.5 (±11.3) years and a mean BMI of 57.3 (±9.7) kg/m2. Fifty-eight percent of patients suffered from type 2 diabetes. Time from initial or first balloon insertion to definitive surgical therapy ranged between 9 and 13 months. Seventy-six patients had intragastric balloon alone, and 131 had intragastric balloon followed by definitive procedure. At 60 months postoperatively the intragastric balloon alone with lifestyle changes demonstrated an excess weight loss of 9.04% and BMI drop of 3.8; intragastric balloon with gastric banding demonstrated an excess weight loss of 32.9% and BMI drop of 8.9. Intragastric balloon and definitive stapled procedure demonstrated a BMI drop of 17.6 and an excess weight loss of 52.8%. Overall, there were 3 deaths (1.4%), 2 within 10 days due to acute gastric perforation secondary to vomiting and 1 cardiac arrest at 4 weeks postoperatively. CONCLUSION Intragastric balloons can offer effective weight loss in selected super-obese patients within a dedicated bariatric center offering multidisciplinary support. Balloon insertion alone offers only short-term weight loss; however, when combined with definitive bariatric surgical approaches, durable weight loss outcomes can be achieved. A strategy of early and continual vigilance for side effects and a low threshold for removal should be implemented. Surgeon and unit experience with intragastric balloons can contribute to "kick starting" successful weight loss as a bridge to definitive therapy in an established bariatric surgical pathway.
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Affiliation(s)
- Hutan Ashrafian
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, Chelsea, London.
| | - Maren Monnich
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, Chelsea, London
| | - Thomas Stephen Braby
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, Chelsea, London
| | - James Smellie
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, Chelsea, London
| | - Gianluca Bonanomi
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, Chelsea, London
| | - Evangelos Efthimiou
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, Chelsea, London
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Uno K, Seki Y, Kasama K, Wakamatsu K, Hashimoto K, Umezawa A, Yanaga K, Kurokawa Y. Mid-term results of bariatric surgery in morbidly obese Japanese patients with slow progressive autoimmune diabetes. Asian J Endosc Surg 2018; 11:238-243. [PMID: 29227039 DOI: 10.1111/ases.12443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Bariatric surgery is recognized as an effective treatment for type 2 diabetes mellitus, but data on its efficacy for type 1 diabetes mellitus, especially slowly progressive insulin-dependent diabetes mellitus, are limited. METHODS We investigated five Japanese patients with slowly progressive insulin-dependent diabetes mellitus who underwent bariatric surgery at our center. RESULTS Five morbidly obese glutamic acid decarboxylase antibody-positive diabetic patients underwent two different types of bariatric surgery. The mean titer of anti-glutamic acid decarboxylase antibody was 4.6 U/mL, and the mean preoperative bodyweight and BMI were 113 kg and 39.6 kg/m2 , respectively. The mean hemoglobin A1c was 8.4%. The mean fasting serum C-peptide was 5.0 ng/mL. Laparoscopic sleeve gastrectomy was performed in two patients, while laparoscopic sleeve gastrectomy with duodenojejunal bypass was performed in three patients. At one year after surgery, the mean bodyweight and BMI significantly dropped, and the mean percentage of excess weight loss was 96.4%. The mean hemoglobin A1c was 5.7%. This favorable trend was maintained at mid-term. CONCLUSION Bariatric surgery for morbidly obese patients with anti-glutamic acid decarboxylase antibody-positive type 1 diabetes mellitus, especially slow progressive autoimmune diabetes, seemed effective in achieving mid-term glycemic control. Longer follow-up with a larger number of patients, as well as validation with more advanced patients with slowly progressive insulin-dependent diabetes mellitus, will be needed.
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Affiliation(s)
- Kohei Uno
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.,Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kotaro Wakamatsu
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenkichi Hashimoto
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan
| | - Akiko Umezawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yoshimochi Kurokawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
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Ang GY. Reversibility of diabetes mellitus: Narrative review of the evidence. World J Diabetes 2018; 9:127-131. [PMID: 30079148 PMCID: PMC6068740 DOI: 10.4239/wjd.v9.i7.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 02/05/2023] Open
Abstract
The global disease burden of diabetes mellitus is high. It is well-established that prediabetes is reversible but it is unclear whether diabetes is reversible once it has been diagnosed. The objective of this narrative review is to review the evidence of reversibility of diabetes mellitus and stimulate interest in prolonged remission as a treatment target. The current evidence for bariatric surgery is stronger than intensive medical management and the evidence is stronger for type 2 diabetes patients compared with type 1 diabetes patients. It is also unclear whether non obese diabetes patients would benefit from such interventions and the duration of diabetes before diabetes become irreversible. Further research is needed in this area especially with regards to the subgroup of diabetes patient who will benefit from these interventions and the long term safety and efficacy remains unknown especially with intensive medical management.
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Affiliation(s)
- Gary Yee Ang
- Health Services and Outcomes Research, National Healthcare Group, Singapore 138543, Singapore
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Driscoll KA, Corbin KD, Maahs DM, Pratley R, Bishop FK, Kahkoska A, Hood KK, Mayer-Davis E. Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps. Curr Diab Rep 2017; 17:58. [PMID: 28660565 PMCID: PMC6053070 DOI: 10.1007/s11892-017-0892-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss. RECENT FINDINGS Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising. A variety of demographic (e.g., female sex), clinical (e.g., greater insulin needs), environmental (e.g., skipping meals), and psychosocial (e.g., depression, stress) factors are associated with overweight/obese weight status in T1D. Fear of hypoglycemia is a significant barrier to engagement in physical activity. Studies evaluating adaptive weight loss strategies in people with T1D are limited. There is a growing literature highlighting the prevalence and seriousness of overweight and obesity among both youth and adults with T1D. There is an urgent need to develop evidence-based weight management guidelines and interventions that address the unique concerns of individuals with T1D and that concurrently address glycemic control.
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Affiliation(s)
- Kimberly A Driscoll
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA.
| | - Karen D Corbin
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Richard Pratley
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Franziska K Bishop
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA
| | - Anna Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, The University of North Carolina Chapel Hill, Chapel Hill, NC, 27599-7461, USA
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McCarthy MM, Whittemore R, Gholson G, Grey M. Self-management of physical activity in adults with type 1 diabetes. Appl Nurs Res 2017; 35:18-23. [PMID: 28532721 DOI: 10.1016/j.apnr.2017.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/01/2017] [Indexed: 12/18/2022]
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Bariatric surgery results in patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion therapy. ACTA ACUST UNITED AC 2016; 63:571-572. [PMID: 27765489 DOI: 10.1016/j.endonu.2016.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 01/22/2023]
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Wang T, Zhang P, Zhang X, Cao T, Zheng C, Yu B. Duodenal-jejunal bypass attenuates progressive failure of pancreatic islets in streptozotocin-induced diabetic rats. Surg Obes Relat Dis 2016; 13:250-260. [PMID: 27865809 DOI: 10.1016/j.soard.2016.08.500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/21/2016] [Accepted: 08/26/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Preservation of pancreatic beta cell function has been increasingly appealing in the treatment of type 2 diabetes. Evidence is still limited on how bariatric surgery affects pancreatic beta cell apoptosis. SETTING University medical center. OBJECTIVE The study aimed to investigate the effect of a major component of Roux-en-Y gastric bypass, duodenal-jejunal bypass, on protecting pancreatic beta cells from progressive loss. METHODS Forty-five normal Sprague-Dawley rats were randomly assigned into 3 groups: duodenal-jejunal bypass (DJB) group (n = 16) and sham (S) group (n = 17), based upon the procedure received, and a control (C) group (n = 12) without any procedure performed, to eliminate potential traumatic effects from surgery. Ten days after surgery, streptozotocin (STZ, 45 mg/kg weight) was injected intraperitoneally into each animal, including the control animals, to selectively induce pancreatic beta cell apoptosis. Weight, food intake, plasma glucose level, and the results of an oral glucose tolerance test were measured before surgery, pre-STZ injection, and up to 4 weeks after STZ injection. Plasma insulin and glucagon-like peptide-1 levels were also assayed during oral glucose tolerance test. At the end, pancreatic tissues were sliced and stained for beta cell analysis. RESULTS There were no significant differences in weight among all groups at any time points measured, despite rats in the S and C groups consuming more food than those in the DJB group as measured on day 10 (P<.05) and day 20 (P<.01) after STZ injection. Animals undergoing DJB did not experience symptoms typical of uncompensated diabetes, including hyperphagia and progressive weight loss. After STZ injection, fasting plasma glucose levels in the DJB group were significantly lower than those in the C and S groups (P<.001). When challenged by glucose load, DJB rats also had a better glycemic excursion (P<.01) and incretin response compared with C and S rats (P<.05). In addition, pancreatic beta cell size and mass was better preserved in DJB rats (P< .001). CONCLUSION DJB is able to protect pancreatic beta cells from apoptosis, which leads to better glycemic control and delayed onset of diabetes. These results imply the necessity of including a DJB component when designing bariatric procedure to achieve a better long-term outcome.
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Affiliation(s)
- Tingfeng Wang
- Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China
| | - Peng Zhang
- Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China; Center for Medical Research and Innovation, Fudan University Pudong Medical Center, Shanghai, China
| | - Xiong Zhang
- Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China
| | - Ting Cao
- Center for Medical Research and Innovation, Fudan University Pudong Medical Center, Shanghai, China
| | - Chengzhu Zheng
- Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China; Division of Minimally Invasive Surgery, Department of Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Bo Yu
- Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China.
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Rizvi AA. The evolving role of bariatric surgery in patients with type 1 diabetes and obesity. INTEGRATIVE OBESITY AND DIABETES 2016; 2:195-199. [PMID: 27398228 PMCID: PMC4936488 DOI: 10.15761/iod.1000144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Bariatric surgery has emerged as a viable treatment option in morbidly obese individuals with type 2 diabetes. Concomitant with societal lifestyle changes and the increased emphasis on achieving metabolic targets, there has been a rise in the number of patients with type 1 diabetes (T1DM) who are overweight and obese. Preliminary experience based on a limited number of observational reports points to substantial weight loss and amelioration of comorbid conditions such as blood pressure and dyslipidemia in patients with T1DM who undergo weight loss surgery. However, there is little evidence to suggest significant improvement in glycemic control and lowering of glycosylated hemoglobin, and bariatric surgical procedures do not necessarily lead to enhanced diabetes management. and improved quality of life. The potential possibility of micronutrient deficiency, weight regain, and psychobehavioral issues post-bariatric surgery also exists. An individualized evaluation of the risks and benefits should be considered, using a a multidisciplinary team approach with expertise in patient selection, surgical technique, and follow-up. A crucial component is the availability of a diabetes care specialist or endocrinologist experienced in intensive, tailored, modifiable insulin regimens who maintains close and careful monitoring during all phases of management. Reliable data from a prospective, longitudinal perspective is required to provide guidelines for clinicians and informed choices for obese patients with T1DM who are contemplating bariatric surgery.
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Affiliation(s)
- Ali A. Rizvi
- Department of Medicine, Director for Division of Endocrinology, University of South Carolina School of Medicine, USA
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