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Long-term Remission of Type 2 Diabetes and Patient Survival After Biliopancreatic Diversion with Duodenal Switch. Obes Surg 2022; 32:3340-3350. [PMID: 35939221 DOI: 10.1007/s11695-022-06223-5] [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: 02/06/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This study investigates the long-term effects of biliopancreatic diversion with duodenal switch (BPD-DS) on patients with advanced type 2 diabetes mellitus (T2DM) while paying special attention to preoperative diabetes severity. MATERIALS AND METHODS A retrospective analysis was conducted using prospective and current data on patients who underwent an open BPD-DS 6-12 years ago. Patients were stratified according to preoperative diabetes severity into 4 groups (group 1: oral antidiabetic drugs only; group 2: insulin < 5 years; group 3: insulin 5-10 years; group 4: insulin > 10 years). The primary endpoint was T2DM remission rate 6-12 years after BPD-DS as a function of preoperative diabetes severity. RESULTS Ninety-one patients with advanced T2DM were included. Sixty-two patients were available for follow-up (rate of 77%). Follow-up was performed (mean ± SD) 8.9 ± 1.3 years after surgery. Glycated hemoglobin (HbA1c) levels were 9.4 ± 2.0% before surgery and decreased to 5.1 ± 0.8% after 1 year and 5.4 ± 1.0% after 6-12 years. Insulin discontinuation rate after surgery as well as the rate of long-term remission decreased steadily from groups 1 to 4, while long-term mortality increased. T2DM remission rates were 93%, 88%, 45%, and 40% in groups 1, 2, 3, and 4, respectively. Late relapse of T2DM occurred in 3 patients (5%). CONCLUSIONS BPD-DS causes a rapid and long-lasting normalization of glycemic metabolism in patients with advanced T2DM. T2DM remission rate after 6-12 years varies significantly (from 40% to more than 90%) and is highly dependent on preoperative diabetes severity.
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Shah A, Holter MM, Rimawi F, Mark V, Dutia R, McGinty J, Levin B, Laferrère B. Insulin Clearance After Oral and Intravenous Glucose Following Gastric Bypass and Gastric Banding Weight Loss. Diabetes Care 2019; 42:311-317. [PMID: 30523032 PMCID: PMC6341286 DOI: 10.2337/dc18-1036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hepatic insulin clearance is a significant regulator of glucose homestasis. We hypothesized that the improvement in insulin clearance rates (ICRs) under fasting conditions and in response to oral and intravenous (IV) glucose would improve similarly after Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) as a function of weight loss; the difference in ICR after oral and IV glucose stimulation will be enhanced after RYGB compared with AGB, an effect mediated by glucagon-like peptide 1 (GLP-1). RESEARCH DESIGN AND METHODS In study 1, the ICR was calculated under fasting condition (F-ICR), after oral glucose (O-ICR), and after an isoglycemic IV glucose clamp (IV-ICR) in individuals from an established cohort with type 2 diabetes mellitus (T2DM) before, after 10% matched weight loss, and 1 year after either RYGB (n = 22) or AGB (n = 12). In study 2, O-ICR was studied in a separate cohort of individuals with T2DM (n = 22), before and 3 months after RYGB, with and without exendin(9-39) infusion. RESULTS In study 1, age, BMI, T2DM duration and control, and ICR did not differ between RYGB and AGB preintervention. Weight loss at 1 year was two times greater after RYGB than after AGB (31.6 ± 5.9% vs. 16.6 ± 9.8%; P < 0.05). RYGB and AGB both significantly increased F-ICR, O-ICR, and IV-ICR at 1 year. ICR was inversely associated with insulinemia. The difference between IV-ICR and O-ICR was significantly greater after RYGB versus AGB. GLP-1 antagonism with exendin(9-39) led to an increase in O-ICR in subjects post-RYGB. CONCLUSIONS Weight loss increased ICR, an effect more pronounced after RYGB compared with AGB. Our data support a potential role for endogenous GLP-1 in the control of postprandial ICR after RYGB.
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Affiliation(s)
- Ankit Shah
- Divison of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Marlena M Holter
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Fatima Rimawi
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Victoria Mark
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Roxanne Dutia
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - James McGinty
- Bariatric Divsion, Department of Surgery, Mount Sinai St. Luke's, New York, NY
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Blandine Laferrère
- Divison of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY .,New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Wang T, Shen Y, Qiao Z, Wang Y, Zhang P, Yu B. Comparison of Diabetes Remission and Micronutrient Deficiency in a Mildly Obese Diabetic Rat Model Undergoing SADI-S Versus RYGB. Obes Surg 2019; 29:1174-1184. [PMID: 30610678 DOI: 10.1007/s11695-018-03630-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has launched a huge challenge to classic Roux-en-Y gastric bypass (RYGB). Our objective was to compare diabetes remission and micronutrient deficiency in a mildly obese diabetic rat model undergoing SADI-S versus RYGB. METHODS Thirty adult male mildly obese diabetic rats were randomly assigned to sham (S), SADI-S, and RYGB groups. Body weight, food intake, fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), plasma insulin, GLP-1, and ghrelin levels were measured at indicated time points. Meanwhile, insulin sensitivity and pancreatic β cell function were assessed during OGTT. Finally, plasma micronutrient evaluation and islet β cell mass analysis were performed after all animals were sacrificed. RESULTS As compared to sham, the SADI-S and RYGB groups achieved almost equivalent efficacy in caloric restriction and FPG control without excessive weight loss. During OGTT, the SADI-S and RYGB groups also provided comparable effects on glycemic excursion, insulin sensitivity, and β cell function; however, only rats in the RYGB group showed significant changes in gut hormones, whereas the three groups were found to exhibit no significant difference in β cell mass. In addition, only vitamin E in the RYGB group was deficient as compared with the SADI-S and S groups. CONCLUSION In mildly obese diabetic rat, SADI-S and RYGB procedures have comparable efficacy in diabetes remission and risk of micronutrient deficiency. These data show that each of the surgery accomplishes diabetes improvements through both overlapping and distinct mechanisms requiring further investigation.
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Affiliation(s)
- Tingfeng Wang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yunlong Shen
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Zhengdong Qiao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yueqian Wang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Peng Zhang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China. .,Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
| | - Bo Yu
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
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Chen X, Kamel D, Barnett B, Yung E, Quinn A, Nguyen C. An unusual presentation of post gastric bypass hypoglycemia with both postprandial and fasting hypoglycemia. Endocrinol Diabetes Metab Case Rep 2018; 2018:18-0089. [PMID: 30427165 PMCID: PMC6215949 DOI: 10.1530/edm-18-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There has been an increasing awareness of post gastric bypass hypoglycemia (PGBH). Histopathologic findings from
such patients who underwent partial/total pancreatomy, however, can vary widely from minimal changes to classic
nesidioblastosis, making the pathologic diagnosis challenging. PGBH typically presents as postprandial hypoglycemia, as
opposed to insulinoma, which presents as fasting hypoglycemia. Herein, we describe an unusual case of a patient with
PGBH who initially presented with postprandial hypoglycemia three years after surgery, but later developed fasting
hyperinsulinemic hypoglycemia as the disease progressed. Our hypothesis for this phenomenon is that this disease is
progressive, and later in its course, the insulin release becomes dissociated from food stimulation and is increased at
baseline. Future studies are needed to investigate the prevalence as well as etiology of this progression from postprandial
to fasting hypoglycemia.
Learning points:
•• There has been an increasing awareness of post gastric bypass hypoglycemia (PGBH).
•• Histopathologically, PGBH can vary from minimal changes to nesidioblastosis.
•• Although uncommon, patients with PGBH after Roux-en-Y gastric bypass may present with both postprandial and
fasting hyperinsulinemic hypoglycemia as disease progresses.
•• Our hypothesis for this phenomenon is that the insulin release becomes dissociated from food stimulation and is
increased at baseline with disease progression.
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Affiliation(s)
- Xin Chen
- Division of Internal Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
| | - Dina Kamel
- Division of Endocrinology, Diabetes, and Metabolism, Keck School of Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
| | - Braden Barnett
- Division of Endocrinology, Diabetes, and Metabolism, Keck School of Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
| | - Evan Yung
- Division of Pathology, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
| | - Adrienne Quinn
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Caroline Nguyen
- Division of Endocrinology, Diabetes, and Metabolism, Keck School of Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
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Capristo E, Panunzi S, De Gaetano A, Spuntarelli V, Bellantone R, Giustacchini P, Birkenfeld AL, Amiel S, Bornstein SR, Raffaelli M, Mingrone G. Incidence of Hypoglycemia After Gastric Bypass vs Sleeve Gastrectomy: A Randomized Trial. J Clin Endocrinol Metab 2018; 103:2136-2146. [PMID: 29590421 DOI: 10.1210/jc.2017-01695] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/20/2018] [Indexed: 01/10/2023]
Abstract
CONTEXT We compared the incidence of hypoglycemia after Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG). DESIGN, SETTING, AND MAIN OUTCOME MEASURES Randomized, open-label trial conducted at the outpatient obesity clinic in a university hospital in Rome, Italy. The primary aim was the incidence of reactive hypoglycemia (<3.1 mmol/L after 75-g oral glucose load) at 1 year after surgery. Secondary aims were hypoglycemia under everyday life conditions, insulin sensitivity, insulin secretion, and lipid profile. RESULTS Of 175 eligible patients, 120 were randomized 1:1 to RYGB or SG; 117 (93%) completed the 12-month follow-up. Reactive hypoglycemia was detected in 14% and 29% of SG and RYGB patients (P = 0.079), respectively, with the effect of treatment in multivariate analysis significant at P = 0.018. Daily hypoglycemic episodes during continuous glucose monitoring did not differ between groups (P = 0.75). Four of 59 RYGB subjects (6.8%) had 1 to 3 hospitalizations for symptomatic hypoglycemia vs 0 in SG. The static β-cell glucose sensitivity index increased after both treatments (P < 0.001), but the dynamic β-cell glucose sensitivity index increased significantly in SG (P = 0.008) and decreased in RYGB (P = 0.004 for time × treatment interaction). Whole-body insulin sensitivity increased about 10-fold in both groups. CONCLUSIONS We show that reactive hypoglycemia is no less common after SG and is not a safer option than RYGB, but RYGB is associated with more severe hypoglycemic episodes. This is likely due to the lack of improvement of β-cell sensitivity to changes in circulating glucose after RYGB, which determines an inappropriately high insulin secretion.
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Affiliation(s)
| | - Simona Panunzi
- CNR-Institute of Systems Analysis and Computer Science, BioMatLab, Rome, Italy
| | - Andrea De Gaetano
- CNR-Institute of Systems Analysis and Computer Science, BioMatLab, Rome, Italy
| | | | | | | | - Andreas L Birkenfeld
- Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Diabetes and Nutritional Sciences, King's College London, London, United Kingdom
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Dresden, a member of the German Center for Diabetes Research, Dresden, Germany
| | - Stephanie Amiel
- Diabetes and Nutritional Sciences, King's College London, London, United Kingdom
| | - Stefan R Bornstein
- Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Diabetes and Nutritional Sciences, King's College London, London, United Kingdom
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Dresden, a member of the German Center for Diabetes Research, Dresden, Germany
| | - Marco Raffaelli
- Department of General Surgery, Catholic University, Rome, Italy
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy
- Diabetes and Nutritional Sciences, King's College London, London, United Kingdom
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Aguilar-Olivos NE, Almeda-Valdes P, Aguilar-Salinas CA, Uribe M, Méndez-Sánchez N. The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome. Metabolism 2016; 65:1196-207. [PMID: 26435078 DOI: 10.1016/j.metabol.2015.09.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is strongly associated with obesity and metabolic syndrome (MetS). Current treatment of NAFLD is based on weight reduction. Bariatric surgery is the most effective treatment for morbid obesity and its associated metabolic comorbidities. There is evidence indicating that bariatric surgery improves histological and biochemical parameters of NAFLD, but currently is not considered a treatment option for NAFLD. The aim of this work is to review the evidence for the effects of bariatric surgery on NAFLD and the MetS. We found that insulin resistance, alterations in glucose metabolism, hypertension, plasma lipids, transaminases, liver steatosis, steatohepatitis and fibrosis improve after bariatric surgery. Weight loss and improvement of NAFLD are greater after RYGB than after other interventions. These findings were obtained from retrospective or cohort studies. There are no studies designed to evaluate liver-specific mortality, liver transplantation, or quality of life. Patients with indications for bariatric surgery will benefit from the improvements in the MetS and NAFLD.
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Affiliation(s)
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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7
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Su Y, Zhao Y, Zhang C. Bariatric surgery: beta cells in type 2 diabetes remission. Diabetes Metab Res Rev 2016; 32:122-31. [PMID: 25959613 DOI: 10.1002/dmrr.2663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/31/2022]
Abstract
Bariatric surgery is a new emerging treatment that demonstrates a favourable effect on type 2 diabetes, although its underlying mechanisms still remain unknown. After receiving bariatric surgery, beta cells undergo the process of rebirth, which involves apoptosis evasion, regeneration and improved beta-cell function. Therefore, further studies are necessary to elucidate how bariatric surgery can resolve type 2 diabetes. Here, our review focuses mainly on beta cells, the insulin-generating cells, whose biological features change dramatically after bariatric surgery. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yinjie Su
- Battalion 8th, Trainee Brigade, Third Military Medical University, Chongqing, China
| | - Yanling Zhao
- Department of Gynaecology and Obstetrics, The Health Center of Kumutamu, Aksu City, Xinjiang Province, China
| | - Chaojun Zhang
- Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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8
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Vrbikova J, Kunesova M, Kyrou I, Tura A, Hill M, Grimmichova T, Dvorakova K, Sramkova P, Dolezalova K, Lischkova O, Vcelak J, Hainer V, Bendlova B, Kumar S, Fried M. Insulin Sensitivity and Secretion in Obese Type 2 Diabetic Women after Various Bariatric Operations. Obes Facts 2016; 9:410-423. [PMID: 27951535 PMCID: PMC5644812 DOI: 10.1159/000453000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/27/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare the effects of biliopancreatic diversion (BPD) and laparoscopic gastric banding (LAGB) on insulin sensitivity and secretion with the effects of laparoscopic gastric plication (P). METHODS A total of 52 obese women (age 30-66 years) suffering from type 2 diabetes mellitus (T2DM) were prospectively recruited into three study groups: 16 BPD; 16 LAGB, and 20 P. Euglycemic clamps and mixed meal tolerance tests were performed before, at 1 month and at 6 months after bariatric surgery. Beta cell function derived from the meal test parameters was evaluated using mathematical modeling. RESULTS Glucose disposal per kilogram of fat free mass (a marker of peripheral insulin sensitivity) increased significantly in all groups, especially after 1 month. Basal insulin secretion decreased significantly after all three types of operations, with the most marked decrease after BPD compared with P and LAGB. Total insulin secretion decreased significantly only following the BPD. Beta cell glucose sensitivity did not change significantly post-surgery in any of the study groups. CONCLUSION We documented similar improvement in insulin sensitivity in obese T2DM women after all three study operations during the 6-month postoperative follow-up. Notably, only BPD led to decreased demand on beta cells (decreased integrated insulin secretion), but without increasing the beta cell glucose sensitivity.
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Affiliation(s)
- Jana Vrbikova
- Institute of Endocrinology, Clinical Department, Prague, Czech Republic
| | - Marie Kunesova
- Institute of Endocrinology, Obesity Management Centre, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ioannis Kyrou
- Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals of Coventry and Warwickshire (UHCW) NHS Trust, Coventry, UK
| | | | - Martin Hill
- Institute of Endocrinology, Steroid Hormone and Proteofactors Department, Prague, Czech Republic
| | | | | | - Petra Sramkova
- Institute of Endocrinology, OB Klinika, Prague, Czech Republic
| | - Karin Dolezalova
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Endocrinology, OB Klinika, Prague, Czech Republic
| | - Olga Lischkova
- Institute of Endocrinology, Department of Molecular Endocrinology, Prague, Czech Republic
- Faculty of Science, Charles University, Prague, Czech Republic
| | - Josef Vcelak
- Institute of Endocrinology, Department of Molecular Endocrinology, Prague, Czech Republic
| | - Vojtech Hainer
- Institute of Endocrinology, Obesity Management Centre, Prague, Czech Republic
| | - Bela Bendlova
- Institute of Endocrinology, Department of Molecular Endocrinology, Prague, Czech Republic
- Faculty of Science, Charles University, Prague, Czech Republic
| | - Sudhesh Kumar
- Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals of Coventry and Warwickshire (UHCW) NHS Trust, Coventry, UK
| | - Martin Fried
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Endocrinology, OB Klinika, Prague, Czech Republic
- *Prof. Dr. Martin Fried, OB Klinika, Pod Krejcárkem 975, 130 00 Prague 3, Czech Republic,
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9
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Dixon JB, Lambert EA, Lambert GW. Neuroendocrine adaptations to bariatric surgery. Mol Cell Endocrinol 2015; 418 Pt 2:143-52. [PMID: 26044866 DOI: 10.1016/j.mce.2015.05.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 02/07/2023]
Abstract
The global epidemic of obesity and its related disease in combination with robust physiological defence of intentional weight loss generates a pressing need for effective weight loss therapies. Bariatric surgery, which works very effectively at delivering substantial sustained weight loss, has been an enigma with respect to mechanism of action. Naive concepts of restriction and malabsorption do not explain the efficacy of the most commonly used bariatric procedures. This century has seen increased interest in unravelling the mystery of the mechanisms underlying surgery associated weight loss with a focus on integrative gastrointestinal (GI) physiology, gut-brain signalling, and beyond weight loss effects on metabolism. GI interventions, some very minor, can alter GI wall stretch and pressure receptors; a range of GI hormones affecting hunger and satiety; bile acid metabolism and signalling; the characteristics of GI microbiome; portal vein nutrient sensing; and circulating concentrations of amino acids. Understanding the mechanisms involved should present targets for less invasive effective therapies.
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Affiliation(s)
- J B Dixon
- Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
| | - E A Lambert
- Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - G W Lambert
- Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
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10
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Botros N, Rijnaarts I, Brandts H, Bleumink G, Janssen I, de Boer H. Effect of carbohydrate restriction in patients with hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass. Obes Surg 2015; 24:1850-5. [PMID: 24902654 DOI: 10.1007/s11695-014-1319-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hyperinsulinemic hypoglycemia is a rare complication of Roux-en-Y gastric bypass (RYGB) surgery. Meals with a high carbohydrate (carb) content and high glycemic index (GI) may provoke these hypoglycemic attacks. The aim of this study is to assess the effects of reducing meal carb content and GI on glycemic responses in patients with post-RYGB hypoglycemia. METHODS Fourteen patients with post-RYGB hypoglycemia underwent two meal tests: a mixed meal test (MMT) with a carb content of 30 g and a meal test with the low GI supplement, Glucerna SR 1.5® (Glucerna meal test (GMT)). Plasma glucose and serum insulin levels were measured for a period of 6 h. RESULTS Peak glucose levels were reached at T 30 during GMT and at T 60 during MMT, and they were 1.5 ± 0.3 mmol/L lower during GMT than during MMT (7.5 ± 0.4 vs 9.0 ± 0.4 mmol/L, P < 0.005). GMT induced the most rapid rise in plasma insulin: at T 30 plasma, insulin was 30.7 ± 8.5 mU/L higher during GMT than during MMT (P < 0.005). None of the carb-restricted meals induced post-prandial hypoglycemia. CONCLUSION A 30-g carb-restricted meal may help to prevent post-prandial hypoglycemia in patients with post-RYGB hypoglycemia. The use of a liquid, low GI, supplement offers no additional advantage.
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Affiliation(s)
- Nadia Botros
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800 TA, Arnhem, The Netherlands
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11
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Affiliation(s)
- Ram Weiss
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Section of Pediatric Endocrinology, Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
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12
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Owers CE, Abbas Y, Ackroyd R, Barron N, Khan M. Perioperative optimization of patients undergoing bariatric surgery. J Obes 2012; 2012:781546. [PMID: 22829998 PMCID: PMC3398654 DOI: 10.1155/2012/781546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/05/2012] [Indexed: 01/06/2023] Open
Abstract
Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.
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Affiliation(s)
- C. E. Owers
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| | - Y. Abbas
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| | - R. Ackroyd
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| | - N. Barron
- Department of Anaesthesia, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S10 2JF, UK
| | - M. Khan
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
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13
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Abstract
Bariatric surgery provides substantial, sustained weight loss and major improvements in glycaemic control in severely obese individuals with type 2 diabetes. However, uptake of surgery in eligible patients is poor, and the barriers are difficult to surmount. We examine the indications for and efficacy and safety of conventional bariatric surgical procedures and their effect on glycaemic control in type 2 diabetes. How surgical gastrointestinal interventions achieve these changes is of great research interest, and is evolving rapidly. Old classifications about restriction and malabsorption are inadequate, and we explore understanding of putative mechanisms. Some bariatric procedures improve glycaemic control in people with diabetes beyond that expected for weight loss, and understanding this additional effect could provide insights into the pathogenesis of type 2 diabetes and assist in the development of new procedures, devices, and drugs both for obese and non-obese patients.
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Affiliation(s)
- John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Abstract
Published data show that bariatric surgery not only leads to significant and sustained weight loss but also resolves or improves multiple comorbidities associated with morbid obesity. Evidence suggests that the earlier the intervention the better the resolution of comorbidities. Patients with metabolic syndrome and comorbidities associated with morbid obesity should be promptly referred for consideration for bariatric surgery earlier in the disease process.
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Affiliation(s)
- Ashutosh Kaul
- Department of Surgery, Westchester Medical Center, 100 Woods Road PMB 583, Valhalla, NY 10595, USA.
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15
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Use of diazoxide in management of severe postprandial hypoglycemia in patient after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2011; 9:e18-9. [PMID: 21723202 DOI: 10.1016/j.soard.2011.05.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 01/17/2023]
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16
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Hussain M, Pomp A. Biliopancreatic Diversion with Duodenal Switch in the Treatment of Diabetes: An Argument that a Chance to Cut is a Chance to Cure. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)52007-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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