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Zhang LH, Wang J, Tan BH, Yin YB, Kang YM. Roux-en-Y Gastric Bypass Improves Insulin Sensitivity in Obese Rats with Type 2 Diabetes Mellitus by Regulating the Grin3a/AMPK Signal Axis in Hypothalamic Arcuate Nucleus. Diabetes Metab Syndr Obes 2023; 16:3617-3629. [PMID: 38028990 PMCID: PMC10644885 DOI: 10.2147/dmso.s430445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The objective of this study was to explore the effects and related mechanisms of Roux-en-Y gastric bypass (RYGB) on insulin sensitivity in obese rats with type 2 diabetes mellitus (T2DM). Methods The obese T2DM rat model was constructed by feeding a high-fat diet and injecting streptozotocin (STZ), and treated with RYGB. Grin3a shRNA was injected into the bilateral hypothalamic arcuate nucleus (ARC) to knockdown the Grin3a expression on T2DM rats. Eight weeks after operation, the body weight, fasting blood glucose (FBG), fasting serum insulin (FSI), homeostatic model assessment of insulin resistance (HOMA-IR), and plasma triglyceride (TG) levels were assessed. Hematoxylin & eosin (H&E) staining was adopted to observe the white adipose tissue (WAT) of rats. Western blot and qRT-PCR were used to detect the expression of Grin3a, adenosine 5' monophosphate-activated protein kinase (AMPK) and p-AMPK in ARC of rats. Later, the plasmid over-expressing or knocking down Grin3a was transfected into differentiated 3T3-L1 adipocytes, and the TG level and the formation of lipid droplets in adipocyte were assessed by TG kit and oil red O staining. The expression of lipogenic transcription factors in cells was detected by qRT-PCR. Results RYGB reduced FBG, FSI, HOMA-IR and plasma TG levels in T2DM rats while increasing Grin3a expression and p-AMPK/AMPK ratio in ARC. Knockdown of Grin3a not only reversed the decrease of FBG, FSI, HOMA-IR and plasma TG levels in T2DM rats induced by RYGB, but also reversed the up-regulation of p-AMPK/AMPK ratio in ARC affected by RYGB. Moreover, knocking down Grin3a significantly increased the TG level, promoted the formation of lipid droplets and up-regulated the expressions of lipogenic transcription factors in adipocytes. Conclusion RYGB improved the insulin sensitivity, reduced the plasma TG level and lessens the fat accumulation in obese T2DM rats by regulating the Grin3a/AMPK signal in ARC.
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Affiliation(s)
- Li-Hai Zhang
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an, People’s Republic of China
- Six Wards of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, People’s Republic of China
| | - Jiao Wang
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an, People’s Republic of China
- Six Wards of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, People’s Republic of China
| | - Bai-Hong Tan
- Six Wards of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, People’s Republic of China
| | - Yan-Bin Yin
- Six Wards of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, People’s Republic of China
| | - Yu-Ming Kang
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an, People’s Republic of China
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Abstract
The term 'diabetic foot disease' (DFD) often signifies the presence of foot ulceration and infection, but one must also be wary of the rarer occurrence of Charcot foot disease. The worldwide prevalence of DFD is 6.3% (95%CI: 5.4-7.3%). Foot complications present a major challenge to both patients and healthcare systems, with increased rates of hospitalisation and an almost trebled 5-year mortality. The Charcot foot often occurs in patients with long-standing diabetes, presenting as an inflamed or swollen foot or ankle, following unrecognised minor trauma. This review focuses on the prevention and early identification of the 'at-risk' foot. DFD is best managed by a multi-disciplinary foot clinic team consisting of podiatrists and healthcare professionals. This ensures a combination of expertise and provision of a multi-faceted evidence-based treatment plan. Current research using endothelial progenitor cells (EPC) and mesenchymal stem cells (MSC) offers a new dimension in wound management.
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Affiliation(s)
| | | | - David V Coppini
- University Hospitals Dorset NHS Trust, Dorset, UK, and visiting fellow, Bournemouth University, Bournemouth, UK
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Barrea L, Verde L, Schiavo L, Sarno G, Camajani E, Iannelli A, Caprio M, Pilone V, Colao A, Muscogiuri G. Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery. Nutrients 2023; 15:nu15081907. [PMID: 37111126 PMCID: PMC10142118 DOI: 10.3390/nu15081907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients' suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143 Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Gerardo Sarno
- San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
- Faculté de Medicine, Université Côte d'Azur, 06000 Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", 06204 Nice, France
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, 00166 Rome, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
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Felipe LA, Bachi ALL, Oliveira MC, Moreira SMBP, Afonso JPR, Lino MEM, Paixão V, Silva CHM, Vieira RP, Vencio S, Jirjos EI, Malheiros CA, Insalaco G, Júnior WRF, Oliveira LVF. Effects of Roux-en-Y gastric bypass on the metabolic profile and systemic inflammatory status of women with metabolic syndrome: randomized controlled clinical trial. Diabetol Metab Syndr 2023; 15:19. [PMID: 36788619 PMCID: PMC9930348 DOI: 10.1186/s13098-023-00986-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Obesity remains a public health problem worldwide. The high prevalence of this condition in the population raises further concerns, considering that comorbidities are often associated with obesity. Among the comorbidities closely associated with obesity, metabolic syndrome (MS) is particularly important, which potentially increases the risk of manifestation of other disorders, such as the prothrombotic and systemic pro-inflammatory states. METHODS A randomized, controlled clinical trial was performed involving female patients (n = 32) aged between 18 and 65 years, with a clinical diagnosis of MS, with severe obesity undergoing Roux-en-Y gastric bypass (RYGB). The study design followed the Consolidated Standards of Reporting Trials statement (CONSORT). Lipid profile, blood glucose and adipokines (adiponectin, leptin, and resistin) and (cytokines IL-1β, IL-6, IL-17, IL-23, and TNF-α) in blood plasma samples were evaluated before and six months after RYGB. RESULTS Patients undergoing RYGB (BSG) showed a significant improvement from preoperative grade III obesity to postoperative grade I obesity. The results showed that while HDL levels increased, the other parameters showed a significant reduction in their postoperative values when compared not only to the values observed before surgery in the BSG group, but also to the values obtained in the control group (CG). As for systemic inflammatory markers adiponectin, leptin, resistin, IL-1β, IL-6, IL-17, IL-23 and TNF- α it was observed that the levels of resistin and IL-17 in the second evaluation increased significantly when compared to the levels observed in the first evaluation in the CG. In the BSG group, while the levels of adiponectin increased, the levels of the other markers showed significant reductions in the postoperative period, in relation to the respective preoperative levels. The analysis of Spearman's correlation coefficient showed a significant positive correlation between IL-17 and IL-23 in the preoperative period, significant positive correlations between TNF-α and IL-6, TNF-α and IL-17, IL-6 and IL-17, and IL-17 and IL-23 were observed postoperatively. CONCLUSIONS According to our results, the reduction of anthropometric measurements induced by RYGB, significantly improves not only the plasma biochemical parameters (lipid profile and glycemia), but also the systemic inflammatory status of severely obese patients with MS. Trials registration NCT02409160.
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Affiliation(s)
- Lucenda A Felipe
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - André L L Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, SP, Brazil
| | - Miriã C Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Sandra M B P Moreira
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - João Pedro R Afonso
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Maria E M Lino
- Scientific Initiation Program, Evangelical University of Goiás, (UniEVANGELICA), Anápolis, GO, Brazil
| | - Vitória Paixão
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04021-001, Brazil
| | - Carlos H M Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Rodolfo P Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania, (GO), Brazil
| | - Elias I Jirjos
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Carlos A Malheiros
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Giuseppe Insalaco
- Institute for Biomedical Research and Innovation, National Research Council of Italy (CNR), 90146, Palermo, Italy
| | - Wilson R Freitas Júnior
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Luis V F Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil.
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5
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Failed Roux-en-Y Gastric Bypass-Long-Term Results of Distalization with Total Alimentary Limb Length of 250 or 300 cm. Obes Surg 2023; 33:293-302. [PMID: 36459358 PMCID: PMC9834116 DOI: 10.1007/s11695-022-06388-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/02/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Weight loss failure or weight regain may occur after Roux-en-Y gastric bypass (RYGB). Revisional surgery includes distalization. However, few studies have looked at the associations between the total alimentary limb length (TALL) and weight loss outcomes, none with long-term results. OBJECTIVES Peri- and postoperative outcomes were assessed after employing TALL of either 250 cm or 300 cm in the failed RYGB. METHODS This study is a retrospective cohort analysis of 90 patients that underwent laparoscopic distalization between January 2006 and January 2016 due to failed RYBG. The index RYGB was modified to TALL of 250 cm (n = 48) or of 300 cm (n = 42) which entailed elongating the bilio-pancreatic limb (BPL) and transposing the Roux limb (RL) to a common limb (CL) of 100 cm and 150 cm, respectively. Long-term weight loss outcomes along with nutritional and vitamin status were analyzed. RESULTS Preoperative BMI at distalization was 38.6 kg/m2. After 8 years, excess weight loss (EWL) was 61.8%. No differences between the two groups were seen in weight loss outcomes or early surgical complication rates (6.7%). However, more vitamin and nutritional deficiencies were present in the TALL 250-cm group (50.0% and 35.4%, respectively) versus the TALL 300-cm group (33.3% and 14.3% respectively), which led to laparoscopic revision in 27 patients by lengthening the TALL with 100 cm. Patients with weight regain after index RYGB had in average 59.9% higher EWL than patients with EWL failure. CONCLUSION Distalization of the failed RYGBP is safe and effective, but TALL should not be shorter than 300 cm (and CL 150 cm) due to high rates of malnutrition. Adequate supplementation and long-term follow-up are mandatory to prevent serious malnutrition.
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Restrepo-Castrillón J, Restrepo-Moreno M, Ramírez-Ceballos M, Román-González A, Toro-Vásquez JP. Baipás gástrico versus manga gástrica para el control de diabetes tipo 2 en pacientes obesos. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introducción. La diabetes mellitus tipo 2 y la obesidad son enfermedades con alta prevalencia, gran morbimortalidad y elevados costos en salud. La cirugía bariátrica ha demostrado efectividad para inducir pérdida de peso y un control adecuado de la glicemia.
Métodos. Estudio observacional analítico retrospectivo, realizado entre 2014 y 2019 en una institución de alta complejidad. Se incluyeron pacientes prediabéticos y diabéticos sometidos a cirugía bariátrica tipo baipás gástrico en Y-de-Roux o manga gástrica. Se analizaron la mejoría o resolución de la diabetes y la pérdida del exceso de peso a los 6, 12, 24 y 36 meses luego de la cirugía.
Resultados. Se incluyeron 103 pacientes en el estudio, 45 pacientes diabéticos y 58 pacientes prediabéticos. La única variable perioperatoria con diferencia estadísticamente significativa fue el tiempo quirúrgico mayor en el baipás (70 vs. 47,5 minutos; p<0,001). La pérdida de exceso de peso fue mayor en el baipás. Los pacientes diabéticos sometidos a baipás tuvieron un mayor porcentaje de resolución o control comparados con los sometidos a manga gástrica. En los pacientes prediabéticos hubo resolución en ambos grupos luego de 24 meses de seguimiento.
Conclusión. El baipás gástrico y la manga gástrica presentan excelentes resultados en cuanto a pérdida de peso y control metabólico en pacientes con diabetes mellitus tipo 2 y prediabetes, pero en nuestros pacientes se lograron resultados superiores en ambos aspectos con el baipás gástrico.
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Cruz-García EM, Frigolet ME, Canizales-Quinteros S, Gutiérrez-Aguilar R. Differential Gene Expression of Subcutaneous Adipose Tissue among Lean, Obese, and after RYGB (Different Timepoints): Systematic Review and Analysis. Nutrients 2022; 14:nu14224925. [PMID: 36432612 PMCID: PMC9693162 DOI: 10.3390/nu14224925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
Abstract
The main roles of adipose tissue include triglycerides storage and adipokine secretion, which regulate energy balance and inflammation status. In obesity, adipocyte dysfunction leads to proinflammatory cytokine production and insulin resistance. Bariatric surgery is the most effective treatment for obesity, the gold-standard technique being Roux-en-Y gastric bypass (RYGB). Since metabolic improvements after RYGB are clear, a better understanding of adipose tissue molecular modifications could be derived from this study. Thus, the aim of this systematic review was to find differentially expressed genes in subcutaneous adipose tissue of lean, obese and post-RYGB (distinct timepoints). To address this objective, publications from 2015-2022 reporting gene expression (candidate genes or transcriptomic approach) of subcutaneous adipose tissue from lean and obese individuals before and after RGYB were searched in PubMed, Elsevier, and Springer Link. Excluded publications were reviews, studies analyzing serum, other types of tissues, or bariatric procedures. A risk-of-bias summary was created for each paper using Robvis, to finally include 17 studies. Differentially expressed genes in post-RYGB vs. obese and lean vs. obese were obtained and the intersection among these groups was used for analysis and gene classification by metabolic pathway. Results showed that the lean state as well as the post-RYGB is similar in terms of increased expression of insulin-sensitizing molecules, inducing lipogenesis over lipolysis and downregulating leukocyte activation, cytokine production and other factors that promote inflammation. Thus, massive weight loss and metabolic improvements after RYGB are accompanied by gene expression modifications reverting the "adipocyte dysfunction" phenomenon observed in obesity conditions.
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Affiliation(s)
- Elena Marisol Cruz-García
- Laboratorio de Investigación en Enfermedades Metabólicas: Obesidad y Diabetes, Hospital Infantil de México “Federico Gómez”, Mexico City 06720, Mexico
| | - María E. Frigolet
- Laboratorio de Investigación en Enfermedades Metabólicas: Obesidad y Diabetes, Hospital Infantil de México “Federico Gómez”, Mexico City 06720, Mexico
| | - Samuel Canizales-Quinteros
- Unidad de Genόmica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genόmica (INMEGEN), Mexico City 14610, Mexico
| | - Ruth Gutiérrez-Aguilar
- Laboratorio de Investigación en Enfermedades Metabólicas: Obesidad y Diabetes, Hospital Infantil de México “Federico Gómez”, Mexico City 06720, Mexico
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
- Correspondence: ; Tel.: +52-5552289917 (ext. 4509)
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Taskin HE, Al M. Longitudinal Outcomes Through 4 Years After Sleeve Gastrectomy with Transit Bipartition. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Halit Eren Taskin
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muzaffer Al
- Department of Surgery, Faculty of Medicine, Near East University Nicosia, Turkey
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McInnes N, Hall S, Hramiak I, Sigal RJ, Goldenberg R, Gupta N, Rabasa-Lhoret R, Braga M, Woo V, Sultan F, Otto R, Smith A, Sherifali D, Liu YY, Gerstein HC, McInnes N, Gerstein HC, Hall S, Blanchard S, Pinder N, Yun Liu Y, McInnes N, Sultan F, Otto R, Smith A, Sherifali D, Gerstein HC, Hramiak I, Paul T, Joy T, Watson M, Driscoll M, Sigal R, Butalia S, Rossiter B, Smith M, Tully V, Goldenberg R, Gupta N, Schlosser R, Sionit D, Talsania T, Huynh J, Birch S, Davdani S, Rabasa-Lhoret R, Bovan D, Raffray M, Braga M, McInnes N, Smith A, Tazzeo T, Otto R, Scott K, Hiltz Mackenzie K, Woo V, Berard L, Mandock C, Anderlic T. Remission of Type 2 Diabetes Following a Short-term Intensive Intervention With Insulin Glargine, Sitagliptin, and Metformin: Results of an Open-label Randomized Parallel-Design Trial. Diabetes Care 2022; 45:178-185. [PMID: 34728531 DOI: 10.2337/dc21-0278] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate remission of type 2 diabetes following a short-term intervention with insulin glargine, sitagliptin/metformin, and lifestyle approaches. RESEARCH DESIGN AND METHODS In this open multicenter trial, 102 patients with type 2 diabetes were randomized to 1) a 12-week intervention with sitagliptin/metformin, insulin glargine, and lifestyle therapy or 2) control group. Participants with HbA1c <7.3% (<56 mmol/mol) at 12 weeks were asked to stop diabetes medications and were followed for evidence of relapse over 52 weeks. Diabetes relapse criteria included HbA1c ≥6.5% (≥48 mmol/mol), ≥50% of capillary glucose readings >10 mmol/L over 1 week, and reinitiation of diabetes medications with or without abnormal fasting plasma glucose (FPG) or 2-h plasma glucose on an oral glucose tolerance test (OGTT). Time-to-relapse analysis was conducted to compare the treatment groups with (primary analysis) and without (supplementary analysis) FPG/OGTT relapse criteria. RESULTS With the FPG/OGTT relapse criteria included, the hazard ratio (HR) of relapse was 0.72 (95% CI 0.47-1.10) in the intervention group compared with the control group (primary analysis), and the number of participants remaining in remission was not significantly different between treatment groups at 24, 36, 48, and 64 weeks. In the supplementary analyses without these criteria, HR of relapse was 0.60 (95% CI 0.39-0.95), and the number of participants remaining in remission was significantly higher (26 vs. 10%) in the intervention group at 36 weeks. CONCLUSIONS Although our primary outcome was not statistically significant, the tested approach deserves further study with further optimization of its components.
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Affiliation(s)
- Natalia McInnes
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,2Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,3Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Hall
- 2Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Irene Hramiak
- 4Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ronald J Sigal
- 5Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Nikhil Gupta
- 6LMC Diabetes and Endocrinology, Concord, Ontario, Canada
| | - Remi Rabasa-Lhoret
- 7Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Manoela Braga
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Woo
- 8Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Farah Sultan
- 3Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rose Otto
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ada Smith
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- 9School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Yan Yun Liu
- 2Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,2Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,3Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Remission of Type II Diabetes Mellitus 1-Year Postoperative Following One Anastomosis Gastric Bypass in Correlation with ABCD, DiaRem, and DRS Scores. Obes Surg 2021; 32:450-456. [PMID: 34780027 DOI: 10.1007/s11695-021-05793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a debilitating chronic illness. Roux en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) present a potential solution to type II DM. Several scoring systems predict DM remission as ABCD score, DiaRem score, and diabetes remission score (DRS). STUDY DESIGN This was a retrospective study that included 138 patients with DM and underwent OAGB. BMI, HbA1C, insulin, and oral hypoglycemics need were recorded pre- and postoperatively with calculation of ABCD, DiaRem, and DRS scores. Effects of OAGB on DM were observed and correlated with the scoring systems to detect their sensitivity and specificity. RESULTS Age, preoperative, and postoperative BMI were 47.38 ± 7.632, 45.096 ± 4.465, and 31.173 ± 3.799 respectively. The preoperative and stimulated C-peptides were 3.357 ± 0.995 and 4.158 ± 0.897 ng/ml respectively. The preoperative and postoperative HbA1C were 7.396 ± 0.743% and 6.564 ± 0.621% respectively. Patients with complete remission were 32 patients (23.2%) and with partial remission were 46 patients (33.3%) adding to 56.5% considered in remission. There was significant decrease of BMI, HbA1C, insulin, and oral hypoglycemic use postoperatively. Receiver operator characteristics (ROC) curve showed that ABCD, DiaRem, and DRS scores had AUC of 0.853 with cut-off > 5, 0.921 with cut-off ≤ 8, and 0.805 with cut-off ≤ 8 respectively. The DiaRem score had the highest AUC followed by ABCD score then DRS score. CONCLUSION OAGB significantly reduced BMI and HbA1C values 1 year postoperatively with 56.5% DM remission. DiaRem score had more remission predictive value following OAGB than ABCD and DRS scores especially when ≤ 8 with 90.6% sensitivity and 83% specificity.
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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Wang L, Lin M, Yu J, Fan Z, Zhang S, Lin Y, Chen X, Peng F. The Impact of Bariatric Surgery Versus Non-Surgical Treatment on Blood Pressure: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:4970-4984. [PMID: 34519991 DOI: 10.1007/s11695-021-05671-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to compare bariatric surgery versus non-surgical treatment on blood pressure for patients with obesity. Nineteen RCTs (1353 total patients) were included. In the pooled analyses, bariatric surgery reduces more systolic blood pressure (WMD: - 3.937 mmHg, CI95%: - 6.000 to - 1.875, p < 0.001, I2 = 0%), diastolic blood pressure (WMD: - 2.690 mmHg, CI95%: - 3.994 to - 1.385, P < 0.001, I2 = 0%) and more antihypertensives. In subgroup analyses, patients after Roux-en-Y gastric bypass, with poor control of hypertension (BP > 130/80 mmHg) and diabetes mellitus (HbA1C > 7.0%, FPG > 7.0 mmol/L), elder patients (> 45 years), non-severe obesity (BMI < 40 kg/cm2, body weight < 120 kg), less waist circumference (< 115 cm) tend to decrease more blood pressure. Besides, patients after surgery also lost more weight (p < 0.001), decreased more waist circumference (p < 0.001), fasting plasma glucose (p < 0.001), glycosylated hemoglobin (p < 0.001), triglycerides (p < 0.001), hsCRP (p = 0.001), increased more high-density lipoprotein cholesterol (p < 0.001), and had better remission of metabolic syndrome (p < 0.001). Changes in total cholesterol, low-density lipoprotein cholesterol, renal function, resting heart rate, and 6-min walking test were not significantly different. Therefore, bariatric surgery is more effective than non-surgical treatment in controlling patients' blood pressure.
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Affiliation(s)
- Laicheng Wang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Meihua Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Jianjian Yu
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Zongcheng Fan
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Shunpeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Yunchai Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Xin Chen
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China.
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Huang TW, Chen JY, Wu YL, Kao CC, Yeh SC, Lin YC. Alterations of bone markers in obese patients with type 2 diabetes after bariatric surgery: A meta-analysis and systemic review of randomized controlled trials and cohorts. Medicine (Baltimore) 2021; 100:e26061. [PMID: 34011124 PMCID: PMC8137048 DOI: 10.1097/md.0000000000026061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 04/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the alterations in bone mineral density and other surrogate markers for osteoporosis in obese patients with type 2 diabetes mellitus (T2DM) who received Roux-en-Y gastric bypass (RYGB) versus medical treatment as control. METHODS We searched 4 electronic databases and reference lists of relevant studies for eligible research published before December, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including lumbar spine bone mineral density (L-spine BMD) change, total hip BMD change, osteocalcin level, C-terminal telopeptide level, and parathyroid hormone level. RESULTS Three randomized clinical trials and 2 observational studies concerning 307 total obese T2DM patients were included. Follow-up ranged from 12 to 60 months. Patients underwent RYGB surgery were associated with both higher L-spine BMD loss (mean difference: -2.90, 95% CI: -2.99∼-2.81, P < .00001) and total hip BMD loss (mean difference: -5.81, 95% CI: -9.22∼-2.40, P = .0008). As to biochemical markers of bone metabolism, we found significantly higher osteocalcin level in medical treatment (control) group compared with RYGB group (mean difference: 11.16, 95% CI: 8.57-13.75, P < .00001). However, higher C-terminal telopeptide level and parathyroid hormone level were noted in medical treatment group (control) compared with RYGB group (mean difference: 0.29, 95% CI: 0.11-0.48, P = .002; mean difference: 1.56, 95% CI: 0.84-2.27, P < .0001). CONCLUSIONS RYGB surgery is associated with negative impact on bone metabolism and increase the risk of osteoporosis in obese patients with T2DM. We suggest that clinicians acknowledge the adverse effects of surgery and keep monitoring bone mineral components in post-RYGB populations. Further studies regarding the optimal amount of perioperative and postsurgical supplementation should be evaluated.
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Affiliation(s)
- Tzu-Wen Huang
- Department of Medical Education, Taichung Veterans General Hospital, Taichung
| | - Jing-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
- TMU-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Lin Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
| | - Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine
- TMU-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Shu-Ching Yeh
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
- TMU-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yen-Chung Lin
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine
- TMU-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
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14
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Turquetil A, Morello R, Joubert M, Le Roux Y, Reznik Y. Early continuous glucose monitoring for predicting remission of type 2 diabetes 1 year after bariatric surgery. DIABETES & METABOLISM 2021; 47:101255. [PMID: 33991661 DOI: 10.1016/j.diabet.2021.101255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric surgery in obese subjects can result in remission of type 2 diabetes (T2D) at a distant time post-surgery. The aim of our observational prospective single-centre study was to examine glycaemic patterns in adult T2D candidates for bariatric surgery using a continuous glucose monitoring (CGM) sensor for 14 days after surgery to search for indicators predictive of T2D remission 1 year later. METHODS Patients underwent CGM preoperatively and for 14 days postoperatively. Thereafter, body weight and glycated haemoglobin (HbA1c) levels were monitored at 3, 6 and 12 months after surgery. RESULTS A total of 31 patients (mean age 47±2 years) were analyzed. After surgery, mean interstitial glucose levels fell rapidly from 157±31mg/dL preoperatively to 109±35mg/dL postoperatively (P<0.001), reaching nadir levels from day 3 after surgery. Successful bariatric surgery (loss of excess weight ≥50%) was observed in 28 (90%) patients, and diabetes remission (HbA1c≤6% with no antidiabetic treatment) 1 year after surgery was noted in 21 (68%) patients. CGM for 14 days post-surgery allowed prediction of diabetes remission 1 year after surgery: time spent above range <14% and standard deviation (SD) of glucose levels <33mg/dL were both strong predictors of T2D remission. Indeed, the association of these two criteria predicted diabetes remission with a 100% positive predictive value, 81% sensitivity and 100% specificity and, when combined with the advanced Diabetes Remission (Ad-DiaRem) score, further increased predictive accuracy. CONCLUSION The use of 14-day postoperative CGM recordings together with presurgical clinical scores can help to predict diabetes remission 1 year after bariatric surgery.
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Affiliation(s)
- A Turquetil
- Department of Endocrinology and Diabetology, CHU Côte de Nacre, 14033 Caen CEDEX, France
| | - R Morello
- Department of Biostatistics, CHU Côte de Nacre, 14033 Caen CEDEX, France
| | - M Joubert
- Department of Endocrinology and Diabetology, CHU Côte de Nacre, 14033 Caen CEDEX, France; University of Caen Basse-Normandie, Medical School, 14032 Caen CEDEX, France
| | - Y Le Roux
- Department of Endocrine Surgery, CHU Côte de Nacre, 14033 Caen CEDEX, France
| | - Y Reznik
- Department of Endocrinology and Diabetology, CHU Côte de Nacre, 14033 Caen CEDEX, France; University of Caen Basse-Normandie, Medical School, 14032 Caen CEDEX, France.
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15
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Laparoscopic Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy for Type 2 Diabetes Mellitus in Nonseverely Obese Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Obes Surg 2021; 30:1660-1670. [PMID: 31912466 DOI: 10.1007/s11695-019-04378-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, randomized controlled trials (RCTs) have indicated that bariatric surgery in nonseverely obese patients with a body mass index (BMI) less than 35 kg/m2 might be even superior to medical therapy with regard to type 2 diabetes mellitus (T2DM) remission, but the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) in nonseverely obese patients has not been conclusively determined. The objective of this study is to compare LRYGB versus LSG for T2DM in nonseverely obese patients. METHODS A meta-analysis identifying RCTs evaluating LRYGB versus LSG for T2DM in nonseverely obese patients was conducted. The primary outcome was T2DM remission. Additional analyses comprised percent excess weight loss (%EWL), BMI, waist circumference, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum lipid level, medication use, quality of life, and adverse events. RESULTS Four RCTs concerning total 296 patients were included. T2DM remission rate and %EWL were of no difference between the two bariatric procedures. LRYGB was associated with lower BMI, waist circumference, low-density lipoprotein, and higher high-density lipoprotein than LSG. However, HbA1c, FPG, total cholesterol, and triglyceride were not significantly different between the two surgical groups. The medication use and quality of life were improved in both two groups. The gastroesophageal reflux diseases of LRYGB group were less than that of LSG group. Dumping syndromes were noted more frequently in the LRYGB group. CONCLUSIONS Both LRYGB and LSG have comparative effect on resolving T2DM in nonseverely obese patients at midterm follow-up. Further RCTs should address the potential risks and long-term effects of LRYGB and LSG in nonseverely obese patients.
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Bhandari M, Kosta S, Khurana M, Mathur W, Reddy MK, Fobi M. Emerging Procedures in Bariatric Metabolic Surgery. Surg Clin North Am 2021; 101:335-353. [PMID: 33743973 DOI: 10.1016/j.suc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand for bariatric/metabolic surgery worldwide. New procedures have been developed and changed the face of modern bariatric surgery. Gastrointestinal metabolic surgery is a new treatment modality for obesity-related type 2 diabetes mellitus for patients with body mass index greater than 35 kg/m2. Providing safe bariatric/metabolic surgery, training qualified bariatric surgeons, and developing better techniques are important issues. This article discusses emerging procedures; a multitude of bariatric metabolic procedures enables surgeons to tailor treatment to patients' needs.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India.
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Kumar Reddy
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
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Salman AA, Salman MA, Marie MA, Rabiee A, Helmy MY, Tourky MS, Qassem MG, Shaaban HED, Sarhan MD. Factors associated with resolution of type-2 diabetes mellitus after sleeve gastrectomy in obese adults. Sci Rep 2021; 11:6002. [PMID: 33727637 PMCID: PMC7966796 DOI: 10.1038/s41598-021-85450-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Many bariatric procedures are more effective for improving type-2 diabetes mellitus (T2DM) than conventional pharmacotherapy. The current research evaluated factors linked to complete and partial remission or improvement of T2DM after laparoscopic sleeve gastrectomy (LSG). The current prospective study included all diabetic patients who were submitted LSG between January 2015 and June 2018 and completed a 2-year follow-up period. Patients were assessed at baseline and 2 years after LSG. This work comprised of 226 diabetic cases. Two years after LSG, 86 patients (38.1%) achieved complete remission of DM, and 24 (10.6%) reached partial remission. Only 14 patients (6.2%) showed no change in their diabetic status. On univariate analysis, age ≤ 45 years, duration of diabetes ≤ 5 years, use of a single oral antidiabetic, HbA1c ≤ 6.5%, HOMA-IR ≤ 4.6, C-peptide > 2.72 ng/mL, and BMI ≤ 40 kg/m2 predicted complete remission. The independent predictors of complete remission were age ≤ 45 years, duration of diabetes ≤ 5 years, use of a single oral antidiabetic, HOMA-IR ≤ 4.6, and C-peptide > 2.72 ng/mL. A combined marker of young age, short duration of DM, and low HOMA-IR predicted complete remission with sensitivity 93% and specificity 82%. Independent predictors of complete remission of T2DM after LSG were younger age, shorter duration, single oral antidiabetic, lower HOMA-IR, and higher C-peptide.
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Affiliation(s)
| | | | - Mohamed A Marie
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Rabiee
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Youssry Helmy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Sabry Tourky
- Department of Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mohamed Gamal Qassem
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed D Sarhan
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Cui BB, Wang GH, Li PZ, Li WZ, Zhu LY, Zhu SH. Long-term outcomes of Roux-en-Y gastric bypass versus medical therapy for patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Surg Obes Relat Dis 2021; 17:1334-1343. [PMID: 33863632 DOI: 10.1016/j.soard.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has been widely used for type 2 diabetes (T2D) patients with overweight or obesity. However, the long-term outcomes of RYGB versus medical therapy have not been well compared. OBJECTIVES To evaluate the long-term outcomes of RYGB versus medical therapy for patients with T2D. SETTING University-affiliated hospital, China. METHODS Four electronic databases-PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov-were searched for articles published through February 2021. Eligible studies were randomized controlled trials. RESULTS Of 7 randomized controlled trials (15 articles), 477 patients were included: 239 were randomly divided into RYGB groups and 238 to medical therapy groups. Statistically higher rates of T2D remission were observed in RYGB groups at 1 year (relative risk [RR], 18.01; 95% confidence interval [CI], 4.53- 71.70; P < .0001), 3 years (RR, 29.58; 95% CI, 5.92-147.82; P < .0001), and 5 years (RR, 16.92; 95% CI, 4.15-69.00; P < .0001). Meanwhile, statistically higher rates of achieving the American Diabetes Association's (ADA's) treatment goal were observed in RYGB groups at 1 year (RR, 3.99; 95% CI, 1.01-15.82; P = .05), 2 years (RR, 2.98; 95% CI, 1.62- 5.48; P = .0004), 3 years (RR, 3.16; 95% CI, 1.33-7.49; P = .009), and 5 years (RR, 6.18; 95% CI, 1.69-22.68; P = .006). CONCLUSION This meta-analysis indicated that RYGB led to higher rates of T2D remission than medical therapy at 1, 3, and 5 years, as well as higher rates of achieving ADA's composite goal at 1, 2, 3, and 5 years.
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Affiliation(s)
- Bei-Bei Cui
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo-Hui Wang
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peng-Zhou Li
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei-Zheng Li
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li-Yong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shai-Hong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Liu Z, Coales I, Penney N, McDonald JAK, Phetcharaburanin J, Seyfried F, Li JV. A Subset of Roux-en-Y Gastric Bypass Bacterial Consortium Colonizes the Gut of Nonsurgical Rats without Inducing Host-Microbe Metabolic Changes. mSystems 2020; 5:e01047-20. [PMID: 33293406 PMCID: PMC8579838 DOI: 10.1128/msystems.01047-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/19/2020] [Indexed: 01/02/2023] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is an effective weight loss surgery, resulting in a characteristic increase of fecal Gammaproteobacteria The contribution of this compositional change to metabolic benefits of RYGB is currently debatable. Therefore, this study employed 16S rRNA gene sequencing and metabolic profiling to monitor the dynamic colonization of the RYGB microbial consortium and their metabolic impact on the host. Eleven Wistar rats received vancomycin and enrofloxacin, followed by fecal microbiota transplantation (FMT) of cecal slurry obtained from either RYGB- or sham-operated rats. Urine and feces from the microbiota recipients (RYGB microbiota recipients [RYGBr], n = 6; sham microbiota recipients [SHAMr], n = 5) were collected pre- and post-antibiotics and 1, 3, 6, 9, and 16 days post-FMT. No significant differences in body weight and food intake were observed between RYGBr and SHAMr. While neither group reached the community richness of that of their donors, by day 6, both groups reached the richness and diversity of that prior to antibiotic treatment. However, the typical signature of RYGB microbiome-increased Enterobacteriaceae-was not replicated in these recipients after two consecutive FMT, suggesting that the environmental changes induced by the anatomical rearrangements of RYGB could be key for sustaining such a consortium. The transplanted bacteria did not induce the same metabolic signature of urine and feces as those previously reported in RYGB-operated rats. Future work is required to explore environmental factors that shape the RYGB microbiota in order to further investigate the metabolic functions of the RYGB microbiota, thereby teasing out the mechanisms of the RYGB surgery.IMPORTANCE Roux-en-Y gastric bypass (RYGB) surgery results in a long-term gut bacterial shift toward Gammaproteobacteria in both patients and rodents. The contribution of this compositional shift, or the RYGB bacterial consortium, to the metabolic benefit of the surgery remains debatable. It is unclear how well these bacteria colonize in an anatomically normal gut. This is a fundamental question in both defining the function of the RYGB microbiota and evaluating its potential as a nonsurgical treatment for obesity. We monitored the dynamic colonization of the RYGB bacterial consortium and observed that while approximately one-third of the bacterial taxa from the RYGB donor colonized in the gut of the nonoperated recipients, Gammaproteobacteria were unable to colonize for longer than 3 days. The study highlighted that a successful long-term colonization of Gammaproteobacteria-rich RYGB microbiota in nonsurgical animals requires key environmental factors that may be dictated by the intestinal anatomical modification by the surgery itself.
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Affiliation(s)
- Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Isabelle Coales
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Nicholas Penney
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St. Mary's Hospital Campus, London, United Kingdom
| | - Julie A K McDonald
- MRC Centre for Molecular Bacteriology and Infection, Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, South Kensington Campus, London, United Kingdom
| | | | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Jia V Li
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, South Kensington Campus, London, United Kingdom
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Guggino J, Coumes S, Wion N, Reche F, Arvieux C, Borel AL. Effectiveness and Safety of Bariatric Surgery in Patients with End-Stage Chronic Kidney Disease or Kidney Transplant. Obesity (Silver Spring) 2020; 28:2290-2304. [PMID: 33230959 DOI: 10.1002/oby.23001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/25/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to evaluate (1) the effectiveness, complications, and postoperative access to transplantation in end-stage chronic kidney disease (ECKD) and (2) the effectiveness and complications of bariatric surgery in patients who had already undergone kidney transplant. METHODS A systematic review and meta-analysis of mortality and complications rates were performed. Thirty studies were reviewed. RESULTS After bariatric surgery, patients with ECKD had similar postoperative weight loss to patients from the general population. Meta-analysis showed post-bariatric surgery rates of 2% (95% CI: 0%-3%) for mortality and 7% (95% CI: 2%-14%) for complications. Approximately one-fifth of the patients had access to a transplant. This rate may be underestimated because of the short duration of follow-up. The lack of control groups did not allow for a conclusion on the role of bariatric surgery in facilitating access to kidney transplantation. In patients who had received a kidney transplant, bariatric surgery seemed to improve renal function but increased graft-rejection risk, possibly because of changes in the bioavailability of immunosuppressant drugs. CONCLUSIONS Bariatric surgery yields significant weight loss in patients with ECKD that improves patients' chances of accessing a transplant but does not guarantee it; however, the risk for complications and death is higher than in other patients. After transplantation, bariatric surgery-induced weight loss appeared to positively impact the function of the grafted kidney, but careful monitoring of immunosuppressant medications is required.
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Affiliation(s)
- Jessica Guggino
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Sandrine Coumes
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Nelly Wion
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Fabian Reche
- Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
- CNRS, UMR 5525, TIMC-IMAG, Domaine de la Merci, Grenoble, France
| | - Catherine Arvieux
- Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
- Hypoxia Pathophysiology (HP2) INSERM U1042, Grenoble Alpes University, Grenoble, France
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21
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Hasan B, Nayfeh T, Alzuabi M, Wang Z, Kuchkuntla AR, Prokop LJ, Newman CB, Murad MH, Rajjo TI. Weight Loss and Serum Lipids in Overweight and Obese Adults: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5909285. [PMID: 32954416 DOI: 10.1210/clinem/dgaa673] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Excess adipose tissue is associated with an abnormal lipid profile that may improve with weight reduction. In this meta-analysis, we aimed to estimate the magnitude of change in lipid parameters associated with weight loss in adults who are overweight or obese. METHODS We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus from 2013 to September, 2018. We included randomized controlled trials (RCTs) that evaluated interventions to treat adult obesity (lifestyle, pharmacologic and surgical) with follow-up of 6 months or more. RESULTS We included 73 RCTs with moderate-to-low risk of bias, enrolling 32 496 patients (mean age, 48.1 years; weight, 101.6 kg; and body mass index [BMI], 36.3 kg/m2). Lifestyle interventions (diet, exercise, or both), pharmacotherapy, and bariatric surgery were associated with reduced triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) concentrations and increased high-density lipoprotein cholesterol (HDL-C) at 6 and 12 months. The following data are for changes in lipid parameters after 12 months of the intervention with 95% CI. Following lifestyle interventions, per 1 kg of weight lost, TGs were reduced by -4.0 mg/dL (95% CI, -5.24 to -2.77 mg/dL), LDL-C was reduced by -1.28 mg/dL (95% CI, -2.19 to -0.37 mg/dL), and HDL-C increased by 0.46 mg/dL (95% CI, 0.20 to 0.71 mg/dL). Following pharmacologic interventions, per 1 kg of weight lost, TGs were reduced by -1.25 mg/dL (95% CI, -2.94 to 0.43 mg/dL), LDL-C was reduced by -1.67 mg/dL (95% CI, -2.28 to -1.06 mg/dL), and HDL-C increased by 0.37 mg/dL (95% CI, 0.23 to 0.52 mg/dL). Following bariatric surgery, per 1 kg of weight lost, TGs were reduced by -2.47 mg/dL (95% CI, -3.14 to -1.80 mg/dL), LDL-C was reduced by -0.33 mg/dL (95% CI, -0.77 to 0.10 mg/dL), and HDL-C increased by 0.42 mg/dL (95% CI, 0.37 to 0.47 mg/dL). Low-carbohydrate diets resulted in reductions in TGs and increases in HDL-C, whereas low-fat diets resulted in reductions in TGs and LDL-C and increases in HDL-C. Results were consistent across malabsorptive and restrictive surgery. CONCLUSIONS Weight loss in adults is associated with statistically significant changes in serum lipids. The reported magnitude of improvement can help in setting expectations, inform shared decision making, and facilitate counseling.
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Affiliation(s)
- Bashar Hasan
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Tarek Nayfeh
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Muayad Alzuabi
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Zhen Wang
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Aravind Reddy Kuchkuntla
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry J Prokop
- Library Public Services, Mayo Clinic, Rochester, Minnesota
| | - Connie B Newman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU School of Medicine, New York, New York
| | - Mohammad Hassan Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Tamim I Rajjo
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
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Role of DiaRem Score in Preoperative Prediction of Type 2 Diabetes Mellitus Remission After Laparoscopic Roux-en-Y Gastric Bypass: Indian Perspective. Obes Surg 2020; 31:1265-1270. [PMID: 33196979 DOI: 10.1007/s11695-020-05129-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has emerged as the most effective treatment in reversing insulin resistance in patients with type 2 diabetes mellitus (T2DM). A number of models and statistical tools have been proposed to predict patients likely to experience diabetes remission post-RYGB. The purpose of our study was to evaluate the preoperative accuracy of DiaRem score in predicting T2DM remission at 1 year of follow-up in a retrospective analysis of diabetic morbidly obese patients who underwent RYGB. METHODS One hundred and forty-three patients underwent RYGB between January 2018 and December 2018. We conducted a retrospective analysis in 55 patients (38.46%) with T2DM with 1 year of follow-up. DiaRem score was calculated, and patients were stratified in five groups. RESULT At a 1-year follow-up, we found a higher proportion of patients with T2DM remission in the lower score group compared to a lower proportion of patients with remission in the higher score group. We derived a DiaRem cut-off score of 6.5 that had high sensitivity and specificity to predict T2DM remission preoperatively. We found a significant decrease in BMI and HbA1C values post-operatively at 1 year following RYGB. CONCLUSION DiaRem score is an easy to determine score based on basic clinical parameters that could identify patients with T2DM who would achieve maximal benefit in terms of remission after bariatric surgery. The development of a suitable scoring tool would be clinically useful as it would enable clinicians to better triage patients for RYGB.
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All-Cause Mortality of Patients With and Without Diabetes Following Bariatric Surgery: Comparison to Non-surgical Matched Patients. Obes Surg 2020; 31:755-762. [PMID: 33150480 DOI: 10.1007/s11695-020-05068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Data are sparse regarding the survival benefit of bariatric surgery on mortality among persons with diabetes. We aimed to investigate the association of bariatric surgery, compared with usual care, on all-cause mortality in individuals who underwent surgery and matched controls, stratified by the presence of diabetes. RESEARCH DESIGN AND METHODS This retrospective cohort study utilized population-based electronic medical record data. Individuals who underwent one of three types of bariatric surgery during 2005-2014 were included. For each surgical patient, three non-surgical individuals were matched according to age, sex, body mass index, and diabetes status. The cohort comprised 9564 individuals with diabetes and 23,976 individuals without diabetes. RESULTS During a median follow-up of 4.2 years, adjusted hazard ratios (HRs) for mortality for non-surgery vs. surgery were 2.38 (95%CI: 1.75, 3.26) and 1.73 (95%CI: 1.26, 2.36) among individuals with diabetes and individuals without diabetes, respectively. Considered separately, HRs for mortality for laparoscopic banding, gastric bypass, and laparoscopic sleeve gastrectomy were 2.83 (95%CI: 1.73, 4.63), 2.30 (95%CI: 1.25, 4.25), and 1.89 (95%CI: 1.1, 3.32) among patients with diabetes; and 1.74 (95%CI: 1.20, 2.52), 2.66 (0.81, 8.76), and 1.16 (0.51, 2.65) among patients without diabetes. CONCLUSION The survival advantage of bariatric surgery after a median follow-up of 4.2 years was greater among individuals with than without diabetes for the three types of surgery performed. Longer follow-up is needed to examine the effect on survival in individuals without diabetes who undergo bariatric surgery. These results suggest priority considerations for bariatric surgery candidates.
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Chiappe EL, Martin M, Molli AI, Millan A, Tetzlaff W, Botta E, Ferraro F, Sáez MS, Lorenzon Gonzalez MV, Boero L, Sorroche P, Beskow A, Gutierrez M, Cerrone G, Gutt S, Frechtel G, Brites F. Effect of Roux-en-Y Gastric Bypass on Lipoprotein Metabolism and Markers of HDL Functionality in Morbid Obese Patients. Obes Surg 2020; 31:1092-1098. [PMID: 33128217 DOI: 10.1007/s11695-020-05076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Morbid obesity represents the most severe form of obesity and surgical intervention would be its only successful treatment. Bariatric surgery could generate modifications in carbohydrate metabolism and in lipid profile plus lipoprotein-associated proteins and enzymes, such as lipoprotein-associated phoslipase A2 (Lp-PLA2), cholesteryl ester transfer protein (CETP), and paraoxonase (PON) 1. The aim of the present study was to analyze changes in inflammation markers, carbohydrate metabolism, and lipid parameters in patients who underwent bariatric surgery. METHODS Thirty-seven patients with morbid obesity were recruited. Evaluations were performed before (T0) and 1 (T1) and 6 (T2) months after surgery. Glucose, insulin, high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apolipoproteins (apo) A-I, and B plus Interleukin 1β and 6 levels in addition to CETP, Lp-PLA2, and PON 1 activities were determined. RESULTS Body mass index decreased at T1 and T2 (p < 0.01). An improvement in all markers of insulin resistance (p < 0.05) was observed at T1. hsCRP levels diminished at T2 (p < 0.05). Triglyceride levels decreased at T1 and T2 (p < 0.05). HDL-C and apo A-I showed a decrease at T1 which was completely reversed at T2 (p < 0.05). Lp-PLA2 activity increased at T1, which was reversed at T2 (p < 0.05), and CETP activity was diminished at T2 (p < 0.05). PON and ARE activities decreased at T1 and partially recovered at T2 (p < 0.05). CONCLUSIONS These results would be indicative of a favorable effect of bariatric surgery on markers of carbohydrate metabolism and cardiovascular disease lipid risk factors.
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Affiliation(s)
- Ezequiel Lozano Chiappe
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Maximiliano Martin
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina.
| | - Andrea Iglesias Molli
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Andrea Millan
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Walter Tetzlaff
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Eliana Botta
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Florencia Ferraro
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Maria S Sáez
- Laboratorio Central, Hospital italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Maria V Lorenzon Gonzalez
- Laboratorio Central, Hospital italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Laura Boero
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Patricia Sorroche
- Laboratorio Central, Hospital italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Axel Beskow
- Servicio de Clinica Médica, Sección Nutrición, Hospital italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Mercedes Gutierrez
- Servicio de Clinica Médica, Sección Nutrición, Hospital italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Gloria Cerrone
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Susana Gutt
- Servicio de Clinica Médica, Sección Nutrición, Hospital italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Gustavo Frechtel
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Fernando Brites
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
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Ilyas S, Al-Refai R, Maharjan R, Diaz Bustamante L, Ghattas KN, Khan S. Bariatric Surgery and Type 2 Diabetes Mellitus: Assessing Factors Leading to Remission. A Systematic Review. Cureus 2020; 12:e9973. [PMID: 32983676 PMCID: PMC7510520 DOI: 10.7759/cureus.9973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/05/2022] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) is a health problem of paramount proportions and is associated with significant morbidity and mortality. Our study aims to review data published on the effects of different types of bariatric surgeries on T2DM remission, compared to lifestyle and medical intervention (LMI) exclusively, along with a comprehensive finding of numerous preoperative factors that lead to remission. We used PubMed, PubMed Central (PMC), and MEDLINE to search for literature. Our criteria included peer-reviewed, English language articles published in 2010 and onwards, consisting of adults with T2DM and a body mass index (BMI) of >30 kg/m2 as the population of interest. Twenty-four articles with 5,411 patients were selected for this systematic review, which included nine randomized controlled trials (RCTs) and 15 observational studies. The primary endpoint was T2DM remission. Based on the review, bariatric surgery is superior to LMI in inducing remission in T2DM, especially when employing the Roux-en-Y Gastric Bypass (RYGB) technique. Lower age of onset and shorter duration of T2DM, along with a high BMI are some of the factors that can lead to greater remission rates. Further research in RCTs is needed by incorporating double/triple-blind protocols, a standard definition of T2DM remission, long follow-up periods to evaluate for relapses in remission and any side effects, with a focus on inflammatory markers (eg, osteopontin), scoring systems (eg, DiaRem), and benefits of One-Anastomosis Gastric Bypass (OAGB) over other modalities, to advance our understanding of T2DM remission.
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Affiliation(s)
- Shahbakht Ilyas
- Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Medicine and Surgery, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Reham Al-Refai
- Pathology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Reeju Maharjan
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Liliana Diaz Bustamante
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Kyrillos N Ghattas
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Internal Medicine, Assiut University, Assiut, EGY
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Zuo D, Xiao X, Yang S, Gao Y, Wang G, Ning G. Effects of bariatric surgery in Chinese with obesity and type 2 diabetes mellitus: A 3-year follow-up. Medicine (Baltimore) 2020; 99:e21673. [PMID: 32846783 PMCID: PMC7447381 DOI: 10.1097/md.0000000000021673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The incidence of obesity and type 2 diabetes mellitus is growing, and bariatric surgery was applied as a new therapy in the past few decades. However, bariatric surgery started rather late in China, and the number of surgeries and the follow-up data is limited.We assessed body weight, glucose, lipid levels, and blood pressure at baseline and 6-month, 1-year, 3-year in patients who underwent bariatric surgery. Vitamins and trace elements were investigated at 3-year after surgery. The quality of life was assessed at 3-year and compared with the control group.In total 20 patients were recruited in the study, and all the 20 patients underwent surgery and completed all follow-ups. Results showed that the body weight, body mass index, glycated hemoglobin (HbA1C), glucose, and insulin level were decreased, and islet function improved significantly in 6-month and 1-year (P < .001), and the changes were more obvious in the first 6 months. However, all the indexes rebound significantly at the 3-year (P < .05), but still better than baseline (P < .05). Weight regain was 50% after 3 years, and the mean weight regain rate was 31.45%. Besides, blood pressure and lipid levels decreased significantly compared with baseline (P < .001). At the 3-year follow-up, we found that 100% of the patients showed vitamin D deficiency, 50% calcium deficiency, 20% vitamin B12 deficiency, 20% iron deficiency, and 15% suffered from anemia. Compared with the control group, the quality of life was better in patients who underwent surgery, especially in the physical health (P < .05).The current study showed that the body weight, glucose and islet function improved significantly after bariatric surgery, and the indexes changed mainly in the first 6 months, but there seemed to be a rebound after 3 years. Furthermore, the surgery may improve the blood pressure, lipid profile, and the quality of life. However, some patients may suffer anemia, calcium deficiency, iron deficiency, vitamin D, and vitamin B12 deficiency after 3 years.
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Affiliation(s)
- Didi Zuo
- The First Hospital of Jilin University, Changchun, Jilin Province
| | - Xianchao Xiao
- The First Hospital of Jilin University, Changchun, Jilin Province
| | - Shuo Yang
- The First Hospital of Jilin University, Changchun, Jilin Province
| | - Yuan Gao
- The First Hospital of Jilin University, Changchun, Jilin Province
| | - Guixia Wang
- The First Hospital of Jilin University, Changchun, Jilin Province
| | - Guang Ning
- The First Hospital of Jilin University, Changchun, Jilin Province
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University, Shanghai, China
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McInnes N, Hall S, Sultan F, Aronson R, Hramiak I, Harris S, Sigal RJ, Woo V, Liu YY, Gerstein HC. Remission of Type 2 Diabetes Following a Short-term Intervention With Insulin Glargine, Metformin, and Dapagliflozin. J Clin Endocrinol Metab 2020; 105:5836895. [PMID: 32403130 DOI: 10.1210/clinem/dgaa248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/12/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine diabetes remission following a short-term intensive metabolic intervention combining lifestyle and glucose-lowering approaches. METHODS We conducted an open-label, randomized controlled trial in 154 patients with type 2 diabetes up to 8 years in duration on 0 to 2 glucose-lowering medications. Participants were randomized to (a) a 12-week intensive intervention comprising lifestyle approaches and treatment with insulin glargine, metformin, and dapagliflozin or (b) standard diabetes care. At 12 weeks, diabetes medications were discontinued in participants with hemoglobin A1c (HbA1C) < 7.3% (56 mmol/mol). Participants were then followed for diabetes relapse until 64 weeks. The primary outcome was complete or partial diabetes remission (HbA1C < 6.5% [48 mmol/mol] off chronic diabetes drugs) at 24 weeks. Main secondary outcomes were complete or partial diabetes remission at 36, 48, and 64 weeks. RESULTS The primary outcome was achieved in 19 (24.7%) intervention group participants and 13 (16.9%) control group participants at 24 weeks (relative risk [RR] 1.5; 95% confidence interval [CI], 0.8-2.7). The relative risks of remission at 36, 48, and 64 weeks were 2.4 (95% CI, 1.2-5.0), 2.1 (95% CI, 1.0-4.4), and 1.8 (95% CI, 0.7-4.7), respectively. In an exploratory analysis, the intervention reduced the hazard of diabetes relapse with overt hyperglycemia by 43% (hazard ratio 0.57; 95% CI, 0.39-0.81). CONCLUSIONS Our primary outcome of diabetes remission at 24 weeks was not statistically significantly different. However, our overall results suggest that some patients with early type 2 diabetes are able to achieve sustained diabetes remission following a short-term intensive intervention. Further studies are needed to optimize the combined therapeutic approach used.
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Affiliation(s)
- Natalia McInnes
- McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stephanie Hall
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Ronnie Aronson
- LMC Diabetes and Endocrinology Community Practice, Toronto, Ontario, Canada
| | | | | | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yan Yun Liu
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Misra S, Nandhini BD, Christinajoice S, Kumar SS, Prabhakaran S, Palanivelu C, Raj PP. Is Laparoscopic Roux-en-Y Gastric Bypass Still the Gold Standard Procedure for Indians? Mid- to Long-Term Outcomes from a Tertiary Care Center. Obes Surg 2020; 30:4482-4493. [PMID: 32725594 DOI: 10.1007/s11695-020-04849-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Laparoscopic Roux-en-Y gastric bypass (RYGB) is the oldest and most widely performed bariatric surgery worldwide. There is, however, a scarcity of mid- to long-term data of RYGB, especially from the Indian subcontinent. MATERIALS AND METHODS The study was a single-center, retrospective analysis from patients who underwent RYGB between January 2009 and November 2014 from a tertiary care center in India. Percent of total weight loss (%TWL) was taken as the primary outcome of the study. Secondary outcomes included type 2 diabetes mellitus (T2DM) remission, comorbidity resolution, revisional surgeries, and complications related to RYGB at 1 year, at 3 years, and during the long term, following surgery. Postoperative visits took place at 1 and 3 years, while the long-term outcome was at median 8.3 years (range 5.4-11.2 years), with a follow-up of 92.4% (488/528), 80.5% (424/527) and 69.5% (363/522), respectively. RESULTS Out of 528 patients studied, 56% were females. The mean body mass index (BMI) was 40.6 ± 6.9 kg/m2. The %TWL in the long-term follow-up was 21.8 ± 11.3%. T2DM remission rates at 1 year, at 3 years, and during the long term were 84.5%, 70.0%, and 60.0%, respectively. Preoperative HBA1c (p = 0.002) and insulin usage (p = 0.016) had a significant predictive effect on T2DM remission. Gastroesophageal reflux disease (GERD) improved significantly (p < 0.001). Early (< 30 days) and late (> 30 days) complications were observed in 2.3% and 4.3% of the patients, respectively. CONCLUSION Weight loss during mid to long-term follow-up was maintained in the majority of the patients after RYGB. However, a small proportion had significant weight regain in the long term. T2DM, GERD, and other comorbidities were well improved after RYGB.
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Affiliation(s)
- Shivanshu Misra
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - B Deepa Nandhini
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Christinajoice
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Saravana Kumar
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Prabhakaran
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - C Palanivelu
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - P Praveen Raj
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India.
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Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes 2019. Diabetol Int 2020; 11:165-223. [PMID: 32802702 PMCID: PMC7387396 DOI: 10.1007/s13340-020-00439-5] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Tatsuya Kondo
- Department of Diabetes, Metabolism and Endocrinology, Kumamoto University Hospital, Kumamoto, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Japan
| | - Hiroshi Noto
- Division of Endocrinology and Metabolism, St. Luke’s International Hospital, Tokyo, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akihiko Taguchi
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yukio Tanizawa
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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30
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Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes 2019. J Diabetes Investig 2020; 11:1020-1076. [PMID: 33021749 PMCID: PMC7378414 DOI: 10.1111/jdi.13306] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Eiichi Araki
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Atsushi Goto
- Department of Health Data ScienceGraduate School of Data ScienceYokohama City UniversityYokohamaJapan
| | - Tatsuya Kondo
- Department of Diabetes, Metabolism and EndocrinologyKumamoto University HospitalKumamotoJapan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and EndocrinologyIchikawa HospitalInternational University of Health and WelfareIchikawaJapan
| | - Hiroshi Noto
- Division of Endocrinology and MetabolismSt. Luke's International HospitalTokyoJapan
| | - Hideki Origasa
- Department of Biostatistics and Clinical EpidemiologyGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular GeneticsEhime University Graduate School of MedicineToonJapan
| | - Akihiko Taguchi
- Department of Endocrinology, Metabolism, Hematological Science and TherapeuticsGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Yukio Tanizawa
- Department of Endocrinology, Metabolism, Hematological Science and TherapeuticsGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Kazuyuki Tobe
- First Department of Internal MedicineGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
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Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Chalopin S, Betry C, Coumes S, Wion N, Reche F, Arvieux C, Borel AL. Benefits and risks of bariatric surgery in patients with bipolar disorders. Surg Obes Relat Dis 2020; 16:798-805. [PMID: 32209316 DOI: 10.1016/j.soard.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of bipolar disorders in patients requesting bariatric surgery is estimated to be 1.5% to 3.4%. There are currently no specific recommendations regarding the way bariatric surgery should be managed in the context of bipolar disorder. The aim was to document the benefit-risk of bariatric surgery in patients with bipolar disorders. A systematic literature review was carried out. In addition, results were reported from a survey of current clinical practice in French referent centers for obesity care. Finally, 3 clinical cases from the "Severe Obesity Outcome Network" cohort are described. This systematic review shows there are few studies in the literature regarding the outcomes of bariatric surgery in patients with bipolar disorders and no randomized, controlled trials. Weight loss appeared similar in all patients, but psychiatric complications were sometimes reported in those with bipolar disorders. Almost all 11 referent centers for obesity care that responded had carried out bariatric surgery in patients with stable bipolar disorders. Postsurgical psychiatric destabilization occurred and included, at least, a need to reinforce treatment and follow-up. In the 3 case studies, postsurgical manic or hypomanic decompensation occurred. Thus, although effective in terms of weight loss, bariatric surgery could be a destabilizing factor for those with bipolar disorders. Current practice is to contraindicate surgery in patients with unstable disorders. There are insufficient data to conclude on the benefits and safety of bariatric surgery in patients with stable bipolar disease. Further studies are required to fully determine the benefits and risks.
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Affiliation(s)
- Sarah Chalopin
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Cécile Betry
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Sandrine Coumes
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Nelly Wion
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Fabian Reche
- Digestive Surgery, University Hospital Grenoble Alpes, Grenoble, France
| | - Catherine Arvieux
- Digestive Surgery, University Hospital Grenoble Alpes, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France; Hypoxia Physiopathology (HP2) Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France.
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Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition in Obese Females with Type 2 Diabetes Mellitus: Results After 1-Year Follow-up. Obes Surg 2020; 29:805-810. [PMID: 30448981 DOI: 10.1007/s11695-018-3603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To present the early metabolic effects of sleeve gastrectomy with transit bipartition (SG + TB) procedure in female obese patients with type 2 diabetes mellitus (T2DM). METHODS This prospective clinical study was carried out between January 2016 and June 2017. Inclusion criteria were female participants under 60 years old with T2DM, body mass index ≥ 40 kg/m2 and HbA1c level ≥ 8%. All patients underwent to SG + TB procedure. Primary outcomes were the glycemic control variables, and the secondary outcomes were weight loss and dyslipidemia levels up to the last follow-up point. RESULTS A total of 35 female participants with an average age of 48.8 ± 6.0 years old and a mean preoperative BMI of 42.0 ± 1.3 kg/m2 were included during the study period. Diabetic remission was achieved in 88.6% of patients (n = 31) on the third month without any antidiabetic medications. The mean postoperative BMI of patients was 24.8 ± 1.6 kg/m2, and dyslipidemia levels were significiantly lower at the last follow-up point of all patients. CONCLUSIONS SG + TB procedure may be a potent therapeutic option for the treatment of obese patients with T2DM.
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Courcoulas AP, Gallagher JW, Neiberg RH, Eagleton EB, DeLany JP, Lang W, Punchai S, Gourash W, Jakicic JM. Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial. J Clin Endocrinol Metab 2020; 105:5699613. [PMID: 31917447 PMCID: PMC7032894 DOI: 10.1210/clinem/dgaa006] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment. OBJECTIVE Compare the remission of T2DM following surgical or nonsurgical treatments. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016. INTERVENTIONS 61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years. MAIN OUTCOMES AND MEASURES Diabetes remission assessed at 5 years. RESULTS The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01). CONCLUSIONS Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.
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Affiliation(s)
- Anita P Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Correspondence and Reprint Requests: Anita P. Courcoulas, MD, MPH, Department of Surgery, University of Pittsburgh, 3380 Boulevard of the Allies, Suite 390, Pittsburgh, PA 15213. E-mail:
| | - James W Gallagher
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily B Eagleton
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James P DeLany
- Translational Research Institute for Metabolism and Diabetes, AdventHealth, Orlando, Florida
| | - Wei Lang
- UniversitätsSpital Zürich Zentrum Alter und Mobilität, Zürich, Switzerland
| | - Suriya Punchai
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - William Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John M Jakicic
- Physical Activity and Weight Management Research Center, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Sheehan A, Patti ME. Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment. Diabetes Metab Syndr Obes 2020; 13:4469-4482. [PMID: 33239898 PMCID: PMC7682607 DOI: 10.2147/dmso.s233078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Post-bariatric hypoglycemia (PBH) is an increasingly encountered complication of upper gastrointestinal surgery; the prevalence of this condition is anticipated to rise given yearly increases in bariatric surgical procedures. While PBH is incompletely understood, there is a growing body of research describing the associated factors, mechanisms, and treatment approaches for this condition. EVIDENCE ACQUISITION Data are integrated and summarized from studies of individuals affected by PBH and hypoglycemia following upper gastrointestinal surgery obtained from PubMed searches (1990-2020). EVIDENCE SYNTHESIS Information addressing etiology, incidence/prevalence, clinical characteristics, assessment, and treatment were reviewed and synthesized for the practicing physician. Literature reports were supplemented by clinical experience as indicated, when published data were not available. CONCLUSION PBH can be life-altering and severe for a subset of individuals. Given the chronic nature of this condition, and sequelae of both acute and recurrent episodes, increasing provider awareness of both the condition and associated risk factors is critical for assessment, prompt diagnosis, treatment, and preoperative identification of individuals at risk.
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Affiliation(s)
- Amanda Sheehan
- Research Division, Joslin Diabetes Center, Boston, MA, USA
| | - Mary Elizabeth Patti
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Correspondence: Mary Elizabeth Patti Research Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA02215, USATel +1 617-309-1966Fax +1 617-309-2593 Email
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Hastuti AAMB, Costas-Rodríguez M, Anoshkina Y, Parnall T, Madura JA, Vanhaecke F. High-precision isotopic analysis of serum and whole blood Cu, Fe and Zn to assess possible homeostasis alterations due to bariatric surgery. Anal Bioanal Chem 2019; 412:727-738. [PMID: 31836925 DOI: 10.1007/s00216-019-02291-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/02/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
Bariatric surgery is an effective procedure to achieve weight loss in obese patients. However, homeostasis of essential metals may be disrupted as the main absorption site is bypassed. In this study, we determined Cu, Fe and Zn isotopic compositions in paired serum and whole blood samples of patients who underwent Roux-en-Y gastric bypass (RYGB) surgery for evaluation of longitudinal changes and their potential relation to mineral element concentrations and relevant clinical parameters used for monitoring the patient's condition. Samples from eight patients were collected pre-surgery and at 3, 6 and 12 months post-surgery. Multi-collector inductively coupled plasma-mass spectrometry (MC-ICP-MS) was used for high-precision isotope ratio measurements. Alterations in metal homeostasis related to bariatric surgery were reflected in the serum and whole blood Cu, Fe and Zn isotopic compositions. The serum and whole blood Cu became isotopically lighter (lower δ65Cu values) after bariatric surgery, reaching statistical significance at 6 months post-surgery (p < 0.05). The difference between the serum and the whole blood Zn isotopic composition increased after surgery, reaching significance from 6 months post-surgery onwards (p < 0.05). Those changes in Cu, Fe and Zn isotopic compositions were not accompanied by similar changes in their respective concentrations, making isotopic analysis more sensitive to physiological changes than elemental content. Furthermore, the Zn isotopic composition correlates with blood glycaemic and lipid parameters, while the Fe isotopic composition correlates with glycaemic parameters. Graphical Abstract.
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Affiliation(s)
- Agustina A M B Hastuti
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281 - S12, 9000, Ghent, Belgium
| | - Marta Costas-Rodríguez
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281 - S12, 9000, Ghent, Belgium
| | - Yulia Anoshkina
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281 - S12, 9000, Ghent, Belgium
| | - Taylor Parnall
- Department of General Surgery, Mayo Clinic, 5779 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - James A Madura
- Department of General Surgery, Mayo Clinic, 5779 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Frank Vanhaecke
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281 - S12, 9000, Ghent, Belgium.
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Jackson HT, Anekwe C, Chang J, Haskins IN, Stanford FC. The Role of Bariatric Surgery on Diabetes and Diabetic Care Compliance. Curr Diab Rep 2019; 19:125. [PMID: 31728654 PMCID: PMC7205514 DOI: 10.1007/s11892-019-1236-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Bariatric surgery is a durable and long-term solution to treat both obesity and its associated comorbidities, specifically type 2 diabetes mellitus (T2DM). Many studies have demonstrated the benefits of bariatric surgery on T2DM, but weight recidivism along with recurrence of comorbidities can be seen following these procedures. Patient compliance post-bariatric surgery is linked to weight loss outcomes and comorbidity improvement/resolution. The role of compliance with respect to T2DM medication in bariatric patients specifically has not recently been examined. This article seeks to review the role of bariatric surgery on short- and long-term resolution of T2DM, recurrence, and compliance with T2DM medication following bariatric surgery. RECENT FINDINGS Seven randomized control trials have examined metabolic surgery versus medical therapy in glycemic control in patients meeting criteria for severe obesity. Six out of seven studies demonstrate a significant advantage in the surgical arms with regards to glycemic control, as well as secondary endpoints such as weight loss, serum lipid levels, blood pressure, renal function, and other parameters. While patient compliance with lifestyle modifications post-bariatric surgery is linked to weight loss outcomes, there are no studies to date that directly evaluate the role of lifestyle modifications and T2DM medication adherence in the management of T2DM post-bariatric surgery. Bariatric surgery is an effective treatment option to achieve long-term weight loss and resolution of obesity-related medical comorbidities, specifically T2DM. Patient compliance to lifestyle modifications post-bariatric surgery is linked to weight loss outcomes and comorbidity resolution. The role of diabetic care compliance in bariatric patient outcomes, however, is poorly understood. Further studies are needed to elucidate the predictors and associated risk factors for non-compliance in this patient population.
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Affiliation(s)
- Hope T Jackson
- Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
| | - Chika Anekwe
- Harvard Medical School, Boston, MA, USA
- Internal Medicine-Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, USA
| | - Julietta Chang
- Weight Loss Surgical Institute of Central Coast, Marian Regional Medical Center, Santa Monica, CA, USA
| | - Ivy N Haskins
- Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, USA
- Internal Medicine-Neuroendocrine Unit and Pediatrics Endocrinology, Massachusetts General Hospital, Boston, MA, USA
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Yan Y, Sha Y, Huang X, Yuan W, Wu F, Hong J, Fang S, Huang B, Hu C, Wang B, Zhang X. Roux-en-Y Gastric Bypass Improves Metabolic Conditions in Association with Increased Serum Bile Acids Level and Hepatic Farnesoid X Receptor Expression in a T2DM Rat Model. Obes Surg 2019; 29:2912-2922. [DOI: 10.1007/s11695-019-03918-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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de Moura EGH, Ponte-Neto AM, Tsakmaki A, Aiello VD, Bewick GA, Brunaldi VO. Histologic assessment of the intestinal wall following duodenal mucosal resurfacing (DMR): a new procedure for the treatment of insulin-resistant metabolic disease. Endosc Int Open 2019; 7:E685-E690. [PMID: 31098390 PMCID: PMC6519358 DOI: 10.1055/a-0862-0263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/29/2019] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background and study aims Minimally invasive procedures that replicate aspects of bariatric surgery with more favorable safety and tolerability offer an attractive alternative in management of metabolic disease. Duodenal mucosal resurfacing (DMR), an endoscopic procedure using hydrothermal ablation, is designed to remove surface epithelium to allow subsequent epithelial regeneration and a reset to a more insulin-sensitive state.
Materials and methods DMR was performed on a healthy pig under general anethesia, approximating the procedure designed for use in humans. Immediately post-DMR, analysis of the histological landscape was conducted in distinct duodenal areas that received ablation treatment.
Results DMR submucosal lift and hydrothermal ablation elicited disruption of villous tips and partial disruption of the crypt base with no damage to deeper tissue. Excessive ablation (purposeful double ablation exposure) did incur damage to the underlying muscle layer.
Conclusion Our results confirmed that DMR elicits superficial ablation of duodenal villi and crypts. Defining the cellular consequences of ablation and regeneration of the epithelium will aid our understanding of how and why DMR affects metabolic homeostasis.
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Affiliation(s)
- Eduardo G. H. de Moura
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alberto M. Ponte-Neto
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
| | - Anastasia Tsakmaki
- Diabetes Research Group, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Vera Demarchi Aiello
- Laboratory of Pathology, Hearth Institute (InCor), Hospital das Clínicas da Faculdade de Medicine da Universidade de São Paulo, Brazil
| | - Gavin A. Bewick
- Diabetes Research Group, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK,Corresponding author Gavin A. Bewick, PhD School of Life Course Sciences6N5 Commonwealth BuildingHammersmith CampusKing’s College LondonLondon SE1 1ULUK+44 (0)73 4459 3806
| | - Vitor O. Brunaldi
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
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De Moura EGH, de Moura DTH, Galvão-Neto M, Sakai CM, Silva GLR, Bazarbashi AN, Thompson CC. Endoscopic Management of Anchor Erosion Adjacent to the Pylorus Following Duodenal-Jejunal Bypass Sleeve. Obes Surg 2019; 29:2003-2004. [PMID: 30972635 DOI: 10.1007/s11695-019-03855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Obesity is a pandemic associated with significant comorbidities such as type 2 diabetes (T2DM). RYGB is an effective treatment modality for obesity and T2DM. However, bariatric surgery is currently limited to a relatively small population of patients. The duodenal-jejunal bypass sleeve (DJBS) has recently emerged as a promising therapy for obesity and T2DM by providing similar physiological effects to RYGB. We describe a case of a patient with a previously placed DJBS presenting with abdominal pain from anchor erosion managed with an endoscopic approach. METHODS A 58-year-old man with obesity and T2DM who had failed prior medical therapy for obesity was referred for DJBS placement. This was placed without complications. At 8 weeks follow-up, he developed abdominal pain and vomiting prompting immediate endoscopic evaluation. RESULTS EGD revealed an anchor erosion resulting in mild stenosis of the pylorus. Additionally, hyperplastic tissue was found to be adhered to the device in the duodenal bulb. Endoscopic removal with balloon dilation was unsuccessful, and a stent was placed in a "stent-in-stent" fashion through the sleeve to compress the area of tissue ingrowth encouraging local tissue necrosis and device extraction. At 15 days follow-up, the stent was removed; however, the DJBS remained adhered and immobile. Next, the ingrowing hyperplastic tissue was resected in a piecemeal fashion. This resulted in mobilization of the sleeve anchors in the duodenal bulb and successful removal of the DJBS. CONCLUSIONS DJBS endoscopic removal is safe and effective even in challenging cases, thus preventing the need for surgical intervention.
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Affiliation(s)
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, São Paulo, SP, Brazil.,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1404, Boston, MA, 02115, USA
| | | | - Christiano Makoto Sakai
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, São Paulo, SP, Brazil
| | - Gustavo Luis Rodela Silva
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, São Paulo, SP, Brazil
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1404, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1404, Boston, MA, 02115, USA.
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Abstract
In recent years the surgical treatment of metabolic diseases has become established as an effective alternative to conservative treatment. The new S3 guidelines address these changes and give clear indications for obesity surgery. One of the core points of the new guidelines is the differentiation between obesity surgery and metabolic surgery. In obesity surgery the primary aim of treatment is weight loss whereas for metabolic indications the aim is an improvement of comorbidities independent of the body mass index (BMI). With respect to the selection of procedures sleeve gastrectomy (SG) and the traditional Roux-en-Y gastric bypass (RYGB) can be used as safe and evidence-based operative procedures. The RYGB has better metabolic effects but higher complication and reintervention rates. More recent procedures, such as the one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal (SADI) bypass possibly have slightly stronger metabolic effects, however, the risk of malnutrition and vitamin deficiency is higher.
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Affiliation(s)
- A T Billeter
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - B P Müller-Stich
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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Pérez-Pevida B, Escalada J, Miras AD, Frühbeck G. Mechanisms Underlying Type 2 Diabetes Remission After Metabolic Surgery. Front Endocrinol (Lausanne) 2019; 10:641. [PMID: 31608010 PMCID: PMC6761227 DOI: 10.3389/fendo.2019.00641] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/04/2019] [Indexed: 01/19/2023] Open
Abstract
Type 2 diabetes prevalence is increasing dramatically worldwide. Metabolic surgery is the most effective treatment for selected patients with diabetes and/or obesity. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving glycemic improvement, reducing number of medications and cardiovascular risk factors, which translates in long-term benefits on cardiovascular morbidity and mortality. The mechanisms underlying diabetes improvement after metabolic surgery have not yet been clearly understood but englobe a complex interaction among improvements in beta cell function and insulin secretion, insulin sensitivity, intestinal gluconeogenesis, changes in glucose utilization, and absorption by the gut and changes in the secretory pattern and morphology of adipose tissue. These are achieved through different mediators which include an enhancement in gut hormones release, especially, glucagon-like peptide 1, changes in bile acids circulation, gut microbiome, and glucose transporters expression. Therefore, this review aims to provide a comprehensive appraisal of what is known so far to better understand the mechanisms through which metabolic surgery improves glycemic control facilitating future research in the field.
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Affiliation(s)
- Belén Pérez-Pevida
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, United Kingdom
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- *Correspondence: Belén Pérez-Pevida
| | - Javier Escalada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Alexander D. Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Gema Frühbeck
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45
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Is Bypassing the Stomach a Means to Optimize Sodium Bicarbonate Supplementation? A Case Study With a Postbariatric Surgery Individual. Int J Sport Nutr Exerc Metab 2018; 28:660-663. [DOI: 10.1123/ijsnem.2017-0394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is increasing in prevalence and associated with numerous metabolic complications leading to increased mortality and costs. Metabolic surgery, or surgery to treat T2DM and obesity, is effective at achieving remission from T2DM. This review discusses the most commonly used surgical options including the adjustable gastric band, the Roux-en-Y gastric bypass, the sleeve gastrectomy, and the biliopancreatic diversion with duodenal switch and their ability to treat and prevent T2DM. RECENT FINDINGS There is an increasing body of literature that justifies the inclusion of metabolic surgery into the treatment algorithm for patients with obesity and T2DM. Metabolic procedures should be performed at centers that offer comprehensive treatment of metabolic disorders and have expertise in gastrointestinal surgery. The incremental improvement in the quality and safety of metabolic surgery has significantly reduced the risk of serious post-operative complications. Metabolic surgery is a safe and effective treatment option for obese patients with T2DM.
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Affiliation(s)
- Eric Rachlin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM 390, Houston, TX, 77030, USA
| | - Carlos Galvani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM 390, Houston, TX, 77030, USA.
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Dong Z, Islam SMS, Yu AM, Qu R, Guan B, Zhang J, Hong Z, Wang C. Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis. BMC Surg 2018; 18:73. [PMID: 30223815 PMCID: PMC6142391 DOI: 10.1186/s12893-018-0406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis. Methods We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis. Results In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m2 to < 35 kg/m2 in Asia. Conclusions Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m2, and that LSG is the most commonly performed surgical procedure for this in Asia.
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Affiliation(s)
- Zhiyong Dong
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | | | - Ashley M Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rui Qu
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Bingsheng Guan
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Junchang Zhang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Zhao Hong
- Robert H Lurie Medical Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Cunchuang Wang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China.
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Raveendran AV, Chacko EC, Pappachan JM. Non-pharmacological Treatment Options in the Management of Diabetes Mellitus. EUROPEAN ENDOCRINOLOGY 2018; 14:31-39. [PMID: 30349592 PMCID: PMC6182920 DOI: 10.17925/ee.2018.14.2.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 02/05/2023]
Abstract
The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.
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Affiliation(s)
| | - Elias C Chacko
- Department of Endocrinology, Jersey General Hospital, Jersey
| | - Joseph M Pappachan
- Department of Endocrinology, Diabetes & Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, UK
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Azagury D, Papasavas P, Hamdallah I, Gagner M, Kim J. ASMBS Position Statement on medium- and long-term durability of weight loss and diabetic outcomes after conventional stapled bariatric procedures. Surg Obes Relat Dis 2018; 14:1425-1441. [PMID: 30242000 DOI: 10.1016/j.soard.2018.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Dan Azagury
- Bariatric & Minimally Invasive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Isam Hamdallah
- Bariatric Surgery Center, Saint Agnes Hospital, Baltimore, Maryland
| | - Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Hôpital du Sacre Coeur, Montreal, Canada
| | - Julie Kim
- Weight Management Center, Mount Auburn Hospital, Cambridge, Massachusetts
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50
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Billeter AT, de la Garza Herrera JR, Scheurlen KM, Nickel F, Billmann F, Müller-Stich BP. MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol 2018; 179:R77-R93. [PMID: 29764908 DOI: 10.1530/eje-18-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Katharina M Scheurlen
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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