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Keweloh B, Terenzi D, Froehlich E, Coricelli C, Stürmer P, Rohmann N, Wietzke-Braun P, Beckmann A, Laudes M, Park SQ. Weight loss impacts risky decisions in obesity. Clin Nutr 2024; 43:1270-1277. [PMID: 38653010 DOI: 10.1016/j.clnu.2024.04.002] [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: 04/01/2023] [Revised: 12/15/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND & AIMS Risky decision making is shaped by individual psychological and metabolic state. Individuals with obesity show not only altered risk behavior, but also metabolic and psychological abnormalities. The aim of the present study was to investigate whether a substantial weight loss in individuals with severe obesity will 1) normalize their metabolic and psychological state and 2) will change their pattern of decision guidance. METHODS We assessed the effect of glycated hemoglobin (HbA1c) and mood on risk behavior in individuals with obesity (n = 62, 41 women; BMI, 46.5 ± 4.8 kg/m2; age, 44.9 ± 14.7 years) before and after 10-weeks weight loss intervention. RESULTS Results showed that this intervention reduced participants' risk behavior, which was significantly predicted by their changes in BMI. Before intervention, mood, but not HbA1c significantly predicted decisions. After the weight loss, mood no longer, but HbA1c significantly predicted decisions. CONCLUSION Our findings shed light on the psychological and metabolic mechanisms underlying altered risky decision making in severe obesity and can inform the development of strategies in the context of weight loss interventions.
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Affiliation(s)
- Beatrix Keweloh
- Department of Decision Neuroscience & Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558 Nuthetal, Germany; German Center for Diabetes Research, 85764 München-Neuherberg, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Neuroscience Research Center, 10117, Berlin, Germany.
| | - Damiano Terenzi
- Department of Decision Neuroscience & Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558 Nuthetal, Germany; German Center for Diabetes Research, 85764 München-Neuherberg, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Neuroscience Research Center, 10117, Berlin, Germany; Institut de Neurosciences de la Timone, Aix-Marseille Université, CNRS UMR 7289, Marseille, France
| | - Eva Froehlich
- Department of Decision Neuroscience & Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558 Nuthetal, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Neuroscience Research Center, 10117, Berlin, Germany
| | - Carol Coricelli
- Department of Decision Neuroscience & Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558 Nuthetal, Germany; German Center for Diabetes Research, 85764 München-Neuherberg, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Neuroscience Research Center, 10117, Berlin, Germany; Institut Lyfe Research and Innovation Center, 69139 Écully, France
| | - Paula Stürmer
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, 24105 Kiel, Germany; Institute of Epidemiology, University of Kiel, 24105 Kiel, Germany
| | - Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, 24105 Kiel, Germany; Institute of Diabetes and Clinical Metabolic Research, University Medical Centre, 24105 Kiel, Germany
| | - Perdita Wietzke-Braun
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Alexia Beckmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, 24105 Kiel, Germany; Institute of Diabetes and Clinical Metabolic Research, University Medical Centre, 24105 Kiel, Germany
| | - Soyoung Q Park
- Department of Decision Neuroscience & Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558 Nuthetal, Germany; German Center for Diabetes Research, 85764 München-Neuherberg, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Neuroscience Research Center, 10117, Berlin, Germany
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Latifi E, Mohammadpour AA, Fathi Hafshejani B, Nourani H. Ferula assa-foetida oleo gum resin ethanolic extract alleviated the pancreatic changes and antioxidant status in streptozotocin-induced diabetic rats: A biochemical, histopathological, and ultrastructural study. J Food Biochem 2022; 46:e14191. [PMID: 35474229 DOI: 10.1111/jfbc.14191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/11/2022] [Accepted: 03/25/2022] [Indexed: 01/07/2023]
Abstract
The current research examines the effects of administration of 150 and 250 mg/kg body weight/day of ethanolic Ferula assa-foetida L. oleo gum resin extract (FAE) for 42 days in streptozotocin-induced diabetes in rats. On day 42, all rats were euthanized; HOMA-β, HOMA-IR, and QUICKI levels in pancreas were examined histopathologically and ultrastructurally . Low-dose FAE (150 mg/kg) treatment resulted in significant improvement in serum glucose, insulin and superoxide dismutase, glutathione, and catalase levels (p < .05). It also improved β-cell function, restored pancreatic β-cells, and reduced insulin resistance compared to the diabetic control rats. Necrotic and degenerative alterations in the islets, pyknotic β-cell nuclei, β-cell degranulation, reduced islet cellular density, and significant vacuolation were found in the islets of STZ-diabetic control group ratsby the histomorphological and ultrastructural examination. The pancreatic histomorphology of low dose of FAE-treated diabetic rats showed remarkable improvements in the islets, such as the β-cell number and the area of the pancreatic islets. PRACTICAL APPLICATIONS: The experiment revealed that Ferula assa-foetida L. may exert antihyperglycemic activity in STZ diabetes via β-cell regeneration and its high antioxidant capacity. This work elucidates the role of Ferula assa-foetida L. in diabetes management. Ferula assa-foetida L. gum extract improved the morphological changes of the diabetic pancreas and stimulated the regeneration of the β cells. The findings demonstrated positive results for the long-term cure of diabetes. Additionally, this study showed the potential of isolating nutraceuticals for the development of medications.
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Affiliation(s)
- Ebrahim Latifi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ahmad Ali Mohammadpour
- Department of Basic Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Behrooz Fathi Hafshejani
- Department of Basic Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Hosein Nourani
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
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The Symbiotic Effect of a New Nutraceutical with Yeast β-Glucan, Prebiotics, Minerals, and Silybum marianum (Silymarin) for Recovering Metabolic Homeostasis via Pgc-1α, Il-6, and Il-10 Gene Expression in a Type-2 Diabetes Obesity Model. Antioxidants (Basel) 2022; 11:antiox11030447. [PMID: 35326098 PMCID: PMC8944780 DOI: 10.3390/antiox11030447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
The use of natural products and derivatives for the prevention and control of non-communicable chronic diseases, such as type-2 diabetes (T2D), obesity, and hepatic steatosis is a way to achieve homeostasis through different metabolic pathways. Thus, male C57BL/6 mice were divided into the following groups: high-fat diet (HFD) vehicle, HFD + Supplemented, HFD + Supplemented_S, and isolated compounds. The vehicle and experimental formulations were administered orally by gavage once a day over the four weeks of the diet (28 consecutive days). We evaluated the energy homeostasis, cytokines, and mitochondrial gene expression in these groups of mice. After four weeks of supplementation, only the new nutraceutical group (HFD + Supplemented) experienced reduced fasting glycemia, insulin, HOMA index, HOMA-β, dyslipidemia, ectopic fat deposition, and hepatic fibrosis levels. Additionally, the PPARγ coactivator 1 α (Pgc-1α), interleukin-6 (Il-6), and interleukin-10 (Il-10) gene expression were augmented, while hepatic steatosis decreased and liver parenchyma was recovered. The glutathione-S-transferase activity status was found to be modulated by the supplement. We discovered that the new nutraceutical was able to improve insulin resistance and hepatic steatosis mainly by regulating IL-6, IL-10, and Pgc-1α gene expression.
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Heidari H, Azizi Y, Maleki-Ravasan N, Tahghighi A, Khalaj A, Pourhamzeh M. Nature׳s gifts to medicine: The metabolic effects of extracts from cocoons of Larinus hedenborgi (Coleoptera: Curculionidae) and their host plant Echinops cephalotes (Asteraceae) in diabetic rats. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114762. [PMID: 34678415 DOI: 10.1016/j.jep.2021.114762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Trehala manna (TM), the edible cocoons of several weevil species, e.g. Larinus hedenborgi Boheman, 1845 (Coleoptera: Curculionidae) and their host plant, i.e. Echinops cephalotes DC. (EC) (Asteraceae), are traditionally used to treat pain, inflammation, infectious diseases, as well as respiratory, renal, reproductive and metabolic disorders. AIM OF THE STUDY This study investigated the metabolic effects of aqueous extracts from TM and EC on diabetic male Wistar albino rats. MATERIALS AND METHODS Animals were orally gavaged with the extracts (75, 150, and 300 mg/kg), normal saline, and glibenclamide (Glbn), for 28 days. The serum levels of glucose, insulin, lipid profile, and hepatic enzymes, plus the body weight of rats were measured at the beginning and the end of study. The proximate composition of the extracts was determined, additionally. The antioxidant and cytotoxic potency of the extracts were evaluated by radical scavenging/ferric reducing and viability assays, respectively. RESULTS Treatment of diabetic rats with the extracts significantly altered metabolic biomarkers compared with diabetic, control and Glbn-treated groups, but not in a dose-dependent manner. However, the antihyperglycemic effects of TM75/EC300, the antiobesity effects of EC150, and the hepatoprotective effects of TM150/EC150 were even stronger than those of Glbn. TM/EC-treated groups represented normal cell architecture in the pancreatic and renal tissues. Nutrient analysis displayed that TM is rich in sugar and magnesium, whereas EC is abundant in protein, sodium, potassium, and calcium. The extracts showed no antioxidant and cytotoxic effects, as compared to the control groups. CONCLUSIONS The findings suggest that active ingredients in the extracts evaluated are responsible for the metabolic effects by lowering blood sugar and restoring the damaged islets of Langerhans. The close trophic relationship of the TM-producing beetle with the host thistle justifies the overlaps of the bioactivity of the TM and EC extracts.
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Affiliation(s)
- Hamid Heidari
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran; Department of Physiology and Pharmacology, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran.
| | - Yaser Azizi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Azar Tahghighi
- Laboratory of Medicinal Chemistry, Department of Clinical Research, Pasteur Institute of Iran, Tehran, Iran.
| | - Azam Khalaj
- Department of Physiology and Pharmacology, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran.
| | - Mahsa Pourhamzeh
- Division of Neuroscience, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Xiang AH, Martinez MP, Trigo E, Utzschneider KM, Cree-Green M, Arslanian SA, Ehrmann DA, Caprio S, Mohamed PHIH, Hwang DH, Katkhouda N, Nayak KS, Buchanan TA. Liver Fat Reduction After Gastric Banding and Associations with Changes in Insulin Sensitivity and β-Cell Function. Obesity (Silver Spring) 2021; 29:1155-1163. [PMID: 34038037 PMCID: PMC8222142 DOI: 10.1002/oby.23174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between changes in liver fat and changes in insulin sensitivity and β-cell function 2 years after gastric banding surgery. METHODS Data included 23 adults with the surgery who had prediabetes or type 2 diabetes for less than 1 year and BMI 30 to 40 kg/m2 at baseline. Body adiposity measures including liver fat content (LFC), insulin sensitivity (M/I), and β-cell responses (acute, steady-state, and arginine-stimulated maximum C-peptide) were assessed at baseline and 2 years after surgery. Regression models were used to assess associations adjusted for age and sex. RESULTS Two years after surgery, all measures of body adiposity, LFC, fasting and 2-hour glucose, and hemoglobin A1c significantly decreased; M/I significantly increased; and β-cell responses adjusted for M/I did not change significantly. Among adiposity measures, reduction in LFC had the strongest association with M/I increase (r = -0.61, P = 0.003). Among β-cell measures, change in LFC was associated with change in acute C-peptide response to arginine at maximal glycemic potentiation adjusted for M/I (r = 0.66, P = 0.007). Significant reductions in glycemic measures and increase in M/I were observed in individuals with LFC loss >2.5%. CONCLUSIONS Reduction in LFC after gastric banding surgery appears to be an important factor associated with long-term improvements in insulin sensitivity and glycemic profiles in adults with obesity and prediabetes or early type 2 diabetes.
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Affiliation(s)
- Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra P Martinez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Enrique Trigo
- Division of Endocrinology and Diabetes, Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kristina M Utzschneider
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and the University of Washington, Seattle, Washington, USA
| | - Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Silva A Arslanian
- School of Medicine, UPMC Children's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David A Ehrmann
- Section of Endocrinology, Diabetes and Metabolism, the University of Chicago, Chicago, Illinois, USA
| | - Sonia Caprio
- Department of Pediatric/Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Passant H I H Mohamed
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Namir Katkhouda
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Krishna S Nayak
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Bhandari V, Kosta S, Bhandari M, Bhandari M, Mathur W, Fobi M. Bariatric metabolic surgery: An effective treatment of type 2 diabetes. J Minim Access Surg 2021; 18:396-400. [PMID: 34259204 PMCID: PMC9306138 DOI: 10.4103/jmas.jmas_325_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Bariatric metabolic surgery is evolving as an option for the treatment of type 2 diabetes mellitus (T2DM) in patients with obesity and T2DM, warranting more studies on the efficacy of bariatric metabolic surgery on T2DM. Objective: To determine T2DM remission in patients with obesity and T2DM with up to two years follow-up after bariatric metabolic surgery. Materials and Methods: A retrospective review of prospectively maintained data was undertaken to identify patients who had T2DM and underwent bariatric surgery at a single centre in 2016. Data collected included age, gender, body mass index (BMI), fasting plasma glucose, haemoglobin A1c, hypertension, (HTN), Obstructive sleep apnea (OSA), initial weight and the weight at intervals of 6, 12, and 24 months. Data on the treatment of T2DM before the surgery was also collected. The criteria of the American Diabetes Association were used for the definition of T2DM remission. Only the data on patients in this study who had more than 12 months’ follow-up information was analysed. Results: Two hundred and eighty patients with T2DM were identified. 191 patients had more than 12 months’ follow-up information. Mean age and BMI were 49.58 ± 10.64 years and 44.03 ± 7.86 kg/m2 respectively. There were 29 patients on insulin, 21 (10.9%) on insulin only and 8 (4.2%) on insulin and oral hypoglycaemic agents (OHA). One hundred and forty-six patients (76.4%) were on OHA, 134 on a single OHA and 12 on more than one OHA. Twenty-six patients (13.6%) were newly diagnosed with T2DM when they came in for bariatric metabolic surgery. One hundred and fifty-six patients (81.7%) achieved complete remission. 14 (7.3%) of these patients used to be on insulin with or without OHA and 142 (74.3%) were patients either on OHA or no OHA. There were 12 (6.4%) patients in partial remission. There was improvement in 23 (12.04%). Eight patients were on insulin but at lower doses and 15 were on a single OHA. The average percentage of total weight loss at 6, 12 and 24 months was 29.7%, 33.9% and 35.6% respectively. Patients with shorter duration of T2DM had higher remission rates as compared to patients with longer duration (r = −0.874, P = 0.001). There was also a significant resolution of HTN (81.8%) and OSA (82.3%) after bariatric metabolic surgery. Conclusion: This study collaborates reports that there is significant remission of T2DM after bariatric metabolic surgery in patients with obesity and T2DM. There is a need for prospective, multi-centre, and long-term studies on bariatric metabolic surgery to treat patients with obesity and T2DM.
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Affiliation(s)
- Vinod Bhandari
- Department of Surgery, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
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Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2020; 16:1701-1712. [PMID: 32800734 DOI: 10.1016/j.soard.2020.06.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/10/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) confers the highest rate of type 2 diabetes (T2D) remission compared with other bariatric procedures. Previous studies suggest that type of antidiabetic therapy used before surgery and duration of disease influence postsurgical glycemic outcomes. Short-term, progressive improvement in insulin sensitivity and beta-cell function after metabolic surgery in patients with noninsulin-treated T2D has been demonstrated. Whether patients with more advanced disease can achieve sustained remission remains unclear. OBJECTIVE The aim of this study was to assess long-term glycemic outcomes in insulin-treated patients with T2D after BPD-DS and identify predictors of sustained diabetes remission or relapse. SETTING University-affiliated tertiary care center. METHODS Data from 141 patients with insulin-treated T2D who underwent BPD-DS between 1994 and 2006 with 10 years of follow-up data were collected from a prospective electronic database. RESULTS Follow-up was available in 132 patients (91%). At 10 years after metabolic surgery, 90 patients (68.1%) had a complete remission of diabetes, 3 (2.3%) had a partial remission, 21 (15.9%) had an improvement, and 3 (2.3%) were unchanged in their diabetes status. Fourteen patients died during the 10-year follow-up period. Relapse after an initial period of remission occurred in 15 (11.4%) patients. Insulin discontinuation was achieved in 97%. Duration of diabetes was an independent predictor of nonremission at 10 years. CONCLUSIONS The BPD-DS maintains remission at 10 years postoperatively in patients with more advanced diabetes. Long-term benefits of the BPD-DS on weight loss and glycemic control should be considered when offering metabolic surgery to patients with insulin-treated T2D.
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Chang GR, Hou PH, Chen WK, Lin CT, Tsai HP, Mao FC. Exercise Affects Blood Glucose Levels and Tissue Chromium Distribution in High-Fat Diet-Fed C57BL6 Mice. Molecules 2020; 25:molecules25071658. [PMID: 32260278 PMCID: PMC7180458 DOI: 10.3390/molecules25071658] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/30/2022] Open
Abstract
Obesity is commonly associated with hyperglycemia and type 2 diabetes and negatively affects chromium accumulation in tissues. Exercise prevents and controls obesity and type 2 diabetes. However, little information is available regarding chromium changes for regulating glucose homeostasis in high-fat diet (HFD)-fed animals/humans who exercise. Therefore, this study explored the effects of exercise and whether it alters chromium distribution in obese mice. Male C57BL6/J mice aged 4 weeks were randomly divided into two groups and fed either an HFD or standard diet (SD). Each group was subgrouped into two additional groups in which one subgroup was exposed to treadmill exercise for 12 weeks and the other comprised control mice. HFD-fed mice that exercised exhibited significant lower body weight gain, food/energy intake, daily food efficiency, and serum leptin and insulin levels than did HFD-fed control mice. Moreover, exercise reduced fasting glucose and enhanced insulin sensitivity and pancreatic β-cell function, as determined by homeostasis model assessment (HOMA)-insulin resistance and HOMA-β indices, respectively. Exercise also resulted in markedly higher chromium levels within the muscle, liver, fat tissues, and kidney but lower chromium levels in the bone and bloodstream in obese mice than in control mice. However, these changes were not noteworthy in SD-fed mice that exercised. Thus, exercise prevents and controls HFD-induced obesity and may modulate chromium distribution in insulin target tissues.
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Affiliation(s)
- Geng-Ruei Chang
- Department of Veterinary Medicine, National Chiayi University, 580 Xinmin Road, Chiayi 60054, Taiwan; (G.-R.C.); (C.-T.L.)
- Veterinary Teaching Hospital, National Chiayi University, 580 Xinmin Road, Chiayi 60054, Taiwan;
| | - Po-Hsun Hou
- Department of Psychiatry, Taichung Veterans General Hospital, 4 Section, 1650 Taiwan Boulevard, Taichung 40705, Taiwan;
- Faculty of Medicine, National Yang-Ming University, 2 Section, 155 Linong Street, Beitou District, Taipei 11221, Taiwan
| | - Wen-Kai Chen
- Department of Veterinary Medicine, National Chung Hsing University, 250 Kuo Kuang Road, Taichung 40227, Taiwan;
| | - Chien-Teng Lin
- Department of Veterinary Medicine, National Chiayi University, 580 Xinmin Road, Chiayi 60054, Taiwan; (G.-R.C.); (C.-T.L.)
| | - Hsiao-Pei Tsai
- Veterinary Teaching Hospital, National Chiayi University, 580 Xinmin Road, Chiayi 60054, Taiwan;
| | - Frank Chiahung Mao
- Department of Veterinary Medicine, National Chung Hsing University, 250 Kuo Kuang Road, Taichung 40227, Taiwan;
- Correspondence: ; Tel.: +886-4-22840368 (ext. 25)
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Rothberg AE, Herman WH, Wu C, IglayReger HB, Horowitz JF, Burant CF, Galecki AT, Halter JB. Weight Loss Improves β-Cell Function in People With Severe Obesity and Impaired Fasting Glucose: A Window of Opportunity. J Clin Endocrinol Metab 2020; 105:5624076. [PMID: 31720686 PMCID: PMC7059991 DOI: 10.1210/clinem/dgz189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In people with obesity, β-cell function may adapt to insulin resistance. We describe β-cell function in people with severe obesity and normal fasting glucose (NFG), impaired fasting glucose (IFG), and type 2 diabetes (T2DM), as assessed before, 3 to 6 months after, and 2 years after medical weight loss to describe its effects on insulin sensitivity, insulin secretion, and β-cell function. METHODS Fifty-eight participants with body mass index (BMI) ≥ 35 kg/m2 (14 with NFG, 24 with IFG, and 20 with T2DM) and 13 normal weight participants with NFG underwent mixed meal tolerance tests to estimate insulin sensitivity (S[I]), insulin secretion (Φ), and β-cell function assessed as model-based Φ adjusted for S(I). All 58 obese participants were restudied at 3 to 6 months and 27 were restudied at 2 years. RESULTS At 3 to 6 months, after a 20-kg weight loss and a decrease in BMI of 6 kg/m2, S(I) improved in all obese participants, Φ decreased in obese participants with NFG and IFG and tended to decrease in obese participants with T2DM, and β-cell function improved in obese participants with NFG and tended to improve in obese participants with IFG. At 2 years, β-cell function deteriorated in participants with NFG and T2DM but remained significantly better in participants with IFG compared to baseline. CONCLUSIONS Short-term weight loss improves β-cell function in participants with NFG and IFG, but β-cell function tends to deteriorate over 2 years. In participants with IFG, weight loss improves longer-term β-cell function relative to baseline and likely relative to no intervention, suggesting that obese people with IFG are a subpopulation whose β-cell function is most likely to benefit from weight loss.
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Affiliation(s)
- Amy E Rothberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan
- Correspondence: Amy E. Rothberg, MD, PhD, University of Michigan, Department of Internal Medicine, Domino’s Farms - Lobby G, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106.
| | - William H Herman
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Chunyi Wu
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Heidi B IglayReger
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Charles F Burant
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan
| | - Andrzej T Galecki
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey B Halter
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
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Douros JD, Tong J, D’Alessio DA. The Effects of Bariatric Surgery on Islet Function, Insulin Secretion, and Glucose Control. Endocr Rev 2019; 40:1394-1423. [PMID: 31241742 PMCID: PMC6749890 DOI: 10.1210/er.2018-00183] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
Abstract
Although bariatric surgery was developed primarily to treat morbid obesity, evidence from the earliest clinical observations to the most recent clinical trials consistently demonstrates that these procedures have substantial effects on glucose metabolism. A large base of research indicates that bariatric surgeries such as Roux-en-Y gastric bypass (RYGB), vertical sleeve gastrectomy (VSG), and biliopancreatic diversion (BPD) improve diabetes in most patients, with effects frequently evident prior to substantial weight reduction. There is now unequivocal evidence from randomized controlled trials that the efficacy of surgery is superior to intensive life-style/medical management. Despite advances in the clinical understanding and application of bariatric surgery, there remains only limited knowledge of the mechanisms by which these procedures confer such large changes to metabolic physiology. The improvement of insulin sensitivity that occurs with weight loss (e.g., the result of diet, illness, physical training) also accompanies bariatric surgery. However, there is evidence to support specific effects of surgery on insulin clearance, hepatic glucose production, and islet function. Understanding the mechanisms by which surgery affects these parameters of glucose regulation has the potential to identify new targets for therapeutic discovery. Studies to distinguish among bariatric surgeries on key parameters of glucose metabolism are limited but would be of considerable value to assist clinicians in selecting specific procedures and investigators in delineating the resulting physiology. This review is based on literature related to factors governing glucose metabolism and insulin secretion after the commonly used RYGB and VSG, and the less frequently used BPD and adjustable gastric banding.
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Affiliation(s)
- Jonathan D Douros
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - Jenny Tong
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - David A D’Alessio
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
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Ligustrum robustum Intake, Weight Loss, and Gut Microbiota: An Intervention Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:4643074. [PMID: 31110550 PMCID: PMC6487153 DOI: 10.1155/2019/4643074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/17/2019] [Accepted: 03/10/2019] [Indexed: 12/05/2022]
Abstract
Ligustrum robustum (LR) shows antiobesity effects in animal studies. However, little is known about the effect on human. The present study aimed to investigate the effect of LR intake on weight change in obese women and the role of gut microbiota. Thirty overweight and obese female participants (BMI ≥24 kg/m2) were recruited in the current study. The participants drank LR 10g/d for 12 wks. Their body composition and related biomarkers were assessed. Alterations of the gut microbiota were analyzed using 16S rRNA sequencing. The primary outcome was the change in body weight. LR intake resulted in 2.5% weight loss over 12 wks (P<0.01). Change in body fat at 12 wk was -1.77 ± 1.19 kg (P<0.01). In addition, decreased Firmicutes-to-Bacteroidetes ratio (P=0.03), increased richness (the ACE estimator, P<0.01; the Chao1 estimator, P<0.01), and altered representative taxa of the gut microbiota were observed. Bacteroidaceae, Bacteroides, Bacilli, and Lactobacillales were higher while Ruminococcaceae, Enterobacteriaceae, Enterobacteriales, Lachnospiraceae, Clostridia, and Clostridiales were lower at 12 wk. Moreover, LR intervention decreased fasting glucose (P<0.01), serum leptin (P<0.01), and IL8 (P=0.02) and increased HOMA-β (P<0.01). LR intervention moderately decreased the body weight in overweight and obese women and such effect might be due to modulation of gut microbiota.
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12
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Buchwald H, Buchwald JN. Metabolic (Bariatric and Nonbariatric) Surgery for Type 2 Diabetes: A Personal Perspective Review. Diabetes Care 2019; 42:331-340. [PMID: 30665965 DOI: 10.2337/dc17-2654] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/17/2018] [Indexed: 02/03/2023]
Abstract
: Metabolic surgery can cause amelioration, resolution, and possible cure of type 2 diabetes. Bariatric surgery is metabolic surgery. In the future, there will be metabolic surgery operations to treat type 2 diabetes that are not focused on weight loss. These procedures will rely on neurohormonal modulation related to the gut as well as outside the peritoneal cavity. Metabolic procedures are and will always be in flux as surgeons seek the safest and most effective operative modality; there is no enduring gold standard operation. Metabolic bariatric surgery for type 2 diabetes is more than part of the clinical armamentarium, it is an invitation to perform basic research and to achieve fundamental scientific knowledge.
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Affiliation(s)
- Henry Buchwald
- Department of Surgery, University of Minnesota, Minneapolis, MN .,Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI
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Xiang AH, Trigo E, Martinez M, Katkhouda N, Beale E, Wang X, Wu J, Chow T, Montgomery C, Nayak KS, Hendee F, Buchanan TA. Impact of Gastric Banding Versus Metformin on β-Cell Function in Adults With Impaired Glucose Tolerance or Mild Type 2 Diabetes. Diabetes Care 2018; 41:2544-2551. [PMID: 30282699 PMCID: PMC6245202 DOI: 10.2337/dc18-1662] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) results from progressive loss of β-cell function. The BetaFat study compared gastric banding and metformin for their impact on β-cell function in adults with moderate obesity and impaired glucose tolerance (IGT) or recently diagnosed, mild T2D. RESEARCH DESIGN AND METHODS Eighty-eight people aged 21-65 years, BMI 30-40 kg/m2, with IGT or diabetes known for <1 year, were randomized to gastric banding or metformin for 2 years. Hyperglycemic clamps (11.1 mmol/L) followed by arginine injection at maximally potentiating glycemia (>25 mmol/L) were performed at baseline, 12 months, and 24 months to measure steady-state C-peptide (SSCP) and acute C-peptide response to arginine at maximum glycemic potentiation (ACPRmax) and insulin sensitivity (M/I). RESULTS At 24 months, the band group lost 10.7 kg; the metformin group lost 1.7 kg (P < 0.01). Insulin sensitivity increased 45% in the band group and 25% in the metformin group (P = 0.30 between groups). SSCP adjusted for insulin sensitivity fell slightly but not significantly in each group (P = 0.34 between groups). ACPRmax adjusted for insulin sensitivity fell significantly in the metformin group (P = 0.002) but not in the band group (P = 0.25 between groups). HbA1c fell at 12 and 24 months in the band group (P < 0.004) but only at 12 months (P < 0.01) in the metformin group (P > 0.14 between groups). Normoglycemia was present in 22% and 15% of band and metformin groups, respectively, at 24 months (P = 0.66 between groups). CONCLUSIONS Gastric banding and metformin had similar effects to preserve β-cell function and stabilize or improve glycemia over a 2-year period in moderately obese adults with IGT or recently diagnosed, mild T2D.
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Affiliation(s)
- Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Enrique Trigo
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mayra Martinez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Namir Katkhouda
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Elizabeth Beale
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Xinhui Wang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jun Wu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Cortney Montgomery
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA
| | - Fadi Hendee
- Division of Endocrinology, Clinical Nutrition and Metabolism, Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
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Sohn SY, Lee EK, Han SS, Lee YJ, Hwangbo Y, Kang YH, Lee SD, Kim SH, Woo SM, Lee WJ, Hong EK, Park SJ. Favorable glycemic response after pancreatoduodenectomy in both patients with pancreatic cancer and patients with non-pancreatic cancer. Medicine (Baltimore) 2018; 97:e0590. [PMID: 29718860 PMCID: PMC6393016 DOI: 10.1097/md.0000000000010590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM) is prevalent in patients with pancreatic cancer and tends to improve after tumor resection. However, the glycemic response of non-pancreatic cancer patients after surgery has not been examined in detail. We aimed to investigate the changes in glucose metabolism in patients with pancreatic cancer or non-pancreatic cancer after pancreatoduodenectomy (PD).We prospectively enrolled 48 patients with pancreatic cancer and 56 patients with non-pancreatic cancer, who underwent PD. Glucose metabolism was assessed with fasting glucose, glycated hemoglobin (HbA1c), plasma C-peptide and insulin, quantitative insulin check index (QUICKI), and a homeostatic model assessment of insulin resistance (HOMA-IR) and β cell (HOMA-β) before surgery and 6 months after surgery. Patients were divided into 2 groups: "improved" and "worsened" postoperative glycemic response, according to the changes in HbA1c and anti-diabetic medication. New-onset DM was defined as diagnosis of DM ≤ 2 years before PD, and cases with DM diagnosis >2 years preceding PD were described as long-standing DM.After PD, insulin resistance (IR), as measured by insulin, HOMA-IR and QUICKI, improved significantly, although C-peptide and HOMA-β decreased. At 6 months after PD, new-onset DM patients showed improved glycemic control in both pancreatic cancer patients (75%) and non-pancreatic cancer patients (63%). Multivariate analysis showed that long-standing DM was a significant predictor for worsening glucose control (odds ratio = 4.01, P = .017).Favorable glycemic control was frequently observed in both pancreatic cancer and non-pancreatic cancer after PD. PD seems to contribute improved glucose control through the decreased IR. New-onset DM showed better glycemic control than long-standing DM.
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Affiliation(s)
- Seo Young Sohn
- Department of Internal Medicine, National Cancer Center
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center
| | | | - You Jin Lee
- Department of Internal Medicine, National Cancer Center
| | - Yul Hwangbo
- Department of Internal Medicine, National Cancer Center
| | | | | | | | | | - Woo Jin Lee
- Department of Internal Medicine, National Cancer Center
| | - Eun Kyung Hong
- Department of Pathology, National Cancer Center, Goyang, Gyeonggi, Korea
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Maladaptive Eating Behaviors and Metabolic Profile in Patients Submitted to Bariatric Surgery: a Longitudinal Study. Obes Surg 2017; 27:1554-1562. [PMID: 28054295 DOI: 10.1007/s11695-016-2523-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aims to investigate relations between maladaptive eating behaviors (MEB) and metabolic profile in patients submitted to bariatric surgery. METHODS Longitudinal study including 70 patients before (T0), in the first year after surgery assessment (T1), and the second year after surgery assessment (T2). A face-to-face clinical interview assessed MEB at T0 and T2. Blood samples were collected at T0, T1, and T2 to assess fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), insulin, insulin resistance (IR), and triglycerides (TG). Mixed model analyses with growth curves tested the differences between patients with MEB (M group) and non-MEB patients (NM group) on the course of metabolic parameters, while controlling for total weight loss and type of surgery. RESULTS No differences between both groups were reached for levels of FPG (F(1, 140) = 2.936, p = 0.089), HbA1c (F(1, 96) = 0.099, p = 0.754), insulin (F(1, 121) = 0.146, p = 0.703), IR (F(1, 60) = 0.976, p = 0.327), and TG (F(1, 128) = 0.725, p = 0.396). All parameters improved from T0 to T1 for both groups. A distinct trend on the course of metabolic markers in the M group but not the NM group is observed, presenting an increase in HbA1c levels, insulin, and TG levels. CONCLUSIONS Both groups progressed favorably in the first 12 months of surgery. MEB may be associated with a trend for deterioration of metabolic profile after 12 months of surgery. The study should be replicated with longer-term assessments and a larger sample size.
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16
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Gastric Band Surgery Leads to Improved Insulin Secretion in Overweight People with Type 2 Diabetes. Obes Surg 2016; 25:2400-7. [PMID: 25994778 DOI: 10.1007/s11695-015-1716-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed to determine the effects of laparoscopic adjustable gastric band (LAGB) on beta-cell function in overweight people with type 2 diabetes and to assess the relationship between baseline beta-cell function and glycemic outcomes. METHODS We studied 44 overweight but not obese people with type 2 diabetes who participated in a randomized trial whose primary outcome was the rate of diabetes remission after 2 years of multidisciplinary diabetes care (MDC group) or multidisciplinary care combined with LAGB. Dynamic beta-cell function was assessed by intravenous glucose challenge, and basal beta-cell function (HOMA-B) and insulin sensitivity (HOMA-S) were determined using the homeostatic model. RESULTS Twelve LAGB participants and two MDC participants were in diabetes remission at 2 years. HOMA-S and the C-peptide response to intravenous glucose increased significantly in LAGB but not in MDC participants. The insulin response to glucose did not change in LAGB participants, whereas their fasting C-peptide/insulin ratio increased. Baseline measures of beta-cell function correlated with diabetes remission but not with reduction in HbA1c following LAGB. CONCLUSIONS In overweight people with diabetes, LAGB improves endogenous beta-cell function after 2 years. Baseline beta-cell function correlated with diabetes remission, but not with HbA1c change following LAGB.
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17
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Erukainure OL, Okafor O, Ajayi A, Obode O, Ogunji A, Okporua T, Suberu Y, Oke O, Ozumba A, Oluwole O, Elemo G. Developed beverage from roselle calyx and selected fruits modulates β-cell function, improves insulin sensitivity, and attenuates hyperlipidaemia in diabetic rats. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2015. [DOI: 10.1016/j.bjbas.2015.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Mallipedhi A, Min T, Prior SL, MacIver C, Luzio SD, Dunseath G, Bracken RM, Islam S, Barry JD, Caplin S, Stephens JW. Association between the preoperative fasting and postprandial C-peptide AUC with resolution of type 2 diabetes 6 months following bariatric surgery. Metabolism 2015; 64:1556-63. [PMID: 26386694 DOI: 10.1016/j.metabol.2015.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/03/2015] [Accepted: 08/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery results in the remission of type 2 diabetes mellitus (T2DM) in morbidly obese subjects. The aim of the study was to investigate the predictive value of both static and dynamic measures of C-peptide in relation to T2DM resolution 6 months after bariatric surgery regardless of the operation type. METHODS AND RESULTS A non-randomized prospective study of 24 participants with T2DM undergoing bariatric surgery. Measurements of fasting and 2-hour plasma glucose, insulin, C-peptide and measures of insulin sensitivity were recorded temporally during an oral glucose tolerance test pre-operatively and 6 months post-operatively. A responder was defined with a fasting glucose <5.6 mmol/L and HbA1c <6.0% postoperatively. Within the sample there were 11 responders and 13 non-responders at 6 months. There was a significant difference in the duration of diabetes between the groups. Fasting C-peptide (P≤0.05) and 2-hour C-peptide (P≤0.05) were higher in responders compared to non-responders. Significantly higher C-peptide levels were observed preoperatively at all time points for responders, with significantly higher area under the curve (AUC0-60 and AUC0-120). Using the lower quartiles for C-peptide levels, both fasting C-peptide (>2.5 ng/mL [0.83 nmol/L]) and 2-hour C-peptide (>5.2 ng/mL [1.73 nmol/L]) had a sensitivity and negative predictive value of 100% to predict T2DM remission. Logistic regression showed that C-peptide, duration of diabetes and BMI were associated with response. The area under the ROC curve was 0.94 and a regression model predicted diabetes remission with a sensitivity of 85.7% and a specificity of 88.9%. CONCLUSIONS This study demonstrated that static (fasting) and dynamic (AUC, 2-hour) C-peptide measurements predict T2DM resolution 6 months following bariatric surgery. This work provides insight into C-peptide dynamics as a predictor of response to bariatric surgery.
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Affiliation(s)
- Akhila Mallipedhi
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK; Department of Diabetes and Endocrinology, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK.
| | - Thinzar Min
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK; Department of Diabetes and Endocrinology, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK
| | - Sarah L Prior
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Claire MacIver
- Department of Diabetes and Endocrinology, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK
| | - Steve D Luzio
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Gareth Dunseath
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Richard M Bracken
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Saiful Islam
- Swansea Trial Unit, College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea SA2 8PP, UK
| | - Jonathan D Barry
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK
| | - Scott Caplin
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK
| | - Jeffrey W Stephens
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK; Department of Diabetes and Endocrinology, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK; Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea SA6 6NL, UK
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19
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Busetto L. Timing of bariatric surgery in people with obesity and diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:94. [PMID: 26015936 DOI: 10.3978/j.issn.2305-5839.2015.03.62] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/11/2015] [Indexed: 01/06/2023]
Abstract
The use of bariatric surgery in the clinical management of type 2 diabetes in severely obese subjects has been included in the clinical practice recommendations released by the most influential diabetologic associations. However, the timing during the diabetic course in which this use may have the better benefit/risk ratio remains debated. Is it better to use surgery very early in the course of the disease in order to anticipate clinical deterioration, or we should favour a delayed approach in which we reserve the more risky surgery only to patients not adequately controlled with the maximal pharmacologic strategy? In this paper, past and recent evidences about the role of bariatric surgery in the different stages of the clinical course of type 2 diabetes have been revised, starting from pre-diabetes and ending to long-standing diabetic state with established or end-stage macro- and micro-vascular complications. Available evidences strongly advocate in favor of the application of bariatric surgery in the early phase of this course, possibly in the pre-diabetic or in very early diabetic stages. To reserve surgery to more advanced and complicated stages of the disease seems to confer less benefits for the clinical course of diabetes and exposes these more frail patients to the possible side effects of a rapid weight loss.
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Affiliation(s)
- Luca Busetto
- Department of Medicine, Centre for the Study and the Integrated Management of Obesity, University of Padua, Padua, Italy
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20
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Romanelli RJ, Chung S, Pu J, Nimbal V, Zhao B, Palaniappan L. Comparative effectiveness of early versus delayed metformin in the treatment of type 2 diabetes. Diabetes Res Clin Pract 2015; 108:170-8. [PMID: 25661984 PMCID: PMC4388779 DOI: 10.1016/j.diabres.2014.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/15/2014] [Accepted: 12/27/2014] [Indexed: 01/05/2023]
Abstract
AIM The purpose of this study was to evaluate the effectiveness of early versus delayed initiation of metformin in type 2 diabetes. METHODS We identified 2925 new users of metformin with type 2 diabetes between 2005 and 2012 in the electronic health records of an integrated health system in Northern California. Patients were matched 1:1 on the propensity for receiving early treatment (defined as ≤6 months from first evidence of diabetes). We evaluated the effectiveness of early versus delayed metformin treatment on intermediate clinical outcomes indicated by changes in hemoglobin A1c (HbA1c) and body mass index (BMI), as well as the incidence of therapy intensification (addition or substitution of a second antihyperglycemic agent). RESULTS A total of 2144 propensity-score matched patients were included in the early or delayed treatment group (n=1072, in each). Early treatment was associated with significantly larger decreases in HbA1c (-0.36%; 95% confidence intervals [CI]: -0.44 to -0.27%; P<0.001) and BMI (-0.46 kg/m(2); 95% CI: -0.64 to -0.29 kg/m(2); P<0.001) relative to delayed treatment. Patients receiving early treatment also had a greater likelihood of attaining an HbA1c<7% (<53 mmol/mol) (odds ratio: 2.00; 95% CI: 1.63-2.45; P<0.001) and a reduced risk of therapy intensification (hazard ratio: 0.72; 95% CI: 0.61-0.85; P<0.001). CONCLUSIONS Treatment with metformin earlier in the course of type 2 diabetes is associated with better glycemic control, more pronounced weight reduction, and a lower risk for therapy intensification than delayed treatment. Antihyperglycemic therapy should be initiated early after diagnosis to achieve optimal outcomes.
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Affiliation(s)
- Robert J Romanelli
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, United States.
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, United States
| | - Jia Pu
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, United States
| | - Vani Nimbal
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, United States
| | - Beinan Zhao
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, United States
| | - Latha Palaniappan
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, United States; Stanford University School of Medicine, Stanford, CA 94305, United States
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Predictors of Short-Term Diabetes Remission After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2014; 25:782-7. [DOI: 10.1007/s11695-014-1477-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Shang L, Hua H, Foo K, Martinez H, Watanabe K, Zimmer M, Kahler DJ, Freeby M, Chung W, LeDuc C, Goland R, Leibel RL, Egli D. β-cell dysfunction due to increased ER stress in a stem cell model of Wolfram syndrome. Diabetes 2014; 63:923-33. [PMID: 24227685 PMCID: PMC3931392 DOI: 10.2337/db13-0717] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Wolfram syndrome is an autosomal recessive disorder caused by mutations in WFS1 and is characterized by insulin-dependent diabetes mellitus, optic atrophy, and deafness. To investigate the cause of β-cell failure, we used induced pluripotent stem cells to create insulin-producing cells from individuals with Wolfram syndrome. WFS1-deficient β-cells showed increased levels of endoplasmic reticulum (ER) stress molecules and decreased insulin content. Upon exposure to experimental ER stress, Wolfram β-cells showed impaired insulin processing and failed to increase insulin secretion in response to glucose and other secretagogues. Importantly, 4-phenyl butyric acid, a chemical protein folding and trafficking chaperone, restored normal insulin synthesis and the ability to upregulate insulin secretion. These studies show that ER stress plays a central role in β-cell failure in Wolfram syndrome and indicate that chemical chaperones might have therapeutic relevance under conditions of ER stress in Wolfram syndrome and other forms of diabetes.
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Affiliation(s)
- Linshan Shang
- The New York Stem Cell Foundation Research Institute, New York, NY
| | - Haiqing Hua
- The New York Stem Cell Foundation Research Institute, New York, NY
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Kylie Foo
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Hector Martinez
- The New York Stem Cell Foundation Research Institute, New York, NY
| | - Kazuhisa Watanabe
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Matthew Zimmer
- The New York Stem Cell Foundation Research Institute, New York, NY
| | - David J. Kahler
- The New York Stem Cell Foundation Research Institute, New York, NY
| | - Matthew Freeby
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Wendy Chung
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Charles LeDuc
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Robin Goland
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Rudolph L. Leibel
- Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Dieter Egli
- The New York Stem Cell Foundation Research Institute, New York, NY
- Corresponding author: Dieter Egli,
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Cobourn C, Chapman MA, Ali A, Amrhein J. Five-year weight loss experience of outpatients receiving laparoscopic adjustable gastric band surgery. Obes Surg 2014; 23:903-10. [PMID: 23446665 PMCID: PMC3671103 DOI: 10.1007/s11695-013-0881-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. METHODS Morbidly obese patients, ≥ 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic in Ontario, Canada, between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time. RESULTS This study included 2,815 patients (82 % female, mean age 43 years, mean baseline BMI 44.6 kg/m(2)) followed for a mean of 21.8 ± 15.4 months. Complications developed in 238 patients (8.5 %), the most frequent being prolapse/slippage (4.2 %), tubing/access port problems (1.2 %), and explantation (1.2 %). Mean %WL and %EWL progressed continuously over the first 2.5 years post-LAGB, plateauing at 20 and 49 %, respectively, for up to 5 years of follow up. Factors associated with increased weight loss were time since surgery, greater baseline weight (excess weight), older age at time of surgery, and male gender. CONCLUSIONS Weight loss was maintained for up to 5 years in our population of patients who underwent LAGB for the treatment of morbid obesity.
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Affiliation(s)
- Chris Cobourn
- Surgical Weight Loss Centre, 1413 Hurontario St., Mississauga, Ontario, L5G 3H5, Canada.
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Robert M, Ferrand-Gaillard C, Disse E, Espalieu P, Simon C, Laville M, Gouillat C, Thivolet C. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg 2014; 23:770-5. [PMID: 23355293 DOI: 10.1007/s11695-013-0868-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Type 2 diabetes (T2D) remission after bariatric procedures has been highlighted in many retrospective and some recent prospective studies. However, in the most recent prospective study, more than 50 % of patients did not reach T2D remission at 1 year. Our aim was to identify baseline positive predictors for T2D remission at 1 year after bariatric surgery and to build a preoperative predictive score. We analysed the data concerning 161 obese operated on between June 2007 and December 2010. Among them, 46 were diabetic and were included in the study-11 laparoscopic adjustable gastric banding (LAGB), 26 Roux-en-Y gastric bypass (RYGB) and 9 sleeve gastrectomy (SG). We compared anthropometric and metabolic features during 1 year of follow-up. A receiver operating characteristic analysis was performed to predict T2D remission. RYGB and SG were similarly efficient for body weight loss and more efficient than LAGB; 62.8 % of patients presented with T2DM remission at 1 year, with no significant difference according to the surgical procedure. A 1-year body mass index (BMI) <35 kg m(-2) was predictive of T2DM remission whatever the procedure. The preoperative predictive factors of diabetes remission were baseline BMI ≤50 kg m(-2), duration of type 2 diabetes ≤4 years, glycated haemoglobin ≤7.1 %, fasting glucose <1.14 g/l and absence of insulin therapy. A short duration of diabetes and good preoperative glycaemic control increase the rate of T2DM remission 1 year after surgery. Preoperative metabolic data could be of greater importance than the choice of bariatric procedure.
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Affiliation(s)
- M Robert
- Department of Digestive Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69008, Lyon, France.
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Dasgupta K, Rosenberg E, Daskalopoulou SS. Step Monitoring to improve ARTERial health (SMARTER) through step count prescription in type 2 diabetes and hypertension: trial design and methods. Cardiovasc Diabetol 2014; 13:7. [PMID: 24393423 PMCID: PMC3893520 DOI: 10.1186/1475-2840-13-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 02/05/2023] Open
Abstract
Background With increasing numbers of type 2 diabetes (DM2) and hypertension patients, there is a pressing need for effective, time-efficient and sustainable strategies to help physicians support their patients to achieve higher physical activity levels. SMARTER will determine whether physician-delivered step count prescriptions reduce arterial stiffness over a one-year period, compared with usual care, in sedentary overweight/obese adults with DM2/hypertension. Design Randomized, allocation-concealed, assessor-blind, multisite clinical trial. The primary outcome is change in arterial stiffness over one year. The secondary outcomes include changes in physical activity, individual vascular risk factors, medication use, and anthropometric parameters. Assessments are at baseline and one year. Methods Participants are sedentary/low active adults with 25 ≤ BMI < 40 kg/m2 followed for DM2/hypertension by a collaborating physician. The active arm uses pedometers to track daily step counts and review logs with their physicians at 3 to 4-month intervals. A written step count prescription is provided at each visit, aiming to increase counts by ≥3,000 steps/day over one year, with an individualized rate increase. The control arm visits physicians at the same frequency and receives advice to engage in physical activity 30-60 minutes/day. SMARTER will enroll 364 individuals to detect a 10 ± 5% difference in arterial stiffness change between arms. Arterial stiffness is assessed noninvasively with carotid femoral pulse wave velocity using applanation tonometry. Discussion The importance of SMARTER lies not simply in the use of pedometer-based monitoring but also on its integration into a prescription-based intervention delivered by the treating physician. Equally important is the measurement of impact of this approach on a summative indicator of arterial health, arterial stiffness. If effectiveness is demonstrated, this strategy has strong potential for widespread uptake and implementation, given that it is well-aligned with the structure of current clinical practice. Trial registration ClinicalTrials.gov (NCT01475201)
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Affiliation(s)
- Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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26
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Vest AR, Heneghan HM, Schauer PR, Young JB. Surgical management of obesity and the relationship to cardiovascular disease. Circulation 2013; 127:945-59. [PMID: 23439447 DOI: 10.1161/circulationaha.112.103275] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Amanda R Vest
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Keogh JB, Turner KM, McDonald F, Toouli J, Clifton PM. Remission of diabetes in patients with long-standing type 2 diabetes following placement of adjustable gastric band: a retrospective case control study. Diabetes Obes Metab 2013; 15:383-5. [PMID: 23137314 DOI: 10.1111/dom.12034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 10/10/2012] [Accepted: 11/01/2012] [Indexed: 01/06/2023]
Abstract
Rates of remission in obese patients with long-standing type 2 diabetes (>2 years), following an adjustable gastric band are unclear. We conducted a retrospective case-control study of patients (n = 89) matched for age and body mass index with non-surgical controls. Cases had a longer duration of diabetes (99 ± 53 and 80 ± 59 months, p < 0.05) and a lower HbA1c than controls (7.9 ± 1.6 vs. 8.5 ± 1.9%, p < 0.05). At follow-up (median 105 weeks) cases had lost 16.8 ± 13.5 kg and controls 1.7 ± 8.9 kg (p < 0.001) and HbA1c decreased by 0.6-0.8% (p < 0.001 for time) with no difference between cases and controls. Diabetes resolution, defined by HbA1c less than 6.5% and taking no medications, occurred in 14 (16%) cases and 2 controls. This is in contrast to published outcomes of resolution of type 2 diabetes after bariatric surgery. We conclude that there is a clear need for randomized studies of the effect of gastric banding in patients with long-standing type 2 diabetes.
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Affiliation(s)
- J B Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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Eizadi M, Bagheri G, Kasparast J, Zahedmanesh F, Afsharmand Z. Effects of training on body composition, blood lipids, and glucose homeostasis assessed by the homeostasis model assessment. Sci Sports 2013. [DOI: 10.1016/j.scispo.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology 2012; 143:897-912. [PMID: 22885332 PMCID: PMC3462491 DOI: 10.1053/j.gastro.2012.07.114] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 12/19/2022]
Abstract
Obesity is an important risk factor for type 2 diabetes mellitus (T2DM). Weight loss improves the major factors involved in the pathogenesis of T2DM, namely insulin action and beta cell function, and is considered a primary therapy for obese patients who have T2DM. Unfortunately, most patients with T2DM fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2DM in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2DM than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early postprandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2DM once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2DM. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2DM.
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Hanusch-Enserer U, Cauza E, Spak M, Endler G, Dunky A, Tura A, Wagner O, Rosen HR, Pacini G, Prager R. Improvement of Insulin Resistance and Early Atherosclerosis in Patients after Gastric Banding. ACTA ACUST UNITED AC 2012; 12:284-91. [PMID: 14981221 DOI: 10.1038/oby.2004.36] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effect of massive weight loss on insulin sensitivity, soluble adhesion molecules, and markers of the insulin resistance syndrome (IRS). RESEARCH METHODS AND PROCEDURES Eighteen morbidly obese patients underwent gastric banding and were evaluated before and 6 and 12 months after surgery. Total insulin secretion, hepatic insulin extraction, and insulin sensitivity were analyzed by oral glucose-tolerance test model analysis. In addition, soluble intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, leptin, high-sensitivity C-reactive protein, plasminogen activating factor-1 (PAI-1), and tissue plasminogen activator were measured. RESULTS BMI dropped from 45.22 +/- 5.62 to 36.99 +/- 4.34 kg/m(2) after 6 months and 33.72 +/- 5.55 kg/m(2) after 12 months (both p < 0.0001). This intervention resulted in a significant reduction of blood pressure (p < 0.00001), triglycerides (p < 0.01), fasting blood glucose (p = 0.03), basal insulin (p < 0.001), and basal C-peptide (p = 0.008) levels. Total insulin secretion decreased (p < 0.05), whereas hepatic insulin extraction (p < 0.05) and oral glucose insulin sensitivity index (p < 0.0001) increased compared with baseline. Leptin (p < 0.0001) and E-selectin levels decreased significantly after 6 and 12 months (p = 0.05), whereas significantly lower levels of intercellular adhesion molecule-1 and PAI-1 were only seen after 6 months. Subclinical inflammation, measured by high-sensitivity C-reactive protein, was lowered to normal ranges. No changes were observed in vascular cell adhesion molecule-1 and tissue plasminogen activator levels. DISCUSSION Although gastric banding ameliorates several features of the IRS, including 29.05% improvement in insulin sensitivity and blood pressure and reduction of soluble adhesion molecules and PAI-1, considerable weight loss did not normalize all components of the IRS in morbidly obese patients.
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Affiliation(s)
- Ursula Hanusch-Enserer
- Department of Internal Medicine V, Division of Endocrinology and Metabolism, Wilhelminenspital, Vienna, Austria.
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Abstract
The objective of this article is to systematically review the changes in insulin resistance after various types of bariatric surgical procedures. A Pubmed and EMBASE search for studies measuring insulin resistance before and after bariatric surgery was done and all original research articles from 1980 to present (2011) were included. Only the currently widely performed bariatric procedures were included. A meta-analysis of change in HOMA-IR was conducted, grouping studies with similar duration of follow-up. The percentage decrease in HOMA-IR at <=2 weeks, 1 month, 3 months, 6 months, 12 months and >16-18 months was found to be (mean ± standard error) -33.48 ± 5.78, -46.43 ± 6.99, -38.79 ± 9.64, -58.62 ± 7.38, -44.91 ± 7.98 and -67.04 ± 10.78%, respectively. RYGB (gastric bypass) and BPD (biliopancreatic diversion) produced a significant decrease in insulin resistance at 2 weeks after surgery, while LSG (sleeve gastrectomy) was strongly trending. LSG produced an earlier decrease in insulin resistance when compared to LAGB (gastric banding). RYGB, BPD and LSG produce an early decrease in insulin resistance through yet unknown mechanisms.
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Affiliation(s)
- R S Rao
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Diabetes and Bone Disease, Mount Sinai School of Medicine, 5 E. 98th St., New York, NY 10029, USA.
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Busetto L, Sbraccia P, Frittitta L, Pontiroli AE. The growing role of bariatric surgery in the management of type 2 diabetes: evidences and open questions. Obes Surg 2012; 21:1451-7. [PMID: 21717182 DOI: 10.1007/s11695-011-0471-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The use of bariatric surgery in the clinical management of type 2 diabetes has been recently endorsed in the clinical practice recommendations released by the most influential diabetologic associations. However, authoritative critic voices about the application of metabolic surgery in type 2 diabetes continue to appear in diabetologic literature. In this review, we will try therefore to understand what the reasons for this apparent dichotomy. In this paper, we revised what we believe are now clear evidences about the role of bariatric surgery in the treatment of type 2 diabetes in patients with morbid obesity: the efficacy of bariatric surgery in metabolic control, the existence of plausible weight-independent metabolic mechanisms at least in some bariatric procedure, and the importance of the early referral to surgery in patients with firm indications. However, we stressed also the lack of clear high-quality long-term data about the effects of bariatric surgery in the prevention of both macro- and micro-vascular hard endpoints in patients with type 2 diabetes. The accrual of these results will be critical to completely clarify the risk/benefit ratio of bariatric surgery in diabetes, as compared to current pharmacologic therapies. This may be particularly important in patients in which data on long-term efficacy are still not completed, such as in patients with lower BMI levels.
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Affiliation(s)
- Luca Busetto
- Unità Bariatrica, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Padova, Padova, Italy.
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33
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Case-Matched Outcomes in Bariatric Surgery for Treatment of Type 2 Diabetes in the Morbidly Obese Patient. Ann Surg 2012; 255:287-93. [DOI: 10.1097/sla.0b013e318232b033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Clifton PM. Bariatric Surgery: Effects on the Metabolic Complications of Obesity. Curr Atheroscler Rep 2012; 14:95-100. [DOI: 10.1007/s11883-012-0231-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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36
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Dixon JB, Straznicky NE, Lambert EA, Schlaich MP, Lambert GW. Surgical approaches to the treatment of obesity. Nat Rev Gastroenterol Hepatol 2011; 8:429-37. [PMID: 21727936 DOI: 10.1038/nrgastro.2011.112] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bariatric surgery, through its efficacy and improved safety, is emerging as an important and broadly available treatment for people with severe and complex obesity that has not responded adequately to other therapy. Established procedures, such as Roux-en-Y gastric bypass and adjustable gastric banding, account for more than 80% of bariatric surgical procedures globally. Sleeve gastrectomy has emerged as a stand-alone procedure. Truly malabsoptive procedures, such as biliopancreatic diversion and its duodenal switch variant, have a diminishing role as primary procedures, but remain an option for patients who do not respond adequately to less disruptive procedures. The procedures vary considerably in their postoperative morbidity and mortality; pattern and extent of weight loss; nature and severity of long-term complications; and nutritional requirements and risks. There is no perfect procedure--an informed risk and benefit assessment should be made by each patient. Gastroenterologists also need to be familiar with the risks and benefits of current and emerging procedures as they are likely to be increasingly involved in the integrated care of these patients.
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Affiliation(s)
- John B Dixon
- Baker IDI Heart & Diabetes Institute, PO Box 6492 St. Kilda Road Central, Melbourne, Vic 3004, Australia.
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37
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Aikenhead A, Knai C, Lobstein T. Effectiveness and cost-effectiveness of paediatric bariatric surgery: a systematic review. Clin Obes 2011; 1:12-25. [PMID: 25586971 DOI: 10.1111/j.1758-8111.2010.00003.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Strong evidence for successful and cost-effective obesity management strategies is still generally lacking, leading the medical profession to rely increasingly on surgical options to treat obesity in children and adolescents. We performed a systematic review to examine the effectiveness of surgical interventions to treat obese children and adolescents, and whether they are cost-effective. We searched PubMed, ISI Web of Science, Embase and the Cochrane Library to 6 September 2010, and hand-searched bibliographies. We included articles with English abstracts if they examined subjects ≤19 years of age, reported at least one postoperative weight loss measure and at least 1 year of postoperative follow-up. Thirty-seven relevant papers on bariatric surgery effectiveness in 831 children or adolescents were included, spanning 36 years. Thirteen studies examined gastric banding, with mean body mass index (BMI) reductions ranging from 8.5 to 43 kg m(-2) . Weight gain was reported in one case study. Eight papers examined Roux-en-Y gastric bypass, with mean BMI reductions ranging from 9 to 25 kg m(-2) . Fourteen publications studied other forms of bariatric surgery: sleeve gastrectomies, vertical banded gastroplasty, biliopancreatic diversion or a combination of procedures. Mean BMI reductions ranged from 9 to 24 kg m(-2) . Three surgery-related mortalities were reported, as was weight regain in several cases. The majority of studies reported resolution or improvement of comorbid conditions. A range of postoperative complications were identified across surgery types, including: ulcers, intestinal leakage, wound infection, anastomotic stricture, nutritional deficiencies, bowel obstruction, pulmonary embolism, disrupted staple lines, band slippage, psychological intolerance and repeated vomiting. Evidence on cost-effectiveness was limited to one Australian modelling project, which deemed laparoscopic adjustable gastric banding cost-effective for adolescents. Existing evidence - although based generally on underpowered, retrospective studies - suggests that bariatric surgery in older children results in significant weight loss and improvements in comorbidities and quality of life. However, postoperative complications, compliance and follow-up may be more problematic in adolescents than adults, and availability of long-term data on safety, effectiveness and cost-effectiveness remains largely unknown. Pending an improvement in the quality of available evidence, a cautious approach to child and adolescent bariatric surgery is warranted, and reversible techniques are advisable compared to approaches that permanently alter anatomy.
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Affiliation(s)
- A Aikenhead
- International Association for the Study of Obesity, London, UKLondon School of Hygiene and Tropical Medicine, London, UK
| | - C Knai
- International Association for the Study of Obesity, London, UKLondon School of Hygiene and Tropical Medicine, London, UK
| | - T Lobstein
- International Association for the Study of Obesity, London, UKLondon School of Hygiene and Tropical Medicine, London, UK
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Abstract
PURPOSE OF REVIEW The use of bariatric surgery is increasing at an enormous rate in all countries but the indications for the operation on the basis of metabolic derangements are not clear as only one controlled randomized trial has been performed so far. Thus, it is not clear whether bariatric surgery should be performed on obese patients with long-standing type 2 diabetes or poorly controlled hypertension or hypertriglyceridemia. The mechanism for the immediate improvement in glucose tolerance after gastric bypass is not clear but is being actively investigated. RECENT FINDINGS Gastric bypass appears to enhance glucagon-like peptide-1 production and suppress glucose-dependent insulinotropic polypeptide production. It appears that patients with type 2 diabetes and a greater BMI gain more benefit from the operation. SUMMARY Bariatric surgery, particularly gastric bypass, has powerful and usually persistent effects on type 2 diabetes, dyslipidemia, and hypertension but randomized controlled trials with predefined metabolic entry criteria and planned comprehensive follow-up are required.
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Affiliation(s)
- Peter M Clifton
- Baker IDI Heart and Diabetes Institute, Adelaide, South Australia, Australia.
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Baez-Duarte BG, Sánchez-Guillén MDC, Pérez-Fuentes R, Zamora-Ginez I, Leon-Chavez BA, Revilla-Monsalve C, Islas-Andrade S. β-cell function is associated with metabolic syndrome in Mexican subjects. Diabetes Metab Syndr Obes 2010; 3:301-9. [PMID: 21437099 PMCID: PMC3047966 DOI: 10.2147/dmsott.s12375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The clinical diagnosis of metabolic syndrome does not find any parameters to evaluate the insulin sensitivity (IS) or β-cell function. The evaluation of these parameters would detect early risk of developing metabolic syndrome. The aim of this study is to determine the relationship between β-cell function and presence of metabolic syndrome in Mexican subjects. MATERIAL AND METHODS This study is part of the Mexican Survey on the Prevention of Diabetes (MexDiab Study) with headquarters in the city of Puebla, Mexico. The study comprised of 444 subjects of both genders, aged between 18 and 60 years and allocated into two study groups: (1) control group of individuals at metabolic balance without metabolic syndrome and (2) group composed of subjects with metabolic syndrome and diagnosed according to the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Defection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Anthropometric, biochemical, and clinical assessments were carried out. RESULTS Average age of the subjects in the control group (n = 254) was 35.7 ± 11.5 years and 42.0 ± 10.7 years for subjects in the metabolic syndrome group (n = 190). Subjects at metabolic balance without metabolic syndrome showed decreased IS, increased insulin resistance (IR), and altered β-cell function. Individuals with metabolic syndrome showed a high prevalence (P ≤ 0.05) of family history of type 2 diabetes (T2D). This group also showed a significant metabolic imbalance with glucose and insulin levels and lipid profile outside the ranges considered safe to prevent the development of cardiovascular disease and T2D. CONCLUSION The main finding in this study was the detection of altered β-cell function, decreased IS, an increased IR in subjects at metabolic balance, and the progressive deterioration of β-cell function and IS in subjects with metabolic syndrome as the number of features of metabolic syndrome increases.
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Affiliation(s)
- Blanca G Baez-Duarte
- Posgrado en Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, México
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Puebla, México
| | | | - Ricardo Pérez-Fuentes
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, México
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Puebla, México
| | - Irma Zamora-Ginez
- Posgrado en Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, México
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Puebla, México
| | | | - Cristina Revilla-Monsalve
- Multidiciplinary Research Group on Diabetes (José Sánchez-Corona, Fernando Guerrero-Romero, Martha Rodriguez-Moran, Agustin Madero, Jorge Escobedo-de-la-Peña, Silvia Flores-Martinez, Esperanza, Martinez-Abundis, Manuel Gonzalez-Ortiz, Alberto Rascon-Pacheco, Margarita Torres-Tamayo), Instituto Mexicano del Seguro Social, México, Distrito Federal, México
| | - Sergio Islas-Andrade
- Multidiciplinary Research Group on Diabetes (José Sánchez-Corona, Fernando Guerrero-Romero, Martha Rodriguez-Moran, Agustin Madero, Jorge Escobedo-de-la-Peña, Silvia Flores-Martinez, Esperanza, Martinez-Abundis, Manuel Gonzalez-Ortiz, Alberto Rascon-Pacheco, Margarita Torres-Tamayo), Instituto Mexicano del Seguro Social, México, Distrito Federal, México
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Schuster DP. Obesity and the development of type 2 diabetes: the effects of fatty tissue inflammation. Diabetes Metab Syndr Obes 2010; 3:253-62. [PMID: 21437093 PMCID: PMC3047970 DOI: 10.2147/dmsott.s7354] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Obesity is a worldwide epidemic with multiple obesity-associated health problems including type 2 diabetes, hypertension, and cardiovascular disease. Adipose tissue serves as a fuel storage depot, but also plays a pivotal role in homeostasis of energy expenditure, appetite regulation, glucose regulation, and immunity. Both genetics and environment play important roles in adipose tissue function and dysfunction. Obesity represents an abnormal accumulation of adipose tissue resulting from chronic overnutrition and reduced physical activity. The nature of this increased accumulation of fat tissue, whether hyperplasia or hypertrophy, local or ectopic, is associated with deleterious perturbations including excess fatty acid secretion, increased production of inflammatory cytokines, and abnormal adipocyte hormone signaling resulting in insulin resistance. In the setting of obesity, insulin resistance and chronic inflammation is postulated to play a role in development of type 2 diabetes and other obesity-related comorbidities including obstructive sleep apnea, hepatic steatosis, polycystic ovarian syndrome, hypertension and cardiovascular disease. Although the exact mechanism of these relationships are complex and not completely understood, the ability to store and limit fatty acid deposition to adipose tissue is a common component to remaining insulin sensitive, controlling the inflammatory cascade and reducing the risk of developing obesity-related comorbidities.
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Affiliation(s)
- Dara P Schuster
- Correspondence: Dara P Schuster, 491 McCampbell Hall, 1581 Dodd Drive, Columbus, Ohio 43210, USA, Tel +1 614 292 0678, Fax +1 614 292 1550, Email
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Briatore L, Salani B, Andraghetti G, Maggi D, Adami GF, Scopinaro N, Cordera R. Beta-cell function improvement after biliopancreatic diversion in subjects with type 2 diabetes and morbid obesity. Obesity (Silver Spring) 2010; 18:932-6. [PMID: 20186136 DOI: 10.1038/oby.2010.28] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In subjects with obesity and type 2 diabetes mellitus (T2DM), biliopancreatic diversion (BPD) improves glucose stimulated insulin secretion, whereas the effects on other secretion mechanisms are still unknown. Our objective was to evaluate the early effects of BPD on nonglucose-stimulated insulin secretion. In 16 morbid obese subjects (9 with T2DM and 7 with normal fasting glucose (NFG)), we measured insulin secretion after glucose-dependent arginine stimulation test and after intravenous glucose tolerance test (IVGTT) before and 1 month after BPD. After surgery the mean weight lost was 13% in both groups. The acute insulin response during IVGTT was improved in T2DM after BDP (from 55 +/- 10 to 277 +/- 91 pmol/l, P = 0.03). A reduction of insulin response to arginine was observed in NFG, whereas opposite was found in T2DM. In particular, acute insulin response to arginine at basal glucose concentrations (AIR(basal)) was reduced but insulin response at 14 mmol/l of plasma glucose (AIR(14)) was increased. Therefore, after BPD any statistical difference in AIR(14) between NFG and T2DM disappeared (1,032 +/- 123 for NFG and 665 +/- 236 pmol/l for T2DM, P = ns). The same was observed for Slope(AIR), a measure of glucose potentiation, reduced in T2DM before BPD but increased after surgery, when no statistically significant difference resulted compared with NFG (Slope(AIR) after BPD: 78 +/- 11 in NFG and 56 +/- 18 pmol/l in T2DM, P = ns). In conclusion, in obese T2DM subjects 1 month after BPD we observed a great improvement of both glucose- and nonglucose-stimulated insulin secretions. The mechanisms by which BDP improve insulin secretion are still unknown.
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Affiliation(s)
- Lucia Briatore
- Department of Endocrinology and Medicine, University of Genova, Genoa, Italy
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Hamza N, Abbas MH, Darwish A, Shafeek Z, New J, Ammori BJ. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis 2010; 7:691-6. [PMID: 20688578 DOI: 10.1016/j.soard.2010.03.292] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 01/23/2010] [Accepted: 03/10/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with obesity and results in considerable morbidity and mortality. Our objectives were to evaluate the effect of laparoscopic bariatric surgery on the control of T2DM in morbidly obese patients in a U.K. population and to determine the predictors of T2DM remission after bariatric surgery. The study was performed at teaching university hospitals and affiliated private hospitals. METHODS Of 487 patients who underwent laparoscopic bariatric procedures from 2002 to 2007, 74 patients (15.2%) had established T2DM. The results are presented as the mean values. Multivariate analysis was used to identify the factors predictive of remission of T2DM after bariatric surgery. RESULTS The body mass index before laparoscopic gastric bypass (LGB; n = 48) and laparoscopic adjustable gastric banding (LAGB; n = 26) were comparable (52 versus 51 kg/m(2), P = .508). At a mean follow-up of 16.9 months, 41% had remission and 59% had experienced improvement in T2DM. Although the duration of follow-up was significantly longer for the patients who had undergone LAGB than for those who had undergone LGB (23 versus 13.4 months, P = .001), the percentage of excess weight loss (%EWL) was significantly greater after LGB than after LAGB (59.4% versus 48.8%, P = .031), with an associated greater remission rate of T2DM (50% versus 24%, P = .034). Multivariate analysis revealed a greater %EWL and younger age to be independent predictors of postoperative remission of T2DM, and LGB, longer follow-up, and female gender were independent predictors of a greater %EWL. CONCLUSION The %EWL was the only predictor of remission of T2DM that was influenced by the choice of bariatric procedure. In our study, LGB offered greater weight loss and a chance of remission of T2DM compared with LAGB and within 2 years of surgery.
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Segato G, Busetto L, De Luca M, De Stefano F, Marangon M, Salvalaio S, Ashton D, Favretti F, Enzi G. Weight loss and changes in use of antidiabetic medication in obese type 2 diabetics after laparoscopic gastric banding. Surg Obes Relat Dis 2010; 6:132-7. [DOI: 10.1016/j.soard.2009.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 08/04/2009] [Accepted: 09/25/2009] [Indexed: 02/05/2023]
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Favretti F, Ashton D, Busetto L, Segato G, De Luca M. The gastric band: first-choice procedure for obesity surgery. World J Surg 2009; 33:2039-48. [PMID: 19551427 DOI: 10.1007/s00268-009-0091-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The advent of laparoscopic adjustable gastric banding (LAGB) during the latter part of the 20th century represents a watershed in the management of chronic obesity. In this paper we provide an overview of LAGB with respect to its development, clinical outcomes, and future role. We also address current controversies, including a comparison of LAGB with Roux-en-Y gastric bypass (RYGBP). At present LAGB seems to be increasing in popularity in the United States, whereas in Europe there seems to be a trend away from gastric banding toward RYGBP. Optimal outcomes after LAGB are a function of correct laparoscopic technique, an experienced surgical team, a well-engineered device, and intensive long-term follow-up. The majority of studies show that LAGB is an extremely safe and effective procedure, with an operative mortality of 0-0.1% and excess weight loss (%EWL) of 50-60%. Commensurate with this degree of weight loss, almost all studies show substantial improvements in obesity-related co-morbidities, such as hypertension, type II diabetes, and dyslipidemia. In addition, LAGB has been shown to be both safe and effective in the super-obese, in adolescents, and in older patients and can be delivered as an ambulatory procedure. Operative mortality and early complication rates are significantly higher for RYGBP and, whilst gastric bypass results in greater weight loss than LAGB in the first 2 years, at 3 years and beyond the difference appears to be less marked. Overall, LAGB provides a safe, effective intervention for obese patients and remains our first-choice procedure for bariatric surgery.
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Affiliation(s)
- Franco Favretti
- Department of Surgery and Obesity Center, Regional Hospital, 36100, Vicenza, Italy
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Abstract
Obesity has reached epidemic proportions in the USA with a nearly fourfold rise in the prevalence of childhood obesity. There are many possible etiologies of obesity as the adipose tissue plays a significant, complex role in the physiology of fuel metabolism and hormone regulation. The development of obesity represents a pathophysiologic increase in fat mass in which multiple metabolic pathways are deranged. The consequences of these metabolic derangements, including insulin resistance and inflammation, are reflected in obesity-related comorbidities and can be seen in the setting of pediatric obesity. Obese adolescents demonstrate increased rates of early maturation, orthopedic growth abnormalities, diabetes mellitus, obstructive sleep apnea, hypertension, steatosis, and polycystic ovarian syndrome, placing this group of children at risk for long-term health problems and reduced quality of life. Given the negative short- and long-term impact of obesity on children, careful attention should be paid to the unique health issues of this "at-risk" population with both prevention and early intervention strategies.
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Affiliation(s)
- Dara P Schuster
- Division of Endocrinology, Department of Pediatrics, The Ohio State University Hospitals and Nationwide Children's Hospital, Columbus, Ohio 43210, USA.
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Kivimäki M, Batty GD, Singh-Manoux A, Nabi H, Sabia S, Tabak AG, Akbaraly TN, Vahtera J, Marmot MG, Jokela M. Association between common mental disorder and obesity over the adult life course. Br J Psychiatry 2009; 195:149-55. [PMID: 19648547 PMCID: PMC2770241 DOI: 10.1192/bjp.bp.108.057299] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prospective data on the association between common mental disorders and obesity are scarce, and the impact of ageing on this association is poorly understood. AIMS To examine the association between common mental disorders and obesity (body mass index > or = 30 kg/m(2)) across the adult life course. METHOD The participants, 6820 men and 3346 women, aged 35-55 were screened four times during a 19-year follow-up (the Whitehall II study). Each screening included measurements of mental disorders (the General Health Questionnaire), weight and height. RESULTS The excess risk of obesity in the presence of mental disorders increased with age (P = 0.004). The estimated proportion of people who were obese was 5.7% at age 40 both in the presence and absence of mental disorders, but the corresponding figures were 34.6% and 27.1% at age 70. The excess risk did not vary by gender or according to ethnic group or socioeconomic position. CONCLUSIONS The association between common mental disorders and obesity becomes stronger at older ages.
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Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, WC1E 6BT London, UK.
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Heath ML, Kow L, Slavotinek JP, Valentine R, Toouli J, Thompson CH. Abdominal adiposity and liver fat content 3 and 12 months after gastric banding surgery. Metabolism 2009; 58:753-8. [PMID: 19375765 DOI: 10.1016/j.metabol.2008.05.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 05/27/2008] [Indexed: 10/20/2022]
Abstract
Weight loss after laparoscopic adjustable gastric banding surgery (LAGB) is associated with mobilization of adipose tissue from a variety of depots. We sought to evaluate and relate abdominal and hepatic lipid deposition in an obese female population 3 and 12 months after LAGB. We related changes in these depots to markers of insulin sensitivity. Eighteen female obese subjects underwent magnetic resonance imaging and spectroscopy before and 3 and 12 months after LAGB for the quantification of abdominal subcutaneous (ABSAT) and visceral (VAT) adipose tissue areas and liver fat content (LFAT). Fasting blood free fatty acids (FFA) were analyzed. Insulin sensitivity was assessed by the homeostasis model assessment of insulin resistance index (HOMA-R). Mean weight loss 3 and 12 months after LAGB was 9.8 +/- 1.1 kg and 20.0 +/- 2.2 kg, respectively. Postoperatively, VAT area loss exceeded ABSAT area loss in the cohort as a whole and when divided according to preoperative liver fat stores. Three months after LAGB, reductions had occurred in VAT and ABSAT areas (both P < .01) and in FFA (P < .05). Twelve months after LAGB, further significant reductions (P < .01) occurred in VAT and ABSAT areas but not in FFA. No significant reduction occurred in LFAT at either time point in the group as a whole. In those with preoperative hepatic steatosis (LFAT > approximately 5%, n = 7), LFAT fell by 42% (P = .036) 3 months after LAGB, with a total reduction of 50% (P = .027 cf baseline) occurring by 12 months. There was an improvement in HOMA-R at 12 months (1.9 +/- 0.3 cf 2.9 +/- 0.5 at baseline, P = .04) but not 3 months (2.7 +/- 0.4). Preoperatively, LFAT related significantly to VAT area (r = 0.67, P = .003) and HOMA-R (r = 0.497, P = .04) but not ABSAT area. Postoperatively at both 3 and 12 months, LFAT continued to relate to VAT area (r = 0.63, P < .01 at both time points) but not HOMA-R. The changes in LFAT and VAT area were unrelated postoperatively. Abdominal adipose tissue loss was greater from the visceral than subcutaneous depots, suggesting that insulin sensitivity may not be an important determinant of selective lipid depot loss. The lack of a significant change in liver fat in the group as a whole may relate to low preoperative liver fat stores and to high postoperative dietary fat intakes. Preoperative liver fat stores did not influence insulin sensitivity or abdominal lipid changes during weight loss. Liver fat content and VAT area interrelated more closely than either related to ABSAT area, suggesting differing regulatory pathways for fat mobilization from ABSAT and VAT depots but possibly similar pathways for storage and mobilization of fat in the liver and viscerally.
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Affiliation(s)
- Madeleine L Heath
- Department of Medicine, Flinders Medical Centre, Flinders University, Bedford Park 5042, South Australia.
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Dufour F, Champault G. [Is bariatric surgery in adolescents appropriate?]. JOURNAL DE CHIRURGIE 2009; 146:24-9. [PMID: 19446689 DOI: 10.1016/j.jchir.2009.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Current recommendations for bariatric surgery are limited to patients older than 18 years. Two studies in 2007 showed that bariatric surgery improves survival in adults. Medical management of severe obesity in adolescents is all too often ineffective. For these reasons, early surgical intervention for adolescents with morbid obesity may be expected to prevent or avoid comorbidities, decrease mortality, and improve the quality of life. Several studies have demonstrated the feasibility of adolescent bariatric surgery with morbidity comparable to that seen in adult series. The earlier the surgery, the better the result in terms of prevention or reversal of comorbid conditions. In the USA, a consensus definition of adolescents eligible for bariatric surgery specifies attainment of Tanner Stage IV of sexual maturity and achievement of 95% of axial growth. Just as in adults, bariatric surgery in adolescents requires prolonged follow-up; it is important that such surgery be performed in centers specialized in adult bariatric surgery having the necessary multidisciplinary structure.
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Affiliation(s)
- F Dufour
- Service de chirurgie digestive, hôpital Jean-Verdier, université Paris XIII, UFR Leonard-de-Vinci, avenue du 14-Juillet, 93143 Bondy, France.
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Dixon JB. Obesity and Diabetes: The Impact of Bariatric Surgery on Type-2 Diabetes. World J Surg 2009; 33:2014-21. [DOI: 10.1007/s00268-009-0062-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Obes Relat Dis 2009; 5:387-405. [DOI: 10.1016/j.soard.2009.01.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 03/25/2008] [Indexed: 02/07/2023]
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