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Obeso-Fernández J, Millan-Alanis JM, Sáenz-Flores M, Rodríguez-Bautista M, Medrano-Juarez S, Oyervides-Fuentes S, Gonzalez-Cruz D, Manzanares-Gallegos DM, González-González JG, Rodríguez-Gutiérrez R. Benefits of metabolic surgery on macrovascular outcomes in adult patients with type 2 diabetes: a systematic review and meta-analysis. Surg Obes Relat Dis 2024; 20:202-212. [PMID: 37845131 DOI: 10.1016/j.soard.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/02/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Abstract
Type 2 diabetes (T2D) is a chronic metabolic disorder that affects millions of individuals associated with an increased risk of mortality and macrovascular complications. We aimed to synthesize the benefit of metabolic surgery (MS) on macrovascular outcomes in adult patients with T2D.We included both cohort studies and randomized controlled trials (RCTs) that evaluated MS added to medical therapy compared with medical therapy alone in the treatment of adult patients with T2D. Studies must have evaluated the incidence of any macrovascular complication of the disease for a period of at least 6 months. We performed our search using PubMed, Scopus, EMBASE, Web of Science, and COCHRANE Central database which was performed from inception date until March 2022. The trial protocol was previously registered at PROSPERO (CRD42021243739). A total of 6338 references were screened throughout the selection process from which 16 studies involving 179,246 participants fulfilled inclusion criteria. MS reduced the risk of any cardiovascular event by 44% (relative risk .56 [95% CI, .42-.75]; P = < .001), myocardial infarction by 54% (.46 [95% CI, .26-.83]; P = .009), coronary artery disease by 40% (.60 [95% CI, .42-.85]; P = .004) and heart failure by 71% (.29 [95% CI, .14-.61]; P = .001). It also provided a risk reduction of stroke by 29% (.71 [95% CI, .51-.99]; P = .04) and 38% (.62 [95% CI, .46-.85]; P = .001) for cerebrovascular events. On mortality, MS yields a risk reduction of 55% (.45 [95% CI, .36-.57]; P <.001) in overall mortality and 69% in cardiovascular mortality (relative risk .31 [95% CI, .22-.42]; P < .001). Peripheral vascular disease risk was also reduced. MS in adult patients with T2D can reduce the risk of mortality and of any macrovascular outcomes. However, there is a need for the planning of randomized clinical trials to further analyze and confirm the results.
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Affiliation(s)
- Javier Obeso-Fernández
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Juan Manuel Millan-Alanis
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Melissa Sáenz-Flores
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Rodríguez-Bautista
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Samantha Medrano-Juarez
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Stephie Oyervides-Fuentes
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniela Gonzalez-Cruz
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Dulce Maria Manzanares-Gallegos
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - José Gerardo González-González
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, México.
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Obeso-Fernández J, Millan-Alanis JM, Rodríguez-Bautista M, Medrano-Juarez S, Oyervides-Fuentes S, Gonzalez-Cruz D, González-González JG, Rodríguez-Gutiérrez R. Benefits of bariatric surgery on microvascular outcomes in adult patients with type 2 diabetes: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:916-927. [PMID: 37169666 DOI: 10.1016/j.soard.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Microvascular diabetes complications impair patients' health-related quality of life. Bariatric surgery (BS) emerged as a compelling treatment that demonstrated to have beneficial effects on patients with diabetes and obesity. OBJECTIVE We aimed to synthesize the benefit of bariatric surgery on microvascular outcomes in adult patients with type 2 diabetes. SETTING 2011-2021. METHODS We included both cohort studies and randomized trials that evaluated bariatric surgery added to medical therapy compared with medical therapy alone in the treatment of adult patients with type 2 diabetes. Studies must have evaluated the incidence of any microvascular complication of the disease for a period of at least 6 months. We performed our search using PubMed, Scopus, EMBASE, Web of Science, and COCHRANE Central database which was performed from inception date until March 2021. PROSPERO (CRD42021243739). RESULTS A total of 25 studies (160,072 participants) were included. Pooled analysis revealed bariatric surgery to reduce the incidence of any stage of retinopathy by 71% (odds ratio [OR] .29; 95% confidence interval [CI] .10-.91), nephropathy incidence by 59% (OR .41; 95% CI 17-96), and hemodialysis/end-stage renal disease by 69% (OR .31 95% CI .20-.48). Neuropathy incidence revealed no difference between groups (OR .11; 95% CI .01-1.37). Bariatric surgery increased the odds of albuminuria regression by 15.15 (95% CI 5.96-38.52); higher odds of retinopathy regression were not observed (OR 3.73; 95% CI .29-47.71). There were no statistically significant differences between groups regarding the change in surrogate outcomes. CONCLUSIONS Bariatric surgery in adult patients with diabetes reduced the odds of any stage of retinopathy, hemodialysis/end-stage renal disease, and nephropathy composite outcome. However, its effect on many individual outcomes, both surrogates, and clinically significant, remains uncertain.
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Affiliation(s)
- Javier Obeso-Fernández
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Juan Manuel Millan-Alanis
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Rodríguez-Bautista
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Samantha Medrano-Juarez
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Stephie Oyervides-Fuentes
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniela Gonzalez-Cruz
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - José Gerardo González-González
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México.
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Yu Y, Groth SW. Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review. Obes Surg 2023; 33:2573-2582. [PMID: 37410260 DOI: 10.1007/s11695-023-06704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
The objective of this scoping review was to summarize the emerging literature on the use of continuous glucose monitoring (CGM) in post-bariatric surgery patients, with a focus on its features (e.g., device, mode, and accuracy), as well as purposes and outcomes of utilization. Three databases (PubMed, EMBASE, and Web of Science) were searched to obtain relevant studies. Results suggested that most studies used CGM for 3-7 days under blinded mode. Accuracy data were available in only one study, which reported a mean absolute relative difference of 21.7% for Freestyle Libre. The primary applications of CGM were for elucidating glucose patterns and assessing glycemic treatment outcomes. No study has tested the effect of CGM as an intervention strategy to enhance glucose control.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Vasdeki D, Koufakis T, Tsamos G, Busetto L, Zebekakis P, Kotsa K. Remission as an Emerging Therapeutic Target in Type 2 Diabetes in the Era of New Glucose-Lowering Agents: Benefits, Challenges, and Treatment Approaches. Nutrients 2022; 14:4801. [PMID: 36432488 PMCID: PMC9695991 DOI: 10.3390/nu14224801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease with a growing prevalence, associated with an increased risk of complications. The introduction of new classes of antidiabetic drugs into clinical practice has dramatically changed the landscape of diabetes therapy. However, despite the progress made in the pharmacotherapy of T2DM, mitigating the burden of the disease on individuals, societies and health care systems remains a challenge. Remission has recently emerged as a therapeutic target in T2DM, achievable through a wide range of interventions. Recent studies have shown that extensive lifestyle changes, such as weight reduction, bariatric surgery, and intensive glucose lowering therapy, can prompt the remission of diabetes, but some unanswered questions remain regarding its long-term effects on diabetic complications. Metabolic surgery and novel classes of glucose-lowering medications are currently the most effective interventions to induce weight loss and by extension remission in patients with diabetes; however, the ideal strategy to achieve the long-term maintenance of remission remains doubtful. In this narrative review, we discuss the available therapeutic approaches to target the remission of diabetes through personalized multimodal care, based on the latest evidence.
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Affiliation(s)
- Dimitra Vasdeki
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Theocharis Koufakis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Georgios Tsamos
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Luca Busetto
- Department of Medicine, University of Padova, 35121 Padova, Italy
| | - Pantelis Zebekakis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
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Flores JE, Berrones R, Guilbert L, Sepúlveda EM, Madrigal V, Hernández J, Zerrweck C. Complications Rate Variability after Bariatric Surgery and the Importance of Standardization of a Reporting System. J Gastrointest Surg 2022; 26:1154-1161. [PMID: 35230642 DOI: 10.1007/s11605-022-05280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rate of early (< 30 days) complications after bariatric surgery has been reported to be 0.4-27.4%. Although the incidence of serious adverse events has decreased with time and experience, controversy regarding how they are reported persists, and the current literature is heterogeneous. METHODS Data from patients, who underwent primary bariatric surgery (gastric bypass and sleeve gastrectomy) at a single institution between 2012 and 2018, were retrospectively reviewed. Any deviation from a "normal" postoperative course (< 30 days) was identified, and a comparative analysis of early complications according to five models was performed: modified Clavien-Dindo; Longitudinal Assessment of Bariatric Surgery (LABS); Bariatric Surgery Centers of Excellence (BSCOE); American Society for Metabolic and Bariatric Surgery (ASMBS); and Li (major/minor). RESULTS A total of 788 patients (83.7% gastric bypass), of whom 8.8% deviated from a "normal" postoperative course, were included. After applying the five classifications, the results were as follows: Clavien-Dindo, 8.8%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 9.9%; and Li, 11.2%. The incidence of major/severe/adverse outcomes were as follows: Clavien-Dindo, 2.4%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 6.9%; and Li 9.2%. Minor complications were as follows: Clavien-Dindo, 6.5%; ASMBS, 3%; and Li, 2%. There was no mortality. CONCLUSION Germane heterogeneity was found in reporting of early complications after bariatric surgery. Incidence varied according to classification system applied, and Clavien-Dindo demonstrated accuracy as a reporting model. To avoid bias, standardized reporting should be mandatory, and a more stringent and homogeneous reporting system should be established.
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Affiliation(s)
- J Eduardo Flores
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico
| | - Ricardo Berrones
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico
| | - Lizbeth Guilbert
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico
| | - Violeta Madrigal
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico
| | - Jorge Hernández
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico
| | - Carlos Zerrweck
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Alcaldía Tláhuac, 13250, Mexico City, Mexico.
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Chen G, Sun L, Jiang S, Chen X, Zhu J, Zhao X, Yu S, Dong Z, Chen Y, Zhang W, Yang W, Wang C. Effects of bariatric surgery on testosterone level and sexual function in men with obesity: A retrospective study. Front Endocrinol (Lausanne) 2022; 13:1036243. [PMID: 36760810 PMCID: PMC9902700 DOI: 10.3389/fendo.2022.1036243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Bariatric surgeries induce well-documented weight loss and resolve obesity comorbidities. Sexual function is one of the aspects of life quality and may benefit from surgery. Few studies have revealed the impact of bariatric surgeries on sexual function in Chinese men with obesity. METHODS This is a retrospective cohort study of patients undergoing bariatric surgery [laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB)]. Data were collected between September 2017 and February 2022. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Sex hormones and other blood tests were evaluated before and at least 1 year after the surgery. RESULTS Fifty-nine Chinese male patients completed the IIEF questionnaire. The multivariate logistic regression analysis revealed that body mass index (BMI) was the single independent risk factor of the severity of erectile dysfunction (ED). Preoperative testosterone levels had negative correlations with BMI and waist circumference. Thirty-seven patients completed the postoperative questionnaire with a mean follow-up of 23.2 months. CONCLUSION BMI and waist circumference were negatively correlated with testosterone levels. BMI was an independent risk factor for the severity of ED. LSG and LRYGB led to positive and sustained improvement in sexual function of men with obesity. The two procedures had a comparable effect, more subjects being needed. Sex hormone levels also could be reversible. However, more weight loss did not predict a positive change in sexual function. A greater BMI loss might predict a greater increase in testosterone.
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Affiliation(s)
- Guoji Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
- Department of Gastrointestinal Surgery, The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Luping Sun
- Department of urinary Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuwen Jiang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Xiaomei Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
| | - Jie Zhu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Xin Zhao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Shuqing Yu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Yuan Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Wen Zhang
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
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Ke Z, Zhou X, Sun F, Li F, Tong W, Zhu Z. Effect of bariatric surgery versus medical therapy on long-term cardiovascular risk in low BMI Chinese patients with type 2 diabetes: a propensity score-matched analysis. Surg Obes Relat Dis 2021; 18:475-483. [PMID: 34969592 DOI: 10.1016/j.soard.2021.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/07/2021] [Accepted: 11/14/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Reducing the risk of death due to cardiovascular disease (CVD) is an important direction for diabetes prevention and treatment. The Chinese population with type 2 diabetes (T2D) has a high risk of developing CVD at relatively low body mass index (BMI) levels. Currently, no studies have evaluated the effect of bariatric surgery versus medical therapy on long-term CVD risk in patients with T2D and low BMI. OBJECTIVES To compare bariatric surgery versus medical therapy for long-term CVD risk in Chinese patients with T2D and low BMI by using the China Prediction for ASCVD Risk equations and the United Kingdom Prospective Diabetes Study risk engine. SETTING University hospital, China. METHODS Medical records of patients with T2D with a BMI <35 kg/m2 undergoing bariatric surgery or medical therapy from May 2010 to December 2018 were reviewed. A 1:1 propensity score matching was performed by using 7 preoperative characteristics. Variables for calculating CVD risk scores over the 5-year follow-up were assessed. RESULTS A total of 684 patients with T2D underwent bariatric surgery (n = 75) or medical therapy (n = 609), and 52 pairs of matched subjects were selected from both groups after propensity score matching. The 10-year and lifetime atherosclerotic CVD risk by using the China Prediction for ASCVD Risk equation at 5 years follow-up period in the bariatric surgery group improved significantly compared with the medical therapy group. In the fifth year of follow-up, the 10-year risk of coronary heart disease, fatal coronary heart disease, stroke, and fatal stroke by using the United Kingdom Prospective Diabetes Study risk engine were much lower in the bariatric surgery group than in the medical therapy group (10.37 ± 5.64% versus 27.25 ± 7.28%, P = .004; 6.3 ± 4.5% versus 22.3 ± 7.35%, P = .002; 4.97 ± 3.73% versus 15.05 ± 3.63%, P = .001; .59 ± .45% versus 1.52 ± .14%, P < .001. respectively). The use of glucose-lowering medications, including insulin, was reduced from baseline in both groups, and patients in the bariatric surgery group required significantly fewer of these medications than those in the medical therapy group. CONCLUSION Bariatric surgery in patients with T2D and low BMI conferred a lower calculated risk of CVD compared with medical therapy over 5 years of follow-up.
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Affiliation(s)
- Zhigang Ke
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xunmei Zhou
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension Chongqing, China
| | - Fang Sun
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension Chongqing, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China.
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension Chongqing, China.
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Akkus G, Tetiker T. Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies? World J Diabetes 2021; 12:1312-1324. [PMID: 34512896 PMCID: PMC8394232 DOI: 10.4239/wjd.v12.i8.1312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus (T2DM). Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM. There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM, but remission rates of T2DM after metabolic surgery can display great variability.
AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy, adjustable gastric banding, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.
METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures.
RESULTS In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patient with T2DM, but further studies are needed to clarify better the rate of diabetes remission.
CONCLUSION In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patients with T2DM, but further studies are needed to clarify better the rate of diabetes remission.
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Affiliation(s)
- Gamze Akkus
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
| | - Tamer Tetiker
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
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The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study. Obes Surg 2021; 30:3489-3495. [PMID: 32314253 PMCID: PMC7378103 DOI: 10.1007/s11695-020-04599-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration. METHODS Cohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the Örebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes. RESULTS Fasting insulin levels improved for all groups (diabetics baseline 25.5 mIU/L, IQR 17.5-38.0, 2 years 7.6 mIU/L, IQR 5.4-11.1, p < 0.001; prediabetics baseline 25.0 mIU/L, IQR 17.5-35.0, 2 years 6.7mIU/L, IQR 5.3-8.8, p < 0.001; non-diabetics baseline 20.0 mIU/L, IQR 14.0-30.0, 2 years 6.4 mIU/L, IQR 5.0-8.5, p < 0.001). HbA1c improved in all groups (diabetics baseline 56 mmol/mol, IQR 49-74 [7.3%, IQP 6.6-8.9], 2 years 38 mmol/mol, IQR 36-47 [5.6%, IQR 5.4-6.4], p < 0.001; prediabetics baseline 40 mmol/mol, IQR 39-42 [5.8%, IQR5.7-6.0], 2 years 36 mmol/mol, IQR 34-38 [5.5%, IQR 5.3-5.6], p < 0.001; non-diabetics baseline 35 mmol/mol, IQR 33-37 [5.4%, IQR 5.2-5.5]; 2 years 34 mmol/mol, IQR 31-36 [5.3%, IQR 5.0-5.4], p < 0.001). HOMA-IR improved in all groups (diabetics baseline 9.3 mmol/mol, IQR 5.4-12.9, 2 years 1.9 mmol/mol, IQR 1.4-2.7, p < 0.001; prediabetics baseline 7.0 mmol/mol, IQR 4.3-9.9, 2 years 1.6 mmol/mol, IQR 1.2-2.1, p < 0.001; non-diabetics 4.9 mmol/mol, IQR 3.4-7.3, 2 years 1.4 mmol/mol, IQR 1.1-1.9, p < 0.001). CONCLUSION Insulin homeostasis and glucometabolic control improve in all patients after LRYGB, not only in diabetics but also in prediabetics and non-diabetic obese patients, and this improvement is sustained 2 years after surgery.
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Amirian H, Torquati A, Omotosho P. Racial Disparity in 30-Day Outcomes of Metabolic and Bariatric Surgery. Obes Surg 2021; 30:1011-1020. [PMID: 31745861 PMCID: PMC7222128 DOI: 10.1007/s11695-019-04282-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background There is evidence of racial disparity in the long-term weight loss outcomes of bariatric surgery. However, there has been a more limited evaluation of the impact of race on immediate perioperative outcomes. The aim of this study was to compare 30-day postoperative outcomes among different races. Study Design The 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried to identify patients aged ≥ 18 and body mass index ≥ 35 who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) with known information on race. We then evaluated the effect of five different races on four different 30-day outcomes. Results Of the total 106,932 patients (79.5% White, 19.3% African American (AA), 0.5% Asian, 0.4% American Indian or Alaska Native, 0.3% Native Hawaiian or other Pacific Islander), 30-day rates of postoperative complication, readmission, re-intervention, and reoperation were 6, 3.8, 1.3, and 1.2%, respectively. After controlling for other covariates in multivariate logistic regression and selecting White as reference, AA was the only race associated with a higher risk of postoperative complications (odds ratio [OR] 1.13; confidence interval [CI] 1.06–1.2) and readmissions (OR 1.47; CI 1.3–1.6). AA and American Indian or Alaska Native were also associated with higher re-interventions (OR 1.31; CI 1.15–1.51 and OR 2.11; CI 1.03–4.34). Furthermore, AA was associated with lower 30-day reoperations (OR 0.83; CI 0.7–0.9). Conclusion This study found significant racial differences in short-term outcomes following bariatric surgery. Factors underlying these disparities are unclear and warrant further investigation.
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Affiliation(s)
| | - Alfonso Torquati
- Division of Minimally Invasive and Bariatric Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building, Suite 604, Chicago, IL, 60612, USA
| | - Philip Omotosho
- Division of Minimally Invasive and Bariatric Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building, Suite 604, Chicago, IL, 60612, USA.
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Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 30:664-672. [PMID: 31724116 DOI: 10.1007/s11695-019-04235-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures. OBJECTIVES We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG. METHODS Medline, Embase, The Cochrane Library, and NHS Evidence were searched for English language RCTs comparing RYGB with SG and assessed weight loss and/or comorbidity resolution at 5 years. RESULTS Five studies were included in the final analysis. Meta-analysis demonstrates a significantly greater percentage excess weight loss in patients undergoing RYGB compared with SG (65.7% vs 57.3%, p < 0.0001). Resolution of diabetes was seen in 37.4% and 27.5% after RYGB and SG respectively. There was no significant difference between RYGB and SG in rates of resolution or improvement of diabetes. Similarly, HbA1C levels were not significantly different between the two procedures. Resolution of dyslipidaemia was more common after RYGB (68.6% vs 55.2%, p = 0.0443). Remission of gastro-oesophageal reflux occurred in 60.4% in the RYGB group in contrast to 25.0% in the SG group (p = 0.002). CONCLUSIONS Both RYGB and SG result in sustained weight loss and comorbidity control at 5 years. RYGB resulted in greater %EWL, improved dyslipidaemia outcomes and a lower incidence of postoperative gastro-oesophageal reflux disease (GORD).
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Impact of Bariatric Surgery in Reducing Macrovascular Complications in Severely Obese T2DM Patients. Obes Surg 2021; 31:1929-1936. [PMID: 33409981 DOI: 10.1007/s11695-020-05155-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evidence from real-world studies have suggested a reduced rate of macrovascular complications following bariatric surgery. We undertook this meta-analysis to investigate the impact of bariatric surgery on macrovascular disease outcomes in severely obese type 2 diabetes mellitus (T2DM) patients. METHODS An extensive literature search was performed in PubMed from inception until March 2020. All cohort studies assessing the association between bariatric surgery and macrovascular complications in severely obese T2DM patients were included. Two independent reviewers screened the articles, extracted data, and assessed the quality using the Newcastle-Ottawa Scale. The primary outcome was to assess the impact of bariatric surgery and the risk of macrovascular complications. Statistical analysis was performed using Review Manager 5.3. RESULTS This meta-analysis comprised of five studies including 49,211 participants (75% female), of which 14,434 underwent bariatric surgery and 34,777 underwent usual care. Participants who underwent bariatric surgery had a significantly lower risk of macrovascular complications as compared to those with non-surgical interventions (RR: 0.50 [95% CI: 0.35-0.73], p = 0.0003). In the subgroup analysis, based on the geographical regions, studies conducted in the USA showed a higher reduction (RR: 0.41 [95% CI: 0.32-0.53], p < 0.00001) in macrovascular complications as compared to other parts of the world. The risk of all-cause mortality was also significantly lower in patients with bariatric surgery (RR 0.39 [95% CI: 0.30-0.50], p < 0.00001). CONCLUSION Bariatric surgery was associated with a 50% reduction in macrovascular complications along with 61% reduction in risk of all-cause mortality in morbidly obese T2DM patients.
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Impact of metabolic surgery on 10-year cardiovascular disease risk in Chinese individuals with type 2 diabetes. Surg Obes Relat Dis 2020; 17:498-507. [PMID: 33358863 DOI: 10.1016/j.soard.2020.11.013] [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: 08/26/2020] [Revised: 10/22/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years, many reports have highlighted that metabolic surgery may ameliorate the cardiovascular risk in morbidly obese patients with or without type 2 diabetes (T2D). However, few studies have evaluated the long-term cardiovascular disease (CVD) risk after metabolic surgery in T2D patients with a low body mass index (BMI). OBJECTIVES To use the Prediction for ASCVD Risk in China (China-PAR) equations and United Kingdom Prospective Diabetes Study (UKPDS) risk engine to assess the 10-year CVD risk in low-BMI T2D patients after metabolic surgery. SETTING University hospital, China. METHODS We retrospectively reviewed our prospectively collected data of T2D patients who underwent metabolic surgery at our hospital between 2010 and 2018. We included patients who met the criteria for calculating a 10-year cardiovascular risk score by the China-PAR equations and UKPDS risk engine. Demographic characteristics, anthropometric variables, and glycolipid metabolic parameters were assessed preoperatively and during a 4-year follow-up period. Patients with a BMI < 30 kg/m2 were compared with those with a BMI > 30 kg/m2. RESULTS We evaluated 117 patients, of whom 62 (53%) had a BMI < 30 kg/m2 and 55 (47%) had a BMI > 30 kg/m2. Patients with a BMI < 30 kg/m2 were significantly older and had a longer duration of diabetes. The rate of complete T2D remission in the group of patients with BMIs < 30 kg/m2 was significantly lower than that in the group with BMIs > 30 kg/m2 (35.2% versus 56.1%, respectively; P = .042). The overall 10-year and lifetime atherosclerotic cardiovascular disease risks were reduced from 4.2% to 2.3% and 25.3% to 13.9%, respectively (both P < .05), at 1 year postoperatively using the China-PAR equation. The overall 10-year coronary heart disease (CHD) and fatal CHD risks were reduced by 48.1% and 53.1%, respectively, at 1 year after surgery using the UKPDS risk engine. The advantages of metabolic surgery in reducing CVD risks are similar in both BMI groups, whether using the China-PAR equation or the UKPDS risk engine. CONCLUSION The 10-year CVD risk in T2D patients with BMIs < 30 kg/m2 and BMIs > 30 kg/m2 were significantly reduced after metabolic surgery, although the rate of complete T2D remission T2Din patients with BMIs < 30 kg/m2 was lower than that in patients with BMIs > 30 kg/m2. The China-PAR equation is a reliable and useful clinical tool for CVD risk evaluation in Chinese patients after metabolic surgery.
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Rossi I, Omotosho P, Poirier J, Spagnoli A, Torquati A. Roux-en-Y gastric bypass decreases serum inflammatory markers and cardiovascular risk factors in obese diabetics. Surgery 2020; 169:539-542. [PMID: 33168209 DOI: 10.1016/j.surg.2020.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/14/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obesity and type 2 diabetes mellitus are associated with elevated levels of inflammatory markers. This chronic inflammation is known to contribute to increased risk of cardiovascular disease in these populations. Laparoscopic Roux-en-Y gastric bypass is associated with a high rate of diabetes remission. We hypothesize that laparoscopic Roux-en-Y gastric bypass decreases systemic inflammatory markers and cardiovascular disease risk factors in obese diabetics. METHODS This was a single-institution prospective cohort study of 61 obese patients with type 2 diabetes mellitus. A total of 30 patients underwent laparoscopic Roux-en-Y gastric bypass surgery, and 31 patients underwent standard medical therapy with diabetes support and education. Collected data included preoperative and postoperative inflammatory biomarkers and clinical parameters. RESULTS Twelve months after undergoing laparoscopic Roux-en-Y gastric bypass, controlling for sex and age, there was a significant correlation between a change in interleukin-6 and a change in systolic blood pressure (Spearman r = 0.41, P = .03). Similarly, when sex and age were controlled for in the laparoscopic Roux-en-Y gastric bypass group, a statistically significant relationship remained between percent excess weight loss and change in interleukin-6 (P = .001). CONCLUSION A significant relationship exists between decreased systemic interleukin-6 levels and both excess weight loss and lowered systolic blood pressure after laparoscopic Roux-en-Y gastric bypass in obese patients with diabetes mellitus. These correlations may explain the decreased risk of cardiovascular disease after surgical weight reduction in this patient population.
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Affiliation(s)
- Isolina Rossi
- Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Jennifer Poirier
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Anna Spagnoli
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, IL.
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Chen X, Zhang J, Zhou Z. The effects of metabolic surgery on microvascular complications in obese patients with type 2 diabetes: a meta-analysis. Surg Obes Relat Dis 2020; 17:434-443. [PMID: 33144039 DOI: 10.1016/j.soard.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/17/2020] [Accepted: 09/09/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Metabolic surgery is a standard treatment for obesity with type 2 diabetes (T2D), although the effects of metabolic surgery on the incidence rate of microvascular complications remain controversial. OBJECTIVES We aimed to evaluate the effect of metabolic surgery versus nonsurgical treatments on the incidence rate of microvascular complications in obesity with T2D. SETTING A meta-analysis of published studies. METHODS We searched PubMed, Web of Science, and the Cochrane Library to identify clinical studies assessing the effect of metabolic surgery on the incidence rate of microvascular diabetic complications compared with that of nonsurgical treatments. We extracted the primary outcomes, including the incidence rate of microvascular complications after metabolic surgery. RESULTS A total of 32,756 participants from 12 studies were identified. Metabolic surgery reduced the incidence rate of microvascular complications (odds ratios [OR], .34; 95% confidence intervals [CI], .30-.39; P < .001) compared with that of nonsurgical treatments in obesity with T2D. Moreover, metabolic surgery also reduced the incidence of diabetic nephropathy (OR, .39; 95% CI, .30-.50; P < .001), diabetic retinopathy (OR, .52; 95% CI, .42-.65; P < .001) and diabetic neuropathy (OR, .27; 95% CI, .22-.34; P < .001) compared with nonsurgical treatments in obesity with T2D. CONCLUSION Metabolic surgery was superior to nonsurgical treatments in reducing the incidence of microvascular complications in obesity with T2D. Prospective studies, preferably randomized controlled trials, with evaluations of different types of metabolic surgery are warranted to provide guidelines for treatment preferences in obesity with T2D.
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Affiliation(s)
- Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China.
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
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Almalki OM, Soong TC, Lee WJ, Chen JC, Wu CC, Lee YC. Variation in Small Bowel Length and Its Influence on the Outcomes of Sleeve Gastrectomy. Obes Surg 2020; 31:36-42. [PMID: 32914323 DOI: 10.1007/s11695-020-04958-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Small bowel length is drawing attention in the development of gastrointestinal bariatric/metabolic surgery, but the importance of the length of the small bowel in bariatric/metabolic is not clear. The present study was conducted to investigate variations in small bowel length and their clinical significance in patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS Small bowel length was measured in 620 patients diagnosed with obesity who underwent LSG between March 2014 and August 2018. Prospectively obtained demographic and clinical data were investigated, focusing on the association between small bowel length and weight loss. RESULTS Small bowel length varied widely among patients (mean 739.8 + 115.7 cm, range 380-1050 cm). Linear regression analysis revealed a significant association between small bowel length and body height, body weight, waist circumference, and serum levels of low-density lipoprotein cholesterol, hemoglobin, C-peptide, glycated hemoglobin (A1C), and gamma-glutamyl transferase (r-GT). Multivariate analysis confirmed that body height and serum A1C% levels independently predicted small bowel length in bariatric patients, strongly with body height (p < 0.001) but weakly with A1C%(p = 0.021). One-year follow-up rate was 75.3% (467/620), and small bowel length did not influence weight loss or the reduction of obesity related cardiovascular risk factors after LSG. CONCLUSION In this study, small bowel length varied widely among bariatric patients and was strongly associated with body height and weakly with serum A1C levels. Small bowel length has no significant role in weight loss or the resolution of cardiovascular risk factors after LSG.
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Affiliation(s)
- Owaid M Almalki
- Department of Surgery, College of Medicine, Taif University, Ta'if, Saudi Arabia.,Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Tien-Chou Soong
- Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan.,Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan.,College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Chun-Chi Wu
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University, Taoyuan, Taiwan
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Vangoitsenhoven R, Mulya A, Mosinski JD, Brethauer SA, Schauer PR, Kirwan JP, Aminian A. Effects of gastric bypass surgery on expression of glucose transporters and fibrotic biomarkers in kidney of diabetic fatty rats. Surg Obes Relat Dis 2020; 16:1242-1248. [PMID: 32505735 PMCID: PMC8276306 DOI: 10.1016/j.soard.2020.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetic nephropathy is the leading cause of chronic kidney disease. Observational studies suggest Roux-en-Y gastric bypass (RYGB) reduces progression of diabetic nephropathy. OBJECTIVES To unravel the mechanisms by which RYGB is beneficial and protective for diabetic nephropathy. SETTING Academic laboratories. METHODS Forty-eight Zucker diabetic fatty rats were randomized to RYGB, sham surgery (SHAM), or pair-fed (PF) groups. An oral glucose tolerance test was performed at 25 days post intervention and kidneys were harvested at 30 days. Primary outcome measures included expression of key genes and proteins in the glucose transport, oxidative stress, inflammation, and fibrosis pathways. RESULTS Thirty days post intervention, RYGB rats weighed 349 ± 8 g, which was lower than SHAM (436 ± 14 g, P < .001), but not PF (374 ± 18 g) rats. RYGB rats had lower fasting glucose than PF animals and improved homeostatic model assessment of insulin resistance compared with PF and SHAM groups. These enhanced metabolic outcomes were accompanied by reduced sodium-glucose co-transporter 1 (Sglt1) gene expression (-23% versus PF, P = .01) in the kidney of RYGB rats. Expression of Sglt2, Glut1, or Glut2 mRNA, or oxidative stress and inflammation markers did not differ significantly. However, RYGB surgery induced a 19% lower expression of transforming growth factor (Tgfβ) mRNA (P = .004) compared with SHAM treated animals. Notably, adenosine monophosphate-activated protein kinase phosphorylation was increased (P = .04) in kidneys of the RYGB surgery animals. CONCLUSIONS Improvement of hyperglycemia after RYGB may reduce the glucose load on the kidney leading to a downregulation of specific glucose transporters. RYGB surgery may also attenuate kidney fibrosis through the adenosine monophosphate-activated protein kinase/TGFβ pathway.
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Affiliation(s)
- Roman Vangoitsenhoven
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Anny Mulya
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - J David Mosinski
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Gannon University, Erie, Pennsylvania
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - John P Kirwan
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
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Goldberg I, Nie L, Yang J, Docimo S, Obici S, Talamini M, Pryor A, Spaniolas K. Impact of bariatric surgery on the development of diabetic microvascular and macrovascular complications. Surg Endosc 2020; 35:3923-3931. [DOI: 10.1007/s00464-020-07848-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
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Chen J, Brethauer S. Recurrent Diabetes Following Bariatric Surgery: Incidence and Management. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Performance and improvement of the DiaRem score in diabetes remission prediction: a study with diverse procedure types. Surg Obes Relat Dis 2020; 16:1531-1542. [PMID: 32690456 DOI: 10.1016/j.soard.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The DiaRem score has proven to be a reliable predictor tool for diabetes remission in Roux-en-Y gastric bypass (RYGB), as well as laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG). To our knowledge there are no studies that analyze DiaRem in patients undergoing biliopancreatic diversion with duodenal switch (BPD/DS). OBJECTIVE To test the validity of the DiaRem score as a predictor of type 2 diabetes remission at 1 year post surgery in patients who underwent LABG, LSG, RYGB, and BPD/DS, as well as to develop and test a novel model that uses DiaRem to predict type 2 diabetes remission by procedure type (LABG, LSG, RYGB, and BPD/DS). SETTING University Medical Center, United States. METHODS A retrospective review of institutional records identified patients who underwent primary bariatric procedures (LAGB, LSG, RYGB, and BPD/DS) between January 1, 2000 to April 10, 2017, had a diagnosis of diabetes and had complete preoperative and 1-year postoperative follow-up information. A univariable logistic regression model was fit to assess the association between DiaRem score and diabetes remission. A multivariable logistic regression model was created, including procedure type and other preoperative characteristics. The area under the receiver operating curve (AUROC) was calculated to analyze the performance of both models for the entire cohort as well as a BPD/DS only subgroup. RESULTS A total study cohort of 602 was obtained. The majority of patients underwent RYGB (456; 75.7%), followed by LSG (84; 14.0%), BPD/DS (35; 5.8%), and LAGB (27; 4.5%). The multivariable regression model with RYGB as the reference procedure, showed that BPD/DS results in higher odds of type 2 diabetes remission at 1 year post surgery (adjusted odds ratio [OR] 3.29, 95% confidence interval [CI] 1.27, 8.51), while LSG (adjusted OR .52, 95%CI .29, .93) and LAGB resulted in lower odds (adjusted OR.23, 95% CI.09,.60). The univariable DiaRem model and the novel model were determined to be moderately strong in classifying diabetes remission in the entire cohort (AUROC: .79, 95% CI: .75, .83 and .82, 95% CI: .79, .85, respectively) as well as in the BPD/DS sub-group (AUROC: .85, 95% CI: .70, .99 and .84, 95% CI .69, .99, respectively). CONCLUSION Our study shows that the DiaRem score is a reliable tool to predict diabetes remission, amongst a wide variety of different procedures as well as specifically those receiving BPD/DS. Our novel model, which takes into account procedure type, not only shows that BPD/DS patients have the highest odds of diabetes remission than other procedures, but also that this model performs significantly better at predicting diabetes remission than DiaRem alone.
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Hasbargen KB, Shen WJ, Zhang Y, Hou X, Wang W, Shuo Q, Bernlohr DA, Azhar S, Kraemer FB. Slc43a3 is a regulator of free fatty acid flux. J Lipid Res 2020; 61:734-745. [PMID: 32217606 DOI: 10.1194/jlr.ra119000294] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Adipocytes take up long chain FAs through diffusion and protein-mediated transport, whereas FA efflux is considered to occur by diffusion. To identify potential membrane proteins that are involved in regulating FA flux in adipocytes, the expression levels of 55 membrane transporters without known function were screened in subcutaneous adipose samples from obese patients before and after bariatric surgery using branched DNA methodology. Among the 33 solute carrier (SLC) transporter family members screened, the expression of 14 members showed significant changes before and after bariatric surgery. One of them, Slc43a3, increased about 2.5-fold after bariatric surgery. Further investigation demonstrated that Slc43a3 is highly expressed in murine adipose tissue and induced during adipocyte differentiation in primary preadipocytes and in OP9 cells. Knockdown of Slc43a3 with siRNA in differentiated OP9 adipocytes reduced both basal and forskolin-stimulated FA efflux, while also increasing FA uptake and lipid droplet accumulation. In contrast, overexpression of Slc43a3 decreased FA uptake in differentiated OP9 cells and resulted in decreased lipid droplet accumulation. Therefore, Slc43a3 seems to regulate FA flux in adipocytes, functioning as a positive regulator of FA efflux and as a negative regulator of FA uptake.
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Affiliation(s)
- Kathrin B Hasbargen
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Biochemistry,Changzhi Medical College, ShanXi, China
| | - Wen-Jun Shen
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Yiqiang Zhang
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Biochemistry,Changzhi Medical College, ShanXi, China
| | - Xiaoming Hou
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Wei Wang
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Endocrinology,Peking University First Hospital, Beijing, China
| | - Qui Shuo
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - David A Bernlohr
- Department of Biochemistry, Molecular Biology, and Biophysics,University of Minnesota, Minneapolis, MN
| | - Salman Azhar
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Fredric B Kraemer
- Division of Endocrinology, Gerontology, and Metabolism,Stanford University, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Diabetes Research Center, Stanford, CA. mailto:
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O'Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, Crosthwaite G, Brown W. Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding. Obes Surg 2020; 29:3-14. [PMID: 30293134 PMCID: PMC6320354 DOI: 10.1007/s11695-018-3525-0] [Citation(s) in RCA: 402] [Impact Index Per Article: 100.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up. Methods Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented. Results Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques. Conclusion All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.
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Affiliation(s)
- Paul E O'Brien
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia. .,Centre for Bariatric Surgery, Melbourne, Australia.
| | - Annemarie Hindle
- School of Behavioural and Health Sciences, Centre for Eating, Weight and Body Image, Australian Catholic University, Melbourne, Australia
| | - Leah Brennan
- School of Behavioural and Health Sciences, Centre for Eating, Weight and Body Image, Australian Catholic University, Melbourne, Australia
| | - Stewart Skinner
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia.,Centre for Bariatric Surgery, Melbourne, Australia
| | - Paul Burton
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia.,Centre for Bariatric Surgery, Melbourne, Australia
| | - Andrew Smith
- Centre for Bariatric Surgery, Melbourne, Australia
| | | | - Wendy Brown
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia.,Centre for Bariatric Surgery, Melbourne, Australia
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Long-term outcomes of macrovascular diseases and metabolic indicators of bariatric surgery for severe obesity type 2 diabetes patients with a meta-analysis. PLoS One 2019; 14:e0224828. [PMID: 31794559 PMCID: PMC6890174 DOI: 10.1371/journal.pone.0224828] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
There is currently no detailed evidence for the long-term effects of bariatric surgery on severely obese with type 2 diabetes, such as the risk of myocardial infarction and stroke. In order to provide evidence on the risks of macrovascular diseases and metabolic indicators of bariatric surgery follow-up for more than five years, we searched in the Cochrane library, Pubmed, and EMBASE databases from the earliest studies to January 31, 2019. Randomized clinical trials or cohort studies compared bariatric surgery and conventional medical therapy for long-term incidence of macrovascular events and metabolic outcomes in severely obese patients with T2DM. Fixed-effects and random-effects meta-analyses were performed to pool the relative risks (RRs), hazard ratios (HRs) and weighted mean difference (WMD). Publication bias and heterogeneity were examined. Four RCTs and six cohort studies were finally involved in this review. Patients in the bariatric surgery group as compared to the conventional treatment group had lower incidence of macrovascular complications (RR = 0.43, 95%CI = 0.27~0.70), cardiovascular events (CVEs) (HR = 0.52, 95%CI = 0.39~0.71), and myocardial infarction (MI) (RR = 0.40, 95%CI = 0.26~0.61). At the same time, the results demonstrate that bariatric surgery is associated with better weight and better glycemic control over the long-term than non-surgical therapies, and reveal that different surgical methods have different effects on various metabolic indicators. Bariatric surgery significantly decreases macrovascular complications over the long term and is associated with greater weight loss and better intermediate glucose outcomes among T2DM patients with severe obesity as compared to patients receiving only conservative medical measures.
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24
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Long-term remission of type 2 diabetes—two roads to the elusive goal. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
OBJECTIVE The aim of this paper is to report, with a high follow-up rate, 10-year results in a large cohort of patients after Roux-en-Y gastric bypass (RYGBP) done essentially by laparoscopy. BACKGROUND RYGBP has been performed for 50 years, including 20 years by laparoscopy, yet very few long-term results have been reported, mostly after open surgery. METHODS Prospective bariatric database established since the introduction of bariatric surgery. Retrospective data analysis on weight loss, long-term complications, quality of life, and comorbidities. RESULTS In all, 658 consecutive patients (515 women/143 men) were included: 554 with primary RYGBP, 104 with reoperative RYGBP. There was 1 (0.15%) postoperative death. Thirty-two (5%) patients died during follow-up from causes unrelated to surgery. Ten years after primary RYGBP, patients lost 28.6 ± 10.5% of their initial weight, corresponding to a mean of 13.2 body mass index (BMI) units. Among them, 72.8% achieved a BMI <35. Weight loss ≥20% was seen in 80.3% and <10% in 3.9% of patients. Results were similar in patients undergoing primary or reoperative RYGBP, but were better in patients who were initially less obese (BMI <50 kg/m) than in superobese patients. Quality of life and comorbidities significantly improved with 80% resolution or improvement of metabolic comorbidities. All patients required supplementations, and 14.6% required long-term reoperation. CONCLUSIONS RYGBP provides long-term satisfactory weight loss up to 10 years, and significantly improves quality of life and comorbidities. Long-term complications requiring reoperation can develop. Mineral and vitamin supplementation are universally necessary. Other more effective surgical options should be discussed in patients with very severe obesity.
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26
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Sharples AJQ, Mullan M, Hardy K, Vergis A. Effect of Roux-en-Y gastric bypass on pharmacologic dependence in obese patients with type 2 diabetes. Can J Surg 2019; 62:259-264. [PMID: 31348633 PMCID: PMC6660272 DOI: 10.1503/cjs.005018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 01/04/2023] Open
Abstract
Background More than half the diabetes-related health care costs in Canada relate to drug costs. We aimed to determine the effect of Roux-en-Y gastric bypass (RYGB) on the use of insulin and orally administered hypoglycemic medications in patients with diabetes. We also looked to determine overall cost savings with the procedure. Methods We reviewed the bariatric clinic records of all patients with a confirmed diagnosis of type 2 diabetes mellitus who underwent RYGB between 2010/11 and 2014/15. Percentage estimated weight loss was recorded at 1 year, along with reductions in glycated hemoglobin (HbA1c) level and use of oral hypoglycemic therapy and insulin. We estimated medication costs using Manitoba-specific pricing data. Results Fifty-two patients with at least 12 months of complete follow-up data were identified. The mean percentage estimated weight loss was 50.2%. The mean HbA1c level decreased from 7.6% to 6.0%, the mean number of orally administered hypoglycemics declined from 1.6 to 0.2, and the number of patients receiving insulin decreased from 18 (35%) to 3 (6%) (all p < 0.001). The rate of resolution of type 2 diabetes was 71%. Estimated mean annual per-patient medication costs decreased from $508.56 to $79.17 (p < 0.001). Potential overall health care savings could total $3769 per patient in the first year, decreasing to $1734 at 10 years. Conclusion Roux-en-Y gastric bypass resulted in significant improvement in diabetic control, with a reduction in hypoglycemic medication use and associated costs in the early postoperative period. Potentially, large indirect and direct cost savings can be realized in the longer term.
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Affiliation(s)
- Alistair J. q Sharples
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Sharples, Mullan, Hardy, Vergis)
| | - Michael Mullan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Sharples, Mullan, Hardy, Vergis)
| | - Krista Hardy
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Sharples, Mullan, Hardy, Vergis)
| | - Ashley Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Sharples, Mullan, Hardy, Vergis)
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Billeter AT, Eichel S, Scheurlen KM, Probst P, Kopf S, Müller-Stich BP. Meta-analysis of metabolic surgery versus medical treatment for macrovascular complications and mortality in patients with type 2 diabetes. Surg Obes Relat Dis 2019; 15:1197-1210. [PMID: 31201113 DOI: 10.1016/j.soard.2019.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 02/09/2019] [Accepted: 04/26/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although research has shown that metabolic surgery is superior to medical therapy in terms of glycemic control and other cardiovascular risk factors, it remains unclear whether these beneficial effects ultimately result in a reduced incidence of macrovascular complications or mortality in patients with type 2 diabetes. OBJECTIVE This meta-analysis assesses the impact of metabolic surgery versus medical therapy on mortality and macrovascular complications in patients with type 2 diabetes. SETTING Academic centers in the United States, Europe, and Asia. METHODS An unrestricted systematic literature search of MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials was performed. Randomized controlled trials (RCTs), case-control trials, and cohort studies comparing the effect of metabolic surgery on mortality and the incidence of diabetes-associated macrovascular complications to a medically treated control group were identified. The last search was performed on June 15, 2018. RESULTS The literature search yielded 3721 potentially eligible articles. Nineteen studies (6 RCTs, 13 nonrandomized studies) were ultimately included. Metabolic surgery was found to be associated with reduced mortality (odds ratio .34, 95% confidence interval [.25-.46], P < .00001) and macrovascular complication rates (odds ratio .38, 95% confidence interval [.22-.67], P = .0008). CONCLUSIONS Because metabolic surgery is associated with lower mortality and macrovascular complication rates than medical therapy, it seems to be the superior treatment choice for patients with type 2 diabetes. Additional, high-quality RCTs with adequate follow-up comparing state of the art surgical and medical therapies including glifozins and liraglutide are nevertheless needed to identify which patients would benefit most from metabolic surgery.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Sebastian Eichel
- 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
| | - Pascal Probst
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Department of Internal Medicine I and Clinical Chemistry, 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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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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29
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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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30
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Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico. Obes Surg 2018; 28:3474-3483. [DOI: 10.1007/s11695-018-3357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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31
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Effects of Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI > 30 and < 30 kg/m 2. Obes Surg 2018; 27:3040-3047. [PMID: 28905292 PMCID: PMC5651707 DOI: 10.1007/s11695-017-2926-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recently, many studies focused on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) < 30 kg/m2 and suggested that those patients might benefit from Roux-en-Y gastric bypass (RYGB). However, evidence on its effectiveness to improve T2DM patients with BMI < 30 kg/m2 is still lacking. The aim of this study is to explore whether T2DM patients with BMI < 30 kg/m2 get similar surgical effect from RYGB compared with those patients with BMI > 30 kg/m2. Methodology Seventy patients with uncontrolled T2DM underwent laparoscopic RYGB from May 2010 to December 2015 in the GI Department of Daping Hospital. Weight, BMI, waist circumference, glucose, and lipid metabolic parameters were collected and evaluated at baseline and 1, 3, 6, 12, and 24 months postsurgery. Patients with BMI < 30 kg/m2 were compared with those with BMI > 30 kg/m2. Results Among the 70 patients, 47 (67.1%) BMI < 30 kg/m2, and 23 (32.9%) BMI > 30 kg/m2. Patients with BMI < 30 kg/m2 are significantly older; they are female predominant and have longer duration of diabetes. The complete remission of T2DM was 28.2% of the BMI < 30 kg/m2 group and 57.9% of the BMI > 30 kg/m2 group (p = 0.029). There was no significant difference in the change of glucose and lipid metabolic parameters of both groups. FPG, 2hPG, and HbA1c% levels were significantly improved after 1 month (p < 0.05), and then remained essentially stable from the sixth month in both groups. Conclusions The 2-year study has shown that RYGB is a safe and effective procedure in treating T2DM with BMI < 30 kg/m2, although the complete remission of T2DM in the BMI < 30 kg/m2 group is lower than the BMI > 30 kg/m2 group.
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32
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Wu D, Yan ZB, Cheng YG, Zhong MW, Liu SZ, Zhang GY, Hu SY. Deactivation of the NLRP3 inflammasome in infiltrating macrophages by duodenal-jejunal bypass surgery mediates improvement of beta cell function in type 2 diabetes. Metabolism 2018; 81:1-12. [PMID: 29129820 DOI: 10.1016/j.metabol.2017.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/12/2017] [Accepted: 10/31/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Bariatric surgery could improve pancreatic beta cell function, thereby leading to the remission of the type 2 diabetes mellitus (T2DM). However, the specific mechanism underlying this phenomenon is yet to be revealed. The aim of this study is to test the hypothesis that Nod-like receptor family pyrin domain containing 3 (NLRP3) inflammasome in infiltrating macrophages plays an important role in the modulation of beta cell function after duodenal-jejunal bypass (DJB) surgery. METHODS DJB and sham surgery were performed in diabetic Sprague-Dawley (SD) rats induced by high-fat diet (HFD) and streptozotocin (STZ). Body weight, food intake, and glucose tolerance test (GTT) were measured at indicated time points. Apoptosis of the beta cells was measured by Terminal deoxynucleotidyl transferase mediated dUTP Nick End Labeling (TUNEL) assay. We also assessed the macrophage content and NLRP3 expression in the rat model. Furthermore, macrophage reconstitution was performed after DJB surgery. Beta cell function and NLRP3 inflammasome pathway were re-evaluated in wild-type macrophage reconstitution group and NLRP3-knockdown macrophage reconstitution group. RESULTS DJB surgery group rats displayed rapid and sustained improvement in glucose tolerance. Decreased apoptosis and improved secretion function of the beta cells were observed in DJB surgery group. NLRP3 inflammasome pathway in infiltrating macrophages was also suppressed after DJB surgery. Moreover, diabetic remission acquired by DJB sustained in NLRP3-knockdown macrophage reconstitution group, while extinguished in group reconstituted with wild-type macrophage. CONCLUSIONS NLRP3 inflammasome deactivation in infiltrating macrophages is involved in marked beta cell function improvement after DJB surgery.
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Affiliation(s)
- Dong Wu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China
| | - Zhi-Bo Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China
| | - Yu-Gang Cheng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China
| | - Ming-Wei Zhong
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China
| | - Shao-Zhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China
| | - Guang-Yong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China
| | - San-Yuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, PR China.
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Billeter AT, Scheurlen KM, Probst P, Eichel S, Nickel F, Kopf S, Fischer L, Diener MK, Nawroth PP, Müller-Stich BP. Meta-analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus. Br J Surg 2018; 105:168-181. [DOI: 10.1002/bjs.10724] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Background
This study aimed to examine the effect of metabolic surgery on pre-existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM regarding glycaemic control, it is unclear whether the incidence or severity of microvascular complications is reduced.
Methods
A systematic literature search was performed in MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions, looking for RCTs, case–control trials and cohort studies that assessed the effect of metabolic surgery on the incidence of microvascular diabetic complications compared with medical treatment as control. The study was registered in the International prospective register of systematic reviews (CRD42016042994).
Results
The literature search yielded 1559 articles. Ten studies (3 RCTs, 7 controlled clinical trials) investigating 17 532 patients were included. Metabolic surgery reduced the incidence of microvascular complications (odds ratio 0·26, 95 per cent c.i. 0·16 to 0·42; P < 0·001) compared with medical treatment. Pre-existing diabetic nephropathy was strongly improved by metabolic surgery versus medical treatment (odds ratio 15·41, 1·28 to 185·46; P = 0·03).
Conclusion
In patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment. Metabolic surgery improved pre-existing diabetic nephropathy compared with medical treatment.
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Affiliation(s)
- A T Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - K M Scheurlen
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - S Eichel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - S Kopf
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - L Fischer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - M K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - P P Nawroth
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Jahansouz C, Xu H, Hertzel AV, Kizy SS, Steen KA, Foncea R, Serrot FJ, Kvalheim N, Luthra G, Ewing K, Leslie DB, Ikramuddin S, Bernlohr DA. Partitioning of adipose lipid metabolism by altered expression and function of PPAR isoforms after bariatric surgery. Int J Obes (Lond) 2018; 42:139-146. [PMID: 28894292 PMCID: PMC5803459 DOI: 10.1038/ijo.2017.197] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/10/2017] [Accepted: 08/02/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bariatric surgery remains the most effective treatment for reducing adiposity and eliminating type 2 diabetes; however, the mechanism(s) responsible have remained elusive. Peroxisome proliferator-activated receptors (PPAR) encompass a family of nuclear hormone receptors that upon activation exert control of lipid metabolism, glucose regulation and inflammation. Their role in adipose tissue following bariatric surgery remains undefined. MATERIALS AND METHODS Subcutaneous adipose tissue biopsies and serum were obtained and evaluated from time of surgery and on postoperative day 7 in patients randomized to Roux-en-Y gastric bypass (n=13) or matched caloric restriction (n=14), as well as patients undergoing vertical sleeve gastrectomy (n=33). Fat samples were evaluated for changes in gene expression, protein levels, β-oxidation, lipolysis and cysteine oxidation. RESULTS Within 7 days, bariatric surgery acutely drives a change in the activity and expression of PPARγ and PPARδ in subcutaneous adipose tissue thereby attenuating lipid storage, increasing lipolysis and potentiating lipid oxidation. This unique metabolic alteration leads to changes in downstream PPARγ/δ targets including decreased expression of fatty acid binding protein (FABP) 4 and stearoyl-CoA desaturase-1 (SCD1) with increased expression of carnitine palmitoyl transferase 1 (CPT1) and uncoupling protein 2 (UCP2). Increased expression of UCP2 not only facilitated fatty acid oxidation (increased 15-fold following surgery) but also regulated the subcutaneous adipose tissue redoxome by attenuating protein cysteine oxidation and reducing oxidative stress. The expression of UCP1, a mitochondrial protein responsible for the regulation of fatty acid oxidation and thermogenesis in beige and brown fat, was unaltered following surgery. CONCLUSIONS These results suggest that bariatric surgery initiates a novel metabolic shift in subcutaneous adipose tissue to oxidize fatty acids independently from the beiging process through regulation of PPAR isoforms. Further studies are required to understand the contribution of this shift in expression of PPAR isoforms to weight loss following bariatric surgery.
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Affiliation(s)
- Cyrus Jahansouz
- Department of Surgery, University of Minnesota. Minneapolis, MN 55455
| | - Hongliang Xu
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, MN, 55455
| | - Ann V. Hertzel
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, MN, 55455
| | - Scott S. Kizy
- Department of Surgery, University of Minnesota. Minneapolis, MN 55455
| | - Kaylee A. Steen
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, MN, 55455
| | - Rocio Foncea
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, MN, 55455
| | | | - Nicholas Kvalheim
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, MN, 55455
| | - Girish Luthra
- Park Nicollet Bariatric Surgery Center, St. Louis Park, MN
| | | | - Daniel B. Leslie
- Department of Surgery, University of Minnesota. Minneapolis, MN 55455
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota. Minneapolis, MN 55455
| | - David A. Bernlohr
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, MN, 55455
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Fischer L, Wekerle AL, Sander J, Nickel F, Billeter AT, Zech U, Bruckner T, Müller-Stich BP. Is there a Reason Why Obese Patients Choose Either Conservative Treatment or Surgery? Obes Surg 2018; 27:1684-1690. [PMID: 28058616 DOI: 10.1007/s11695-016-2534-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effects of bariatric surgery on excess weight loss (EWL) and comorbidities are proven. Still, a significant number of patients prefer conservative therapy (ConsP). OBJECTIVES The goal of this study was to examine why ConsP and patients awaiting bariatric surgery (SurgP) choose which therapy, and to define the differences in their expectations. SETTING Prospective study, 1 university hospital, 1 general hospital, Germany. METHODS ConsP and SurgP were asked to complete a questionnaire. Statistical analysis including all patients and a BMI-matched cohort was performed using the chi-square and Wilcoxon rank-sum test. RESULTS Overall, 151 patients participated in this study (50 ConsP, 101 SurgP, 69.4% females). The mean age was 41.1 years (SD ± 12.2 years). ConsP had a significant lower body mass index (BMI, 44.7 kg/m2 vs. 49.3 kg/m2, p < 0.01). The educational level was significantly higher in ConsP. SurgP suffered significantly more often from depression (21.6% vs. 36.6%, p = 0.02) and joint pain (45.1% vs. 68.7%, p = 0.02). ConsP completed significantly more diets that were supervised by physicians or considered well-structured (56.3% vs. 31.0%, p = 0.04). SurgP considered their chosen therapy a last resort significantly more often (p < 0.01). A BMI-matched analysis between ConsP and SurgP revealed no significant differences in the prevalence of comorbidities but showed that fear of surgery plays a major role in the decision-making processes of obese patients. CONCLUSION A higher BMI and a greater prevalence of comorbidities had driven patients to seek a more radical solution for their obesity, i.e., surgery. The BMI-matched analysis suggests that fear of surgery is a relevant factor in why obese patients do not decide to undergo bariatric surgery lightly.
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Affiliation(s)
- Lars Fischer
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Anna-Laura Wekerle
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Johannes Sander
- Obesity Clinic, Schön Klinik Hamburg Eilbek, 22081, Hamburg, Germany
| | - Felix Nickel
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Adrian T Billeter
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Ulrike Zech
- Department of Internal Medicine, Endocrinology and Metabolism, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis. Obes Surg 2017; 27:2724-2732. [DOI: 10.1007/s11695-017-2866-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mazidi M, Rezaie P, Jangjoo A, Tavassoli A, Rajabi MT, Kengne AP, Nematy M. Effect of bariatric surgery on adiposity and metabolic profiles: A prospective cohort study in Middle-Eastern patients. World J Diabetes 2017; 8:374-380. [PMID: 28751961 PMCID: PMC5507835 DOI: 10.4239/wjd.v8.i7.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/05/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate changes in adiposity and cardio-metabolic risk profile following Roux-en-Y gastric bypass in patients of Middle Eastern ethnicity with severe obesity. METHODS This prospective cohort study involved 92 patients who met the indications of bariatric surgery. Post-procedure markers of obesity and cardiometabolic profile were monitored regularly for a year. RESULTS Mean body mass index decreased by 29.5% from 41.9 to 29.5 kg/m2 between baseline and 12-mo follow-up, while mean fat mass decreased by 45.9% from 64.2 kg to 34.7 kg. An improvement was also observed in the gluco-metabolic profile with both fasting glucose and HbA1c substantially decreasing (P < 0.001). CONCLUSION The present study shows the short to medium term (1 year) health benefits of bariatric surgery for patients of Middle Eastern ethnicity.
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Concurrent ventral hernia repair in patients undergoing laparoscopic bariatric surgery: a case-matched study using the National Surgical Quality Improvement Program Database. Surg Obes Relat Dis 2017; 13:997-1002. [DOI: 10.1016/j.soard.2017.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/19/2016] [Accepted: 01/02/2017] [Indexed: 12/18/2022]
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Benotti PN, Wood GC, Carey DJ, Mehra VC, Mirshahi T, Lent MR, Petrick AT, Still C, Gerhard GS, Hirsch AG. Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure. J Am Heart Assoc 2017; 6:JAHA.116.005126. [PMID: 28536154 PMCID: PMC5524077 DOI: 10.1161/jaha.116.005126] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Obesity and its association with reduced life expectancy are well established, with cardiovascular disease as one of the major causes of fatality. Metabolic surgery is a powerful intervention for severe obesity, resulting in improvement in comorbid diseases and in cardiovascular risk factors. This study investigates the relationship between metabolic surgery and long‐term cardiovascular events. Methods and Results A cohort of Roux‐en‐Y gastric bypass surgery (RYGB) patients was tightly matched by age, body mass index, sex, Framingham Risk Score, smoking history, use of antihypertension medication, diabetes mellitus status, and calendar year with a concurrent cohort of nonoperated control patients. The primary study end points of major cardiovascular events (myocardial infarction, stroke, and congestive heart failure) were evaluated using Cox regression. Secondary end points of longitudinal cardiovascular risk factors were evaluated using repeated‐measures regression. The RYGB and matched controls (N=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan–Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events (P=0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42–0.82). Improvements of cardiovascular risk factors (eg, 10‐year cardiovascular risk score, total cholesterol, high‐density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery. Conclusions Gastric bypass is associated with a reduced risk of major cardiovascular events and the development of congestive heart failure.
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Affiliation(s)
- Peter N Benotti
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, PA
| | - G Craig Wood
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, PA
| | - David J Carey
- Center for Health Research, Geisinger Medical Center, Danville, PA
| | | | - Tooraj Mirshahi
- Center for Health Research, Geisinger Medical Center, Danville, PA
| | - Michelle R Lent
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, PA
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Mazidi M, Gao HK, Li L, Hui H, Zhang Ye. Effects of Roux-en-Y gastric bypass on insulin secretion and sensitivity, glucose homeostasis, and diabetic control: A prospective cohort study in Chinese patients. Surgery 2017; 161:1423-1429. [DOI: 10.1016/j.surg.2016.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/04/2016] [Accepted: 11/19/2016] [Indexed: 02/06/2023]
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Dimitriadis GK, Randeva HS, Miras AD. Microvascular complications after metabolic surgery. Lancet Diabetes Endocrinol 2017; 5:240-241. [PMID: 28237789 DOI: 10.1016/s2213-8587(17)30042-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 12/19/2022]
Affiliation(s)
- George K Dimitriadis
- Division of Investigative and Translational Medicine, Clinical Sciences Research Laboratories, University of Warwick Medical School, Coventry, UK
| | - Harpal S Randeva
- Division of Investigative and Translational Medicine, Clinical Sciences Research Laboratories, University of Warwick Medical School, Coventry, UK
| | - Alexander D Miras
- Academic Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, UK.
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Carlsson LMS, Sjöholm K, Karlsson C, Jacobson P, Andersson-Assarsson JC, Svensson PA, Larsson I, Hjorth S, Neovius M, Taube M, Carlsson B, Peltonen M. Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 2017; 5:271-279. [PMID: 28237791 PMCID: PMC5394228 DOI: 10.1016/s2213-8587(17)30061-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery is associated with remission of diabetes and prevention of diabetic complications in patients with obesity and type 2 diabetes. Long-term effects of bariatric surgery on microvascular complications in patients with prediabetes are unknown. The aim of this study was to examine the effects of bariatric surgery on incidence of microvascular complications in patients with obesity stratified by baseline glycaemic status. METHODS Patients were recruited to the Swedish Obese Subjects (SOS) study between Sept 1, 1987, and Jan 31, 2001. Inclusion criteria were age 37-60 years and BMI of 34 kg/m2 or greater in men and 38 kg/m2 or greater in women. Exclusion criteria were identical in surgery and control groups and designed to exclude patients not suitable for surgery. The surgery group (n=2010) underwent gastric bypass (265 [13%]), gastric banding (376 [19%]), or vertical-banded gastroplasty (1369 [68%]). Participants in the control group (n=2037) received usual care. Bodyweight was measured and questionnaires were completed at baseline and at 0·5 years, 1 year, 2 years, 3 years, 4 years, 6 years, 8 years, 10 years, 15 years, and 20 years. Biochemical variables were measured at baseline and at 2 years, 10 years, and 15 years. We categorised participants into subgroups on the basis of baseline glycaemic status (normal [fasting blood glucose concentration <5·0 mmol/L], prediabetes [5·0-6·0 mmol/L], screen-detected diabetes [≥6·1 mmol/L at baseline visit without previous diagnosis], and established diabetes [diagnosis of diabetes before study inclusion]). We obtained data about first incidence of microvascular disease from nationwide registers and about diabetes incidence at study visits at 2 years, 10 years, and 15 years. We did the main analysis by intention to treat, and subgroup analyses after stratification by baseline glycaemic status and by diabetes status at the 15 year follow-up. The SOS study is registered with ClinicalTrials.gov, NCT01479452. FINDINGS 4032 of the 4047 participants in the SOS study were included in this analysis. We excluded four patients with suspected type 1 diabetes, and 11 patients with unknown glycaemic status at baseline. At baseline, 2838 patients had normal blood glucose, 591 had prediabetes, 246 had screen-detected diabetes, and 357 had established diabetes. Median follow-up was 19 years (IQR 16-21). We identified 374 incident cases of microvascular disease in the control group and 224 in the surgery group (hazard ratio [HR] 0·56, 95% CI 0·48-0·66; p<0·0001). Interaction between baseline glycaemic status and effect of treatment on incidence of microvascular disease was significant (p=0·0003). Unadjusted HRs were lowest in the subgroup with prediabetes (0·18, 95% CI 0·11-0·30), followed by subgroups with screen-detected diabetes (0·39, 0·24-0·65), established diabetes (0·54, 0·40-0·72), and normoglycaemia (0·63, 0·48-0·81). Surgery was associated with reduced incidence of microvascular events in people with prediabetes regardless of whether they developed diabetes during follow-up. INTERPRETATION Bariatric surgery was associated with reduced risk of microvascular complications in all subgroups, but the greatest relative risk reduction was observed in patients with prediabetes at baseline. Our results suggest that prediabetes should be treated aggressively to prevent future microvascular events, and effective non-surgical treatments need to be developed for this purpose. FUNDING US National Institutes of Health, Swedish Research Council, Sahlgrenska University Hospital Regional Agreement on Medical Education and Research, and Swedish Diabetes Foundation.
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Affiliation(s)
- Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kajsa Sjöholm
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Karlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; AstraZeneca Gothenburg, Mölndal, Sweden
| | - Peter Jacobson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Per-Arne Svensson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Larsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephan Hjorth
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Taube
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; AstraZeneca Gothenburg, Mölndal, Sweden
| | - Markku Peltonen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
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Cohen RV, Pereira TV, Aboud CM, Caravatto PPDP, Petry TBZ, Correa JLL, Schiavon CA, Correa M, Pompílio CE, Pechy FNQ, le Roux C. Microvascular Outcomes after Metabolic Surgery (MOMS) in patients with type 2 diabetes mellitus and class I obesity: rationale and design for a randomised controlled trial. BMJ Open 2017; 7:e013574. [PMID: 28077412 PMCID: PMC5253594 DOI: 10.1136/bmjopen-2016-013574] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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
INTRODUCTION There are several randomised controlled trials (RCTs) that have already shown that metabolic/bariatric surgery achieves short-term and long-term glycaemic control while there are no level 1A of evidence data regarding the effects of surgery on the microvascular complications of type 2 diabetes mellitus (T2DM). PURPOSE The aim of this trial is to investigate the long-term efficacy and safety of the Roux-en-Y gastric bypass (RYGB) plus the best medical treatment (BMT) versus the BMT alone to improve microvascular outcomes in patients with T2DM with a body mass index (BMI) of 30-34.9 kg/m2. METHODS AND ANALYSIS This study design includes a unicentric randomised unblinded controlled trial. 100 patients (BMI from 30 to 34.9 kg/m2) will be randomly allocated to receive either RYGB plus BMT or BMT alone. The primary outcome is the change in the urine albumin-to-creatinine ratio (uACR) captured as the proportion of patients who achieved nephropathy remission (uACR<30 mg/g of albumin/mg of creatinine) in an isolated urine sample over 12, 24 and 60 months. ETHICS AND DISSEMINATION The study was approved by the local Institutional Review Board. This study represents the first RCT comparing RYGB plus BMT versus BMT alone for patients with T2DM with a BMI below 35 kg/m2. TRIAL REGISTRATION NUMBER NCT01821508; Pre-results.
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Affiliation(s)
- Ricardo Vitor Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Tiago Veiga Pereira
- Health Technology Assessment Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | | | | | | | - Mariangela Correa
- Health Research Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | - Carel le Roux
- Diabetes Complication Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Kothari SN, Borgert AJ, Kallies KJ, Baker MT, Grover BT. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 13:972-978. [PMID: 28223086 DOI: 10.1016/j.soard.2016.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the "gold standard" for weight loss surgery. Long-term data are limited, and reporting methods for LRYGB outcomes vary in the literature. In addition, follow-up compliance within bariatric centers is poor due to insurance and access to care issues, making long-term follow-up evaluation difficult. OBJECTIVE Evaluate long-term LRYGB outcomes using standard outcome reporting definitions. SETTING Integrated multispecialty health system. METHODS A retrospective review of our institution's prospective bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015. Data were defined according to the 2015 Standards for Outcome Reporting. RESULTS During the study period, 1402 patients underwent primary LRYGB; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m2, respectively. Early complications included anastomotic leak (0.2%), venous thromboembolism (0.6%), surgical site infections (1.4%), and urinary tract infections (1.6%). The 30-day readmission rate was 3.5%. There were no 30-day mortalities. Follow-up weight data were available for>70% of eligible patients through 12 years postoperative. The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79% and 30.1 kg/m2, respectively. Remission of diabetes, dyslipidemia, and hypertension were observed through 8 years postoperatively. CONCLUSION This is the first report of long-term (>10-year) outcomes from a single integrated health system using the 2015 Standards for Outcome Reporting. LRYGB results in significant, sustained weight loss and durable improvement and remission of obesity-related co-morbidities. Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up.
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Affiliation(s)
- Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
| | - Andrew J Borgert
- Department of Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Kara J Kallies
- Department of Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Matthew T Baker
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Brandon T Grover
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
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Ramírez-Avilés E, Espinosa-González O, Amado-Galván M, Maydón-González H, Sepúlveda-Guerrero E, Zerrweck-López C. [Evolution of type 2 diabetes and carbohydrate intolerance following bariatric surgery in a Mexican mestizo population]. CIR CIR 2016; 85:135-142. [PMID: 27842762 DOI: 10.1016/j.circir.2016.07.005] [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: 04/25/2016] [Accepted: 07/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bariatric surgery continues to be the best treatment for weight loss and control of obesity related comorbidities. Gastric bypass and sleeve gastrectomy have demonstrated to be the most effective surgeries, but this has not been established in a Mexican (non-American) population. OBJECTIVE To analyse the improvement in type 2 diabetes mellitus and carbohydrate intolerance in obese patients after bariatric surgery. MATERIAL AND METHODS A retrospective analysis was performed on the data collected prospectively between 2013 and 2015 on every obese patient with diabetes and carbohydrate intolerance submitted for bariatric surgery. Analysis was performed at baseline, and at 1, 3, 6, 9 and 12 months, and included metabolic, clinical, lipid, and anthropometrical parameters. A peri-operative and morbidity and mortality analysis was also performed. Remission rates for patients with diabetes were also established. RESULTS The analysis included 73 patients, 46 with diabetes and 27 with carbohydrate intolerance. Sixty-two patients were female with a mean age of 42 years. Baseline glucose and glycosylated haemoglobin were 123±34mg/dl and 6.8±1.6%, and at 12 months they were 90.1±8mg/dl and 5.4±0.3%, respectively. Diabetes remission was observed in 68.7% of patients, including 9.3% with partial remission and 21.8% with an improvement. There was also a significant improvement in all metabolic and non-metabolic parameters. CONCLUSIONS Bariatric surgery safely improves the metabolic status of patients with diabetes mellitus or carbohydrate intolerance during the first year, inducing high rates of complete remission. It has also shown a significant improvement on blood pressure, lipid, and anthropometric parameters during the first year of follow-up.
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Affiliation(s)
- Eva Ramírez-Avilés
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas del Hospital General Tláhuac, Secretaría de Salud del Distrito Federal, Ciudad de México, México
| | - Omar Espinosa-González
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas del Hospital General Tláhuac, Secretaría de Salud del Distrito Federal, Ciudad de México, México
| | - Mónica Amado-Galván
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas del Hospital General Tláhuac, Secretaría de Salud del Distrito Federal, Ciudad de México, México
| | - Hernán Maydón-González
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas del Hospital General Tláhuac, Secretaría de Salud del Distrito Federal, Ciudad de México, México
| | - Elisa Sepúlveda-Guerrero
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas del Hospital General Tláhuac, Secretaría de Salud del Distrito Federal, Ciudad de México, México
| | - Carlos Zerrweck-López
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas del Hospital General Tláhuac, Secretaría de Salud del Distrito Federal, Ciudad de México, México.
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Abstract
PURPOSE OF REVIEW Obesity is a worldwide epidemic, having profound effects on Western populations. Bariatric surgery has long been employed to treat obesity and its related comorbidities. Over time, researchers have amassed significant data to support bariatric surgery in the pursuit of treating diabetes mellitus. This review serves to introduce the most recent findings and their relation to the various bariatric surgical options as bariatric surgery will continue to cement itself in the treatment paradigm of diabetes mellitus. RECENT FINDINGS Numerous studies performed in the past 10 years have demonstrated the improvement or cessation of diabetes with bariatric surgical intervention. In comparing the vertical sleeve gastrectomy and Roux-en-Y gastric bypass, data demonstrate a more beneficial response of diabetes to the Roux-en-Y gastric bypass, and an even further exaggerated response with the biliopancreatic diversion/duodenal switch. The benefit has long been established, but what causes the improvement in diabetes mellitus after bariatric surgery? Recent data suggest a decrease in circulating bile salts as well as changes to inflammatory markers and circulating cytokines. Furthermore, tailoring of existing surgical procedures has led to the development of the SIPS procedure, and its benefit is demonstrated in bypassing a large portion of intestine while eliminating an enteroenterostomy, helping to reduce short gut syndrome and resultant diarrhea. SUMMARY The surgical climate within the bariatric field is changing and will continue to do so in the future. As the understanding of the causes or mechanisms in which bariatric surgery improves metabolic disorders becomes more evident, the process of individualizing care for specific patients will become more prevalent.
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Shantavasinkul PC, Omotosho P, Corsino L, Portenier D, Torquati A. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2016; 12:1640-1645. [PMID: 27989521 DOI: 10.1016/j.soard.2016.08.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. OBJECTIVES This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. SETTING An academic medical center in the United States. METHODS A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. RESULTS Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (P<.001). Average weight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (P<.001). Time elapsed since RYGB was significantly longer in the WR group (WR 6.0±2.4 years versus SWL 3.3±1.8 years; P<.001; range 2-12 yr). Patients in the WR group were significantly younger (WR 42.3±9.8 yr versus SWL 45.7±10.8 years; P<.001), had fewer co-morbidities, and were less likely to have type 2 diabetes with insulin dependence preoperatively. Univariate analysis found that older age, male gender, having hypertension, dyslipidemia, and insulin-treated type 2 diabetes were all factors associated with sustained weight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. CONCLUSION The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB.
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Affiliation(s)
- Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Center for Weight Loss and Bariatric Surgery, Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Philip Omotosho
- Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Leonor Corsino
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC
| | - Dana Portenier
- Center for Weight Loss and Bariatric Surgery, Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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Haskins IN, Corcelles R, Froylich D, Boules M, Hag A, Burguera B, Schauer PR, Kroh M, Brethauer SA. Primary Inadequate Weight Loss After Roux-en-Y Gastric Bypass Is not Associated with Poor Cardiovascular or Metabolic Outcomes: Experience from a Single Institution. Obes Surg 2016; 27:676-680. [DOI: 10.1007/s11695-016-2328-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Effectiveness of Bariatric Surgery in the Remission of Type 2 Diabetes and Vascular Complications. Ann Surg 2016; 267:e25-e26. [PMID: 27501168 DOI: 10.1097/sla.0000000000001953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Adams TD, Arterburn DE, Nathan DM, Eckel RH. Clinical Outcomes of Metabolic Surgery: Microvascular and Macrovascular Complications. Diabetes Care 2016; 39:912-23. [PMID: 27222549 PMCID: PMC5562446 DOI: 10.2337/dc16-0157] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/10/2016] [Indexed: 02/03/2023]
Abstract
Understanding of the long-term clinical outcomes associated with bariatric surgery has recently been advanced. Research related to the sequelae of diabetes-in particular, long-term microvascular and macrovascular complications-in patients who undergo weight-loss surgery is imperative to this pursuit. While numerous randomized control trials have assessed glucose control with bariatric surgery compared with intensive medical therapy, bariatric surgery outcome data relating to microvascular and macrovascular complications have been limited to observational studies and nonrandomized clinical trials. As a result, whether bariatric surgery is associated with a long-term reduction in microvascular and macrovascular complications when compared with current intensive glycemic control therapy cannot be determined because the evidence is insufficient. However, the consistent salutary effects of bariatric surgery on diabetes remission and glycemic improvement support the opportunity (and need) to conduct high-quality studies of bariatric surgery versus intensive glucose control. This review provides relevant background information related to the treatment of diabetes, hyperglycemia, and long-term complications; reports clinical findings (to date) with bariatric surgery; and identifies ongoing research focusing on long-term vascular outcomes associated with bariatric surgery.
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Affiliation(s)
- Ted D Adams
- Intermountain LiVe Well Center, Intermountain Healthcare, and Division of Cardiovascular Genetics, University of Utah, Salt Lake City, UT
| | | | - David M Nathan
- Diabetes Center, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO
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