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Badran S, Doi SA, Hammouda A, Musa OAH, Habib AM. Validation of Doi's weighted average glucose as a measure of post-load glucose excursion for clinical use. BIOMOLECULES & BIOMEDICINE 2023; 23:914-919. [PMID: 36967663 PMCID: PMC10494857 DOI: 10.17305/bb.2022.8807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/03/2023]
Abstract
In this study, we examined the performance of a novel index of glucose excursion (Doi's weighted average glucose [dwAG]) in relation to the conventional measure of area under the oral glucose tolerance test (A-GTT) and the homeostatic model assessment for insulin sensitivity (HOMA-S) and pancreatic beta cell function (HOMA-B). A cross-sectional comparison of the new index was conducted using 66 oral glucose tolerance tests (GTTs) performed at different follow-up times among 27 participants who had undergone surgical subcutaneous fat removal (SSFR). Comparisons across categories were made using box plots and the Kruskal-Wallis one-way ANOVA on ranks. Passing-Bablok regression was used to compare the dwAG against the conventional A-GTT. The Passing-Bablok regression model suggested a cutoff for normality for the A-GTT of 15.14 mmol/L·2h-1 compared to the dwAG's suggested threshold of 6.8 mmol/L. For every 1 mmol/L·2h-1 increase in A-GTT, the dwAG value increased by 0.473 mmol/L. The glucose area under the curve correlated well with the four defined dwAG categories, with at least one of the categories having a different median A-GTT value (KW Chi2 = 52.8 [df = 3], P < 0.001). The HOMA-S tertiles were also associated with significantly different levels of glucose excursion measured through both the dwAG value (KW Chi2 = 11.4 [df = 2], P = 0.003) and A-GTT measure (KW Chi2 = 13.1 [df = 2], P = 0.001). It is concluded that the dwAG value and categories serve as a simple and accurate tool that can be used for interpreting glucose homeostasis across clinical settings.
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Affiliation(s)
- Saif Badran
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Suhail A Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Atalla Hammouda
- Department of Plastic Surgery, Hamad General Hospital, Doha, Qatar
| | - Omran A H Musa
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Abdella M Habib
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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2
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Liu T, Zou X, Ruze R, Xu Q. Bariatric Surgery: Targeting pancreatic β cells to treat type II diabetes. Front Endocrinol (Lausanne) 2023; 14:1031610. [PMID: 36875493 PMCID: PMC9975540 DOI: 10.3389/fendo.2023.1031610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Pancreatic β-cell function impairment and insulin resistance are central to the development of obesity-related type 2 diabetes mellitus (T2DM). Bariatric surgery (BS) is a practical treatment approach to treat morbid obesity and achieve lasting T2DM remission. Traditionally, sustained postoperative glycemic control was considered a direct result of decreased nutrient intake and weight loss. However, mounting evidence in recent years implicated a weight-independent mechanism that involves pancreatic islet reconstruction and improved β-cell function. In this article, we summarize the role of β-cell in the pathogenesis of T2DM, review recent research progress focusing on the impact of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on pancreatic β-cell pathophysiology, and finally discuss therapeutics that have the potential to assist in the treatment effect of surgery and prevent T2D relapse.
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Affiliation(s)
- Tiantong Liu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Xi Zou
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rexiati Ruze
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Qiang Xu,
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3
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Suleiman M, Marselli L, Cnop M, Eizirik DL, De Luca C, Femia FR, Tesi M, Del Guerra S, Marchetti P. The Role of Beta Cell Recovery in Type 2 Diabetes Remission. Int J Mol Sci 2022; 23:ijms23137435. [PMID: 35806437 PMCID: PMC9267061 DOI: 10.3390/ijms23137435] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/11/2022] Open
Abstract
Type 2 diabetes (T2D) has been considered a relentlessly worsening disease, due to the progressive deterioration of the pancreatic beta cell functional mass. Recent evidence indicates, however, that remission of T2D may occur in variable proportions of patients after specific treatments that are associated with recovery of beta cell function. Here we review the available information on the recovery of beta cells in (a) non-diabetic individuals previously exposed to metabolic stress; (b) T2D patients following low-calorie diets, pharmacological therapies or bariatric surgery; (c) human islets isolated from non-diabetic organ donors that recover from “lipo-glucotoxic” conditions; and (d) human islets isolated from T2D organ donors and exposed to specific treatments. The improvement of insulin secretion reported by these studies and the associated molecular traits unveil the possibility to promote T2D remission by directly targeting pancreatic beta cells.
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Affiliation(s)
- Mara Suleiman
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.S.); (L.M.); (C.D.L.); (M.T.); (S.D.G.)
| | - Lorella Marselli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.S.); (L.M.); (C.D.L.); (M.T.); (S.D.G.)
| | - Miriam Cnop
- ULB Center for Diabetes Research, Université Libre de Bruxelles, 1050 Brussels, Belgium; (M.C.); (D.L.E.)
- Division of Endocrinology, ULB Erasmus Hospital, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Decio L. Eizirik
- ULB Center for Diabetes Research, Université Libre de Bruxelles, 1050 Brussels, Belgium; (M.C.); (D.L.E.)
| | - Carmela De Luca
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.S.); (L.M.); (C.D.L.); (M.T.); (S.D.G.)
| | - Francesca R. Femia
- Departmental Section of Endocrinology and Metabolism of Transplantation, AOUP Cisanello Hospital, 56124 Pisa, Italy;
| | - Marta Tesi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.S.); (L.M.); (C.D.L.); (M.T.); (S.D.G.)
| | - Silvia Del Guerra
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.S.); (L.M.); (C.D.L.); (M.T.); (S.D.G.)
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.S.); (L.M.); (C.D.L.); (M.T.); (S.D.G.)
- Departmental Section of Endocrinology and Metabolism of Transplantation, AOUP Cisanello Hospital, 56124 Pisa, Italy;
- Correspondence: ; Tel.: +39-050-995-110
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4
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Evans RM, Wei Z. Interorgan crosstalk in pancreatic islet function and pathology. FEBS Lett 2022; 596:607-619. [PMID: 35014695 DOI: 10.1002/1873-3468.14282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/16/2021] [Accepted: 12/28/2021] [Indexed: 12/14/2022]
Abstract
Pancreatic β cells secrete insulin in response to glucose, a process that is regulated at multiple levels, including a network of input signals from other organ systems. Impaired islet function contributes to the pathogenesis of type 2 diabetes mellitus (T2DM), and targeting inter-organ communications, such as GLP-1 signalling, to enhance β-cell function has been proven to be a successful therapeutic strategy in the last decade. In this review, we will discuss recent advances in inter-organ communication from the metabolic, immune and neural system to pancreatic islets, their biological implication in normal pancreas endocrine function and their role in the (mal)adaptive responses of islet to nutrition-induced stress.
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Affiliation(s)
- Ronald M Evans
- Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Zong Wei
- Department of Physiology and Biomedical Engineering, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Brodersen K, Nielsen MF, Richelsen B, Lauritzen ES, Pahle E, Abrahamsen J, Hartmann B, Holst JJ, Møller N. Comparable Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Basal Fuel Metabolism and Insulin Sensitivity in Individuals with Obesity and Type 2 Diabetes. J Diabetes Res 2022; 2022:5476454. [PMID: 36589629 PMCID: PMC9798105 DOI: 10.1155/2022/5476454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
AIM Bariatric surgery improves insulin sensitivity and glucose tolerance in obese individuals with type 2 diabetes (T2D), but there is a lack of data comparing the underlying metabolic mechanisms after the 2 most common surgical procedures Roux-en-Y gastric bypass surgery (RYGB) and sleeve gastrectomy (SG). This study was designed to assess and compare the effects of RYGB and SG on fuel metabolism in the basal state and insulin sensitivity during a two-step euglycemic glucose clamp. MATERIALS AND METHODS 16 obese individuals with T2D undergoing either RYGB (n = 9) or SG (n = 7) were investigated before and 2 months after surgery, and 8 healthy individuals without obesity and T2D served as controls. All underwent a 2 h basal study followed by a 5 h 2-step hyperinsulinemic euglycemic glucose clamp at insulin infusion rates of 0.5 and 1.0 mU/kg LBM/min. RESULTS RYGB and SG induced comparable 15% weight losses, normalized HbA1c, fasting glucose, fasting insulin, and decreased energy expenditure. In parallel, we recorded similar increments (about 100%) in overall insulin sensitivity (M-value) and glucose disposal and similar decrements (about 50%) in endogenous glucose production and FFA levels during the clamp; likewise, basal glucose and insulin concentrations decreased proportionally. CONCLUSION Our data suggest that RYGB and SG improve basal fuel metabolism and two-step insulin sensitivity in the liver, muscle, and fat and seem equally favourable when investigated 2 months after surgery. This trial is registered with NCT02713555.
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Affiliation(s)
- Katrine Brodersen
- Department of Surgery, Viborg Regional Hospital, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Denmark
| | | | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Denmark
| | - Esben S. Lauritzen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Denmark
| | - Einar Pahle
- Department of Surgery, Viborg Regional Hospital, Denmark
| | - Jan Abrahamsen
- Department of Clinical Physiology, Viborg Regional Hospital, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Jens J. Holst
- Department of Biomedical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Niels Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Denmark
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Guida C, Ramracheya R. PYY, a Therapeutic Option for Type 2 Diabetes? CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2020; 13:1179551419892985. [PMID: 32030069 PMCID: PMC6977199 DOI: 10.1177/1179551419892985] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/13/2019] [Indexed: 12/23/2022]
Abstract
Metabolic surgery leads to rapid and effective diabetes reversal in humans, by weight-independent mechanisms. The crucial improvement in pancreatic islet function observed after surgery is induced by alteration in several factors, including gut hormones. In addition to glucagon-like peptide 1 (GLP-1), increasing lines of evidence show that peptide tyrosine tyrosine (PYY) plays a key role in the metabolic benefits associated with the surgery, ranging from appetite regulation to amelioration of islet secretory properties and survival. Here, we summarize the current knowledge and the latest advancements in the field, which pitch a strong case for the development of novel PYY-based therapy for the treatment of diabetes.
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Affiliation(s)
- Claudia Guida
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Reshma Ramracheya
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Douros JD, Tong J, D’Alessio DA. The Effects of Bariatric Surgery on Islet Function, Insulin Secretion, and Glucose Control. Endocr Rev 2019; 40:1394-1423. [PMID: 31241742 PMCID: PMC6749890 DOI: 10.1210/er.2018-00183] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
Abstract
Although bariatric surgery was developed primarily to treat morbid obesity, evidence from the earliest clinical observations to the most recent clinical trials consistently demonstrates that these procedures have substantial effects on glucose metabolism. A large base of research indicates that bariatric surgeries such as Roux-en-Y gastric bypass (RYGB), vertical sleeve gastrectomy (VSG), and biliopancreatic diversion (BPD) improve diabetes in most patients, with effects frequently evident prior to substantial weight reduction. There is now unequivocal evidence from randomized controlled trials that the efficacy of surgery is superior to intensive life-style/medical management. Despite advances in the clinical understanding and application of bariatric surgery, there remains only limited knowledge of the mechanisms by which these procedures confer such large changes to metabolic physiology. The improvement of insulin sensitivity that occurs with weight loss (e.g., the result of diet, illness, physical training) also accompanies bariatric surgery. However, there is evidence to support specific effects of surgery on insulin clearance, hepatic glucose production, and islet function. Understanding the mechanisms by which surgery affects these parameters of glucose regulation has the potential to identify new targets for therapeutic discovery. Studies to distinguish among bariatric surgeries on key parameters of glucose metabolism are limited but would be of considerable value to assist clinicians in selecting specific procedures and investigators in delineating the resulting physiology. This review is based on literature related to factors governing glucose metabolism and insulin secretion after the commonly used RYGB and VSG, and the less frequently used BPD and adjustable gastric banding.
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Affiliation(s)
- Jonathan D Douros
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - Jenny Tong
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - David A D’Alessio
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
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8
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Salehi M, Gastaldelli A, D'Alessio DA. Beta-cell sensitivity to insulinotropic gut hormones is reduced after gastric bypass surgery. Gut 2019; 68:1838-1845. [PMID: 30772836 DOI: 10.1136/gutjnl-2018-317760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Postprandial hyperinsulinaemia after Roux-en Y gastric bypass (GB) has been attributed to rapid nutrient flux from the gut, and an enhanced incretin effect. However, it is unclear whether surgery changes islet cell responsiveness to regulatory factors. This study tested the hypothesis that β-cell sensitivity to glucagon like-peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) is attenuated after GB. DESIGN Ten non-diabetic subjects with GB, and 9 body mass index (BMI)-matched and age-matched non-surgical controls (CN) with normal glucose tolerance had blood glucose clamped at ~7.8 mM on three separate days. Stepwise incremental infusions of GLP-1 (15, 30, 60, 120 and 300 ng/LBkg/h), GIP (75, 150, 300, 600 and 1200 ng/LBkg/h) or saline were administered from 90 to 240 min and insulin secretion measured. RESULTS GB subjects had similar fasting glucose levels but lower fasting insulin compared with CN, likely due to increased insulin clearance. The average insulin secretion rates (ISRs) to 7.8 mM glucose were ~30% lower in GB relative to CN subjects. However, incretin-stimulated ISRs, adjusted for insulin sensitivity and glucose-stimulated insulin secretion, were even more attenuated in the GB subjects, by threefold to fourfold (AUCISR(90-240 min) during GLP-1 and GIP: 47±8 and 44±12 nmol in GB and 116±16 and 161±44 in CN; p<0.01). CONCLUSION After GB, the sensitivity of insulin secretion to both glucose and incretins is diminished.
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Affiliation(s)
- Marzieh Salehi
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Medicine, University of Texas at San Antonio, San Antonio, Texas, USA.,Bartter Research Unit, South Texas Veterans Health Care System, Audie Murphy Hospital, San Antonio, Texas, USA
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - David A D'Alessio
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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9
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Gletsu-Miller N, Shevni N, Manatunga A, Lin E, Musselman D. A multidimensional analysis of the longitudinal effects of roux en y gastric bypass on fatigue: An association with visceral obesity. Physiol Behav 2019; 209:112612. [PMID: 31299372 DOI: 10.1016/j.physbeh.2019.112612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/22/2019] [Accepted: 07/08/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Severe obesity is associated with fatigue, however, the effects of weight loss after bariatric surgery on particular dimensions of fatigue are unknown. In a secondary analysis of a prospective cohort study of women undergoing roux-en-y gastric bypass (RYGB) we explored relationships among multiple dimensions of fatigue and improving adiposity, insulin resistance and inflammation. METHODS Before, and 1 and 6 months after RYBG, dimensions of fatigue were assessed using the validated, self-report, Multidimensional Fatigue Inventory. Total, abdominal visceral (VAT) and subcutaneous (SAT) adiposity, insulin sensitivity (Si and HOMA) and plasma concentrations of leptin, C-reactive protein (CRP) and interleukin-6 (Il-6) were measured using air displacement plethysmography, computed tomography, glucose tolerance testing and enzyme-linked immunoassay. Associations were assessed using Spearman correlations and linear regression. RESULTS At baseline, the majority of our female participants (N = 19, body mass index, 46.5 kg/m2, age 37.2 years) were experiencing elevated levels of fatigue. By 6 months, dimensions of physical (-43%), reduced activity (-43%), reduced motivation (-38%), general (-31%; all p < .005), and mental (-18%, p < .05) fatigue improved, concomitant with decreases in markers of adiposity, inflammation and insulin resistance. The decrease in VAT was associated with improvement in mental fatigue (beta, 0.447 ± 0.203, p = .045), independent of other indices of adiposity, IL-6 concentrations, or Si. CONCLUSIONS In the 6 months after RYGB, fatigue improved, especially physical fatigue. Decreases in mental fatigue were strongly associated with decreases in visceral adiposity. Nevertheless, the biologic mechanisms underlying changes in these specific fatigue dimensions remain undetermined.
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Affiliation(s)
- Nana Gletsu-Miller
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA.
| | - Neeta Shevni
- Emory University School of Public Health, Department of Biostatistics, Atlanta, Georgia, USA
| | - Amita Manatunga
- Emory University School of Public Health, Department of Biostatistics, Atlanta, Georgia, USA
| | - Edward Lin
- Emory University School of Medicine, Department of Surgery, Atlanta, Georgia, USA
| | - Dominique Musselman
- University of Miami Leonard H. Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
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Borgeraas H, Hjelmesæth J, Birkeland KI, Fatima F, Grimnes JO, Gulseth HL, Halvorsen E, Hertel JK, Hillestad TOW, Johnson LK, Karlsen TI, Kolotkin RL, Kvan NP, Lindberg M, Lorentzen J, Nordstrand N, Sandbu R, Seeberg KA, Seip B, Svanevik M, Valderhaug TG, Hofsø D. Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surg ery in Tøns berg ( Oseberg) study. BMJ Open 2019; 9:e024573. [PMID: 31167860 PMCID: PMC6561424 DOI: 10.1136/bmjopen-2018-024573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Bariatric surgery is increasingly recognised as an effective treatment option for subjects with type 2 diabetes and obesity; however, there is no conclusive evidence on the superiority of Roux-en-Y gastric bypass or sleeve gastrectomy. The Oseberg study was designed to compare the effects of gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function. METHODS AND ANALYSIS Single-centre, randomised, triple-blinded, two-armed superiority trial carried out at the Morbid Obesity Centre at Vestfold Hospital Trust in Norway. Eligible patients with type 2 diabetes and obesity were randomly allocated in a 1:1 ratio to either gastric bypass or sleeve gastrectomy. The primary outcome measures are (1) the proportion of participants with complete remission of type 2 diabetes (HbA1c≤6.0% in the absence of blood glucose-lowering pharmacologic therapy) and (2) β-cell function expressed by the disposition index (calculated using the frequently sampled intravenous glucose tolerance test with minimal model analysis) 1 year after surgery. ETHICS AND DISSEMINATION The protocol of the current study was reviewed and approved by the regional ethics committee on 12 September 2012 (ref: 2012/1427/REK sør-øst B). The results will be disseminated to academic and health professional audiences and the public via publications in international peer-reviewed journals and conferences. Participants will receive a summary of the main findings. TRIAL REGISTRATION NUMBER NCT01778738;Pre-results.
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Affiliation(s)
- Heidi Borgeraas
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jøran Hjelmesæth
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Farhat Fatima
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Hanne L Gulseth
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Erling Halvorsen
- Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway
| | | | | | | | - Tor-Ivar Karlsen
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
| | - Ronette L Kolotkin
- Quality of Life Consulting, PLLC, Durham, North Carolina, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nils Petter Kvan
- Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Morten Lindberg
- Department of Biochemistry, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jolanta Lorentzen
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Njord Nordstrand
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rune Sandbu
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kathrine Aagelen Seeberg
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Birgitte Seip
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marius Svanevik
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Tone Gretland Valderhaug
- Department of Endocrinology, Division of Medicine, Akershus University Hospital HF, Oslo, Norway
| | - Dag Hofsø
- The Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
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11
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Musselman D, Shenvi N, Manatunga A, Miller AH, Lin E, Gletsu-Miller N. The effects of roux en y gastric bypass surgery on neurobehavioral symptom domains associated with severe obesity. Physiol Behav 2019; 204:86-92. [PMID: 30763595 DOI: 10.1016/j.physbeh.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/17/2019] [Accepted: 02/10/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Neurobehavioral symptoms and cognitive dysfunction related to mood disorders are present in individuals with severe obesity. We sought to determine acute improvements in these symptoms and relationships with adiposity, inflammation, and insulin sensitivity after roux-en-y gastric bypass (RYGB) surgery. METHODS The self-report Zung Depression Rating (ZDRS) and Neurotoxicity Rating (NRS) scales were administered before, and at 6-months after RYGB surgery in severely obese women (body mass index > 35 kg/m2; N = 19). Symptom domains corresponding to depressed mood/suicide ideation, anxiety, cognitive, somatic, and neurovegetative symptoms were assessed. Biologic measures were of adiposity [leptin, abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue], inflammation [IL-6, C-reactive protein (CRP)], and insulin sensitivity (Si). Spearman correlations and linear regression (adjusted for biologic measures) assessed relationships between changes in biologic measures and changes in neurobehavioral domains. RESULTS By 6-months after RYGB, VAT, SAT, Si, CRP, and IL-6 had improved (p < .05). Anxiety, somatic, and neurovegetative symptoms domains improved (p < .05), but depressed mood/suicidal ideation and cognitive domains did not. Reductions in VAT were associated with decreases in neurovegetative symptoms (beta = 295 ± 85, p < .01). We also found significant positive longitudinal associations between IL-6 concentrations and minor changes in cognitive symptoms. CONCLUSION Anxiety, somatic and neurovegetative symptoms, improved within 6 months after RYGB, but depressed mood/suicidal ideation and cognitive symptoms did not improve. Associations between visceral adiposity, IL-6 concentrations and neurovegetative and cognitive symptoms support links between obesity, inflammation and distinct neurobehavioral symptoms.
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Affiliation(s)
- Dominique Musselman
- University of Miami Leonard H. Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, United States
| | - Neeta Shenvi
- Emory University School of Public Health, Department of Biostatistics, Atlanta, GA, United States
| | - Amita Manatunga
- Emory University School of Public Health, Department of Biostatistics, Atlanta, GA, United States
| | - Andrew H Miller
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States
| | - Edward Lin
- Emory University School of Medicine, Department of Surgery, Atlanta, GA, United States
| | - Nana Gletsu-Miller
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States.
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12
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Douros JD, Niu J, Sdao S, Gregg T, Fisher-Wellman K, Bharadwaj M, Molina A, Arumugam R, Martin M, Petretto E, Merrins MJ, Herman MA, Tong J, Campbell J, D’Alessio D. Sleeve gastrectomy rapidly enhances islet function independently of body weight. JCI Insight 2019; 4:126688. [PMID: 30777938 PMCID: PMC6483064 DOI: 10.1172/jci.insight.126688] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/11/2019] [Indexed: 12/14/2022] Open
Abstract
Bariatric surgeries including vertical sleeve gastrectomy (VSG) ameliorate obesity and diabetes. Weight loss and accompanying increases to insulin sensitivity contribute to improved glycemia after surgery; however, studies in humans also suggest weight-independent actions of bariatric procedures to lower blood glucose, possibly by improving insulin secretion. To evaluate this hypothesis, we compared VSG-operated mice with pair-fed, sham-surgical controls (PF-Sham) 2 weeks after surgery. This paradigm yielded similar postoperative body weight and insulin sensitivity between VSG and calorically restricted PF-Sham animals. However, VSG improved glucose tolerance and markedly enhanced insulin secretion during oral nutrient and i.p. glucose challenges compared with controls. Islets from VSG mice displayed a unique transcriptional signature enriched for genes involved in Ca2+ signaling and insulin secretion pathways. This finding suggests that bariatric surgery leads to intrinsic changes within the islet that alter function. Indeed, islets isolated from VSG mice had increased glucose-stimulated insulin secretion and a left-shifted glucose sensitivity curve compared with islets from PF-Sham mice. Isolated islets from VSG animals showed corresponding increases in the pulse duration of glucose-stimulated Ca2+ oscillations. Together, these findings demonstrate a weight-independent improvement in glycemic control following VSG, which is, in part, driven by improved insulin secretion and associated with substantial changes in islet gene expression. These results support a model in which β cells play a key role in the adaptation to bariatric surgery and the improved glucose tolerance that is typical of these procedures.
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Affiliation(s)
- Jonathan D. Douros
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Jingjing Niu
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Sophia Sdao
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Trillian Gregg
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kelsey Fisher-Wellman
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Manish Bharadwaj
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anthony Molina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ramamani Arumugam
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - MacKenzie Martin
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Enrico Petretto
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Matthew J. Merrins
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mark A. Herman
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Jenny Tong
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Jonathan Campbell
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - David D’Alessio
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
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Smith EP, Polanco G, Yaqub A, Salehi M. Altered glucose metabolism after bariatric surgery: What's GLP-1 got to do with it? Metabolism 2018; 83:159-166. [PMID: 29113813 DOI: 10.1016/j.metabol.2017.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 01/20/2023]
Abstract
Bariatric surgery is an effective treatment for obesity. The two widely performed weight-loss procedures, Roux-en-Y gastric bypass (GB) and sleeve gastrectomy (SG), alter postprandial glucose pattern and enhance gut hormone secretion immediately after surgery before significant weight loss. This weight-loss independent glycemic effects of GB has been attributed to an accelerated nutrient transit from stomach pouch to the gut and enhanced secretion of insulinotropic gut factors; in particular, glucagon-like peptide-1 (GLP-1). Meal-induced GLP-1 secretion is as much as tenfold higher in patients after GB compared to non-surgical individuals and inhibition of GLP-1 action during meals reduces postprandial hyperinsulinemia after GB two to three times more than that in persons without surgery. Moreover, in a subgroup of patients with the late complication of postprandial hyperinsulinemic hypoglycemia after GB, GLP1R blockade reverses hypoglycemia by reducing meal stimulated insulin secretion. The role of enteroinsular axis activity after SG, an increasingly popular alternative to GB, is less understood but, similar to GB, SG accelerates nutrient delivery to the intestine, improves glucose tolerance, and increases postprandial GLP-1 secretion. This review will focus on the current evidence for and against the role of GLP-1 on glycemic effects of GB and will also highlight differences between GB and SG.
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Affiliation(s)
- Eric P Smith
- Division of Endocrinology, Diabetes & Metabolism, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Georgina Polanco
- Division of Endocrinology, Diabetes & Metabolism, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Abid Yaqub
- Division of Endocrinology, Diabetes & Metabolism, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Marzieh Salehi
- Division of Endocrinology, Diabetes & Metabolism, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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14
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Salehi M, Gastaldelli A, D’Alessio DA. Beta-cell sensitivity to glucose is impaired after gastric bypass surgery. Diabetes Obes Metab 2018; 20:872-878. [PMID: 29152839 PMCID: PMC5847451 DOI: 10.1111/dom.13165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/29/2017] [Accepted: 11/14/2017] [Indexed: 01/15/2023]
Abstract
AIMS Patients who have undergone Roux-en-Y gastric bypass surgery (GB) have exaggerated postprandial insulin secretion, which has been attributed to increased meal glucose appearance and enhanced incretin effect. Here, we sought to determine β-cell glucose sensitivity in the absence of meal stimulation and insulinotropic gut factors. MATERIALS AND METHODS A total of 12 non-diabetic subjects with prior GB, and 7 matched non-surgical control subjects with normal glucose tolerance were studied. Blood glucose and insulin secretion rates were measured during a graded glucose infusion at increasing and then decreasing rates. Insulin sensitivity (SI ) and glucose effectiveness (SG ) were determined by the minimal model. RESULTS GB subjects had SI comparable to that of control subjects. GB subjects had relative hyperglycaemia during the highest dose of glucose infusion associated with significantly reduced β-cell glucose sensitivity throughout both step-up (GB: 34 ± 6, CN: 82 ± 9 pmol min-1 mM-1 L, P < .0001) and step-down (GB: 31 ± 6, CN: 74 ± 9 pmol min-1 mM-1 L, P < .0001) phases of the glucose infusion. GB subjects also had reduced SG (GB: 0.04 ± 0.00, CN: 0.07 ± 0.01 min-1 , P = .004). CONCLUSION In the absence of enteric stimuli, β-cell sensitivity to changes in glycaemia is blunted among individuals with GB, indicating a significant shift in a fundamental property of β-cell function several years after surgery.
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Affiliation(s)
- Marzieh Salehi
- University of Cincinnati College of Medicine, Department of Medicine, Cincinnati, OH
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - David A. D’Alessio
- University of Cincinnati College of Medicine, Department of Medicine, Cincinnati, OH
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15
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Huang T, Fu J, Zhang Z, Zhang Y, Liang Y, Ge C, Qin X. Pancreatic islet regeneration through PDX-1/Notch-1/Ngn3 signaling after gastric bypass surgery in db/db mice. Exp Ther Med 2017; 14:2831-2838. [PMID: 28966671 PMCID: PMC5613180 DOI: 10.3892/etm.2017.4896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/11/2017] [Indexed: 01/27/2023] Open
Abstract
In view of the compelling anti-diabetic effects of gastric bypass surgery (GBS) in the treatment of morbid obesity, it is important to clarify its enhancing effect on pancreatic islets, which is closely linked with diabetes remission in obese patients, as well as the underlying mechanisms. The present study evaluated the effects of GBS on glycemic control and other pancreatic changes in db/db mice. The db/db mice were divided into Control, Sham and GBS group. A significant improvement in fasting plasma glucose levels and glucose intolerance were observed post-surgery. At 4 weeks after surgery, further noteworthy changes were observed in the GBS group, including improved islet structure (revealed by immunohistochemical analysis), enhanced insulin secretion, pancreatic hyperplasia and a marked increase in the ratio of β-cells to non-β endocrine cells. Furthermore, notable changes in the levels of Notch-1, pancreatic and duodenal homeobox 1 (PDX-1) and neurogenin 3 (Ngn3) were observed in the GBS group, indicating a potential role of Notch signaling in pancreatic islet regeneration after surgery. In addition, results obtained in PDX-1 knockout (KO), Notch-1 KO and Ngn3 KO mouse models with GBS suggested that elevated PDX-1 resulted in the inhibition of Notch-1, further facilitated Ngn3 and thus promoted pancreatic β-cell regeneration after GBS. The present findings demonstrated that GBS in db/db mice resulted in pancreatic islet regeneration through the PDX-1/Notch-1/Ngn3 signaling pathway, which also reflected the important role of the gastrointestinal system in metabolism control.
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Affiliation(s)
- Tao Huang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Jun Fu
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Zhijing Zhang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Yuhao Zhang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Yunjia Liang
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Cuicui Ge
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
| | - Xianju Qin
- Department of General Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, P.R. China
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16
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Zhao X, Duan W, Sun C, Li Z, Liu Y, Xiao X, Wang G, Gang X, Wang G. Decreased Cardiovascular Risk after Roux-en-Y Gastric Bypass Surgery in Chinese Diabetic Patients with Obesity. J Diabetes Res 2017; 2017:5612049. [PMID: 28744472 PMCID: PMC5514332 DOI: 10.1155/2017/5612049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/05/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The influence of bariatric surgery on cardiovascular risks in Chinese diabetic patients remains unclear. Here, we aimed to explore the impact of Roux-en-Y gastric bypass surgery (RYGB) on cardiovascular risks in Chinese diabetic patients with obesity. METHODS Twenty Chinese patients with T2DM and obesity undergoing RYGB surgery were included in this study. Cardiovascular risk factors were measured before and 18 months after surgery. A 10-year cardiovascular risk was calculated by the UKPDS risk engine. Linear regression analysis was performed on CHD risk, stroke risk, and baseline metabolic parameters. RESULTS The complete remission rate of diabetes was 90% after RYGB surgery, with significant improvements in blood pressure, BMI, glucose, and lipid metabolism (P < 0.05). The 10-year cardiovascular risk of coronary heart disease reduced from 13.05% to 3.81% (P = 0.001) and the 10-year risk of stroke reduced from 19.66% to 14.22% (P = 0.002). In subgroup analysis, Chinese diabetic patients who were women, <45 years old, with BMI < 35 kg/m2, and DM duration > 5 years, using noninsulin therapy presented more obvious improvements in the 10-year cardiovascular risk after RYGB surgery. WHR, age, LDL-C, and HbA1c were the most important factors influencing CHD or stroke risk after RYGB surgery (P < 0.01). CONCLUSION RYGB surgery is an effective treatment to reduce cardiovascular risk in Chinese diabetic patients with obesity.
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Affiliation(s)
- Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Wenyan Duan
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
- Jilin Province People's Hospital, Changchun, Jilin Province 130021, China
| | - Chenglin Sun
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Zhuo Li
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Yujia Liu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Xianchao Xiao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Gang Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province 130021, China
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17
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Does Bariatric Surgery Improve Obesity Associated Comorbid Conditions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:545-570. [PMID: 28585216 DOI: 10.1007/978-3-319-48382-5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Obesity is a constantly growing health problem which reduces quality of life and life expectancy. Bariatric surgery for obesity is taken into account when all other conservative treatment modalities have failed. Comparison of the multidisciplinary programs with bariatric surgery regarding to weight loss showed that substantial and durable weight reduction have been achieved only with bariatric surgical treatments. However, the benefits of weight loss following bariatric procedures are still debated regarding the pro-inflammatory and metabolic profile of obesity.
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18
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Holter MM, Dutia R, Stano SM, Prigeon RL, Homel P, McGinty JJ, Belsley SJ, Ren CJ, Rosen D, Laferrère B. Glucose Metabolism After Gastric Banding and Gastric Bypass in Individuals With Type 2 Diabetes: Weight Loss Effect. Diabetes Care 2017; 40:7-15. [PMID: 27999001 PMCID: PMC5180462 DOI: 10.2337/dc16-1376] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/08/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The superior effect of Roux-en-Y gastric bypass (RYGB) on glucose control compared with laparoscopic adjustable gastric banding (LAGB) is confounded by the greater weight loss after RYGB. We therefore examined the effect of these two surgeries on metabolic parameters matched on small and large amounts of weight loss. RESEARCH DESIGN AND METHODS Severely obese individuals with type 2 diabetes were tested for glucose metabolism, β-cell function, and insulin sensitivity after oral and intravenous glucose stimuli, before and 1 year after RYGB and LAGB, and at 10% and 20% weight loss after each surgery. RESULTS RYGB resulted in greater glucagon-like peptide 1 release and incretin effect, compared with LAGB, at any level of weight loss. RYGB decreased glucose levels (120 min and area under the curve for glucose) more than LAGB at 10% weight loss. However, the improvement in glucose metabolism, the rate of diabetes remission and use of diabetes medications, insulin sensitivity, and β-cell function were similar after the two types of surgery after 20% equivalent weight loss. CONCLUSIONS Although RYGB retained its unique effect on incretins, the superiority of the effect of RYGB over that of LAGB on glucose metabolism, which is apparent after 10% weight loss, was attenuated after larger weight loss.
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Affiliation(s)
- Marlena M Holter
- 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
| | - Sarah M Stano
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Peter Homel
- Albert Einstein School of Medicine, Bronx, NY
| | - James J McGinty
- Division of Minimally Invasive Surgery, Department of Surgery, Mount Sinai St. Luke's Hospital, New York, NY
| | - Scott J Belsley
- Division of Minimally Invasive Surgery, Department of Surgery, Mount Sinai St. Luke's Hospital, New York, NY
| | | | | | - Blandine Laferrère
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Papamargaritis D, Tzovaras G, Sioka E, Zachari E, Koukoulis G, Zacharoulis D. Comparison of glucose homeostasis parameters between patients with high and low risk of diabetes at 6 weeks and 6 months after sleeve gastrectomy. Surg Obes Relat Dis 2016; 13:1016-1024. [PMID: 28254260 DOI: 10.1016/j.soard.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The changes in glucose homeostasis after sleeve gastrectomy (SG) for patients with high (HRD) and low risk (LRD) of developing diabetes have not been investigated. OBJECTIVE To compare the glucose homeostasis parameters between patients with HRD and LRD after SG. SETTING University hospital in Greece. METHODS Thirteen patients were categorized as HRD (9 females, mean body mass index 46.3±1.6 kg/m2) and 10 as LRD (8 females, mean body mass index 45.4±1.7 kg/m2) based on a preoperative 2-hour oral glucose tolerance test (OGTT). OGTT was repeated 6 weeks and 6 months postoperatively. OGTT-derived indices of insulin secretion, insulin sensitivity, and β-cell function (oral disposition index [ODI]) were calculated. RESULTS Preoperatively, in the HRD group, fasting and postload glucose levels were higher and the ODIs were lower compared with those in the LRD group. Six weeks postoperatively, glucose levels and ODIs were not different between the 2 groups. However, 6 months postoperatively, the HRD group had demonstrated higher postload glucose levels and lower ODI (0-30) and ODI (0-120) compared with the LRD group. Six weeks postoperatively, insulin levels, early insulin secretion, and insulin resistance indices were decreased compared with preoperative levels only in the HRD group. Six months postoperatively, ODIs and insulin sensitivity indices improved in both groups compared with baseline. CONCLUSION Six months after SG, glucose levels and ODIs improved for both HRD and LRD patients; however, postprandial glucose levels and ODI (0-30) and ODI (0-120) in HRD patients did not return to LRD levels. Moreover, during the first 6 postoperative weeks, the changes in glucose homeostasis parameters compared with preoperative levels were different for HRD and LRD patients.
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Affiliation(s)
- Dimitris Papamargaritis
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom; Department of Endocrinology, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece.
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - George Koukoulis
- Department of Endocrinology, University Hospital of Larissa, Larissa, Greece
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20
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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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21
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Inge TH, Prigeon RL, Elder DA, Jenkins TM, Cohen RM, Xanthakos SA, Benoit SC, Dolan LM, Daniels SR, D'Alessio DA. Insulin Sensitivity and β-Cell Function Improve after Gastric Bypass in Severely Obese Adolescents. J Pediatr 2015; 167:1042-8.e1. [PMID: 26363548 PMCID: PMC4843108 DOI: 10.1016/j.jpeds.2015.08.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 06/18/2015] [Accepted: 08/05/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To test the hypothesis that insulin secretion and insulin sensitivity would be improved in adolescents after Roux-en-Y gastric bypass (RYGB). STUDY DESIGN A longitudinal study of 22 adolescents and young adults without diabetes undergoing laparoscopic RYGB (mean age 17.1 ± 1.42 years; range 14.5-20.1; male/female 8/14; Non-Hispanic White/African American 17/5) was conducted. Intravenous glucose tolerance tests were done to obtain insulin sensitivity (insulin sensitivity index), insulin secretion (acute insulin response to glucose ), and the disposition index as primary outcome variables. These variables were compared over the 1 year of observation using linear mixed modeling. RESULTS In the 1-year following surgery, body mass index fell by 38% from a mean of 61 ± 12.3 to 39 ± 8.0 kg/m(2) (P < .01). Over the year following surgery, fasting glucose and insulin values declined by 54% and 63%, respectively. Insulin sensitivity index increased 300% (P < .01), acute insulin response to glucose decreased 56% (P < .01), leading to a nearly 2-fold increase in the disposition index (P < .01). Consistent with improved β-cell function, the proinsulin to C-peptide ratio decreased by 21% (P < .01). CONCLUSIONS RYGB reduced body mass index and improved both insulin sensitivity and β-cell function in severely obese teens and young adults. These findings demonstrate that RYGB is associated with marked metabolic improvements in obese young people even as significant obesity persists. TRIAL REGISTRATION ClinicalTrials.gov: NCT00360373.
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Affiliation(s)
- Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Ronald L Prigeon
- University of Maryland School of Medicine, and Baltimore VA Medical Center Geriatric Research, Education and Clinical Center, Baltimore, MD
| | - Deborah A Elder
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert M Cohen
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH
| | | | - Stephen C Benoit
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH
| | | | | | - David A D'Alessio
- Division of Endocrinology, Diabetes and Metabolism, Duke University Medical Center, Durham, NC; Durham Veteran's Affairs Medical Center, Durham, NC
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22
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Metabolic consequences of the incorporation of a Roux limb in an omega loop (mini) gastric bypass: evaluation by a glucose tolerance test at mid-term follow-up. Surg Endosc 2015; 30:2935-45. [DOI: 10.1007/s00464-015-4581-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/19/2015] [Indexed: 01/08/2023]
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Hansen M, Lund MT, Gregers E, Kraunsøe R, Van Hall G, Helge JW, Dela F. Adipose tissue mitochondrial respiration and lipolysis before and after a weight loss by diet and RYGB. Obesity (Silver Spring) 2015; 23:2022-9. [PMID: 26337597 DOI: 10.1002/oby.21223] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/22/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To study adipose tissue mitochondrial respiration and lipolysis following a massive weight loss. METHODS High resolution respirometry of adipose tissue biopsies and tracer determined whole body lipolysis. Sixteen obese patients with type 2 diabetes (T2DM) and 27 without (OB) were studied following a massive weight loss by diet and Roux-en-Y gastric bypass (RYGB). RESULTS The mitochondrial respiratory rates were similar in OB and T2DM, and the mass-specific oxygen flux increased significantly 4 and 18 months post-surgery (P < 0.05). With normalization to mitochondrial content, no differences in oxidative capacity after RYGB were seen. The ratio between the oxidative phosphorylation system capacity (P) and the capacity of the electron transfer system (E) increased 18 months after RYGB in both groups (P < 0.05). Lipolysis per fat mass was similar in the two groups and was increased (P < 0.05) and lipid oxidation during hyperinsulinemia decreased 4 months post-surgery. In T2DM, visceral fat mass was always higher relative to the body fat mass (%) compared to OB. CONCLUSIONS Adipose tissue mitochondrial respiratory capacity increases with RYGB. Adipocytes adapt to massive weight loss by increasing the phosphorylation system ratio (P/E), suggesting an increased ability to oxidize substrates after RYGB. Lipolysis increases in the short term post-surgery, and insulin sensitivity for suppression of lipolysis increases with RYGB.
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Affiliation(s)
- Merethe Hansen
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael T Lund
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Koege Hospital, Koege, Denmark
| | - Emilie Gregers
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Regitze Kraunsøe
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gerrit Van Hall
- Clinical Metabolomics Core Facility, Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørn W Helge
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Dela
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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24
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Martinussen C, Bojsen-Møller KN, Dirksen C, Jacobsen SH, Jørgensen NB, Kristiansen VB, Holst JJ, Madsbad S. Immediate enhancement of first-phase insulin secretion and unchanged glucose effectiveness in patients with type 2 diabetes after Roux-en-Y gastric bypass. Am J Physiol Endocrinol Metab 2015; 308:E535-44. [PMID: 25628424 DOI: 10.1152/ajpendo.00506.2014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Roux-en-Y gastric bypass surgery (RYGB) in patients with type 2 diabetes often leads to early disease remission, and it is unknown to what extent this involves improved pancreatic β-cell function per se and/or enhanced insulin- and non-insulin-mediated glucose disposal (glucose effectiveness). We studied 30 obese patients, including 10 with type 2 diabetes, 8 with impaired glucose tolerance, and 12 with normal glucose tolerance before, 1 wk, and 3 mo after RYGB, using an intravenous glucose tolerance test (IVGTT) to estimate first-phase insulin response, insulin sensitivity (Si), and glucose effectiveness with Bergman's minimal model. In the fasting state, insulin sensitivity was estimated by HOMA-S and β-cell function by HOMA-β. Moreover, mixed-meal tests and oral GTTs were performed. In patients with type 2 diabetes, glucose levels normalized after RYGB, first-phase insulin secretion in response to iv glucose increased twofold, and HOMA-β already improved 1 wk postoperatively, with further enhancements at 3 mo. Insulin sensitivity increased in the liver (HOMA-S) at 1 wk and at 3 mo in peripheral tissues (Si), whereas glucose effectiveness did not improve significantly. During oral testing, GLP-1 responses and insulin secretion increased regardless of glucose tolerance. Therefore, in addition to increased insulin sensitivity and exaggerated postprandial GLP-1 levels, diabetes remission after RYGB involves early improvement of pancreatic β-cell function per se, reflected in enhanced first-phase insulin secretion to iv glucose and increased HOMA-β. A major role for improved glucose effectiveness after RYGB was not supported by this study.
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Affiliation(s)
- Christoffer Martinussen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine N Bojsen-Møller
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Dirksen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Siv H Jacobsen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Nils B Jørgensen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Viggo B Kristiansen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Jens J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; and
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark;
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25
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Abstract
A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.
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Affiliation(s)
- Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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26
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Vis DJ, Westerhuis JA, Hoefsloot HCJ, Roelfsema F, van der Greef J, Hendriks MMWB, Smilde AK. Network identification of hormonal regulation. PLoS One 2014; 9:e96284. [PMID: 24852517 PMCID: PMC4031081 DOI: 10.1371/journal.pone.0096284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 04/06/2014] [Indexed: 11/28/2022] Open
Abstract
Relations among hormone serum concentrations are complex and depend on various factors, including gender, age, body mass index, diurnal rhythms and secretion stochastics. Therefore, endocrine deviations from healthy homeostasis are not easily detected or understood. A generic method is presented for detecting regulatory relations between hormones. This is demonstrated with a cohort of obese women, who underwent blood sampling at 10 minute intervals for 24-hours. The cohort was treated with bromocriptine in an attempt to clarify how hormone relations change by treatment. The detected regulatory relations are summarized in a network graph and treatment-induced changes in the relations are determined. The proposed method identifies many relations, including well-known ones. Ultimately, the method provides ways to improve the description and understanding of normal hormonal relations and deviations caused by disease or treatment.
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Affiliation(s)
- Daniel J. Vis
- Department of Metabolic and Endocrine Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- * E-mail:
| | - Johan A. Westerhuis
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
| | - Huub C. J. Hoefsloot
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
| | - Ferdinand Roelfsema
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan van der Greef
- Netherlands Metabolomics Centre, Leiden, The Netherlands
- TNO Quality of Life, Zeist, The Netherlands
| | - Margriet M. W. B. Hendriks
- Department of Metabolic and Endocrine Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
| | - Age K. Smilde
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Metabolomics Centre, Leiden, The Netherlands
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27
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Bojsen-Møller KN, Dirksen C, Jørgensen NB, Jacobsen SH, Serup AK, Albers PH, Hansen DL, Worm D, Naver L, Kristiansen VB, Wojtaszewski JFP, Kiens B, Holst JJ, Richter EA, Madsbad S. Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass. Diabetes 2014; 63:1725-37. [PMID: 24241533 DOI: 10.2337/db13-1307] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and β-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes (T2D) and 10 obese glucose-tolerant subjects before and 1 week, 3 months, and 1 year after RYGB. Participants were included after a preoperative diet-induced total weight loss of -9.2 ± 1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic- euglycemic clamp combined with the glucose tracer technique, and β-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity, and increased insulin clearance, highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery. Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year; this increase likely was related to the reduction in body weight. Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose, underscoring the importance of the changed gut anatomy.
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28
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Effects of Roux-en-Y gastric bypass or diabetes support and education on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes. Ann Surg 2014; 259:494-501. [PMID: 23732262 DOI: 10.1097/sla.0b013e318294d19c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The long-term changes in insulin sensitivity and β-cell function in morbidly obese patients with type 2 diabetes mellitus who undergo Roux-en-Y gastric bypass (RYGB) surgery or standard medical care remain unclear. We prospectively studied longitudinal changes of glucostatic parameters in morbidly obese patients with type 2 diabetes mellitus undergoing RYGB surgery or diabetes support and education (DSE). RESEARCH METHODS AND DESIGN Sixty-one morbidly obese subjects (41.7 ± 0.6 kg/m) with type 2 diabetes mellitus were assigned to RYGB surgery (n = 30) or DSE (n = 31). They were matched for sex, age, and body weight. Insulin sensitivity index (Si) and acute insulin response (AIR) were derived from frequently sampled intravenous glucose tolerance test. Body composition was measured using dual-energy x-ray absorptiometry. General linear model with repeated measures was used to examine the longitudinal changes (baseline, 6 months, 12 months) in these parameters. RESULTS At 12-month follow-up, significant improvement in obesity measures, body composition, glucose homeostasis, Si, and AIR was observed after RYGB surgery and weight loss. These outcomes were not influenced by preoperative insulin use. Although there were no significant changes in the body composition among DSE subjects, they experienced a decline in the Si and AIR, along with an increase in fasting glucose and HbA1c. The between-group differences in Si and AIR at 12-month follow-up were completely attenuated with adjustment to changes in body weight. CONCLUSIONS The long-term effects of RYGB surgery on glucostatic parameters are partly dependent on weight loss. In morbidly obese patients with diabetes who were offered DSE, a progressive decline in the glucose homeostasis and glucostatic parameters is observed despite absence of weight gain. (NCT00787670).
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29
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Lin E. Appropriateness of Statistics in Manuscript Reviews: A Decision Tree Approach. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.9965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Edward Lin
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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30
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Gletsu-Miller N, Kahn HS, Gasevic D, Liang Z, Frediani JK, Torres WE, Ziegler TR, Phillips LS, Lin E. Sagittal abdominal diameter and visceral adiposity: correlates of beta-cell function and dysglycemia in severely obese women. Obes Surg 2014; 23:874-81. [PMID: 23408092 DOI: 10.1007/s11695-013-0874-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the context of increasing obesity prevalence, the relationship between large visceral adipose tissue (VAT) volumes and type 2 diabetes mellitus (T2DM) is unclear. In a clinical sample of severely obese women (mean body mass index [BMI], 46 kg/m(2)) with fasting normoglycemia (n = 40) or dysglycemia (impaired fasting glucose + diabetes; n = 20), we sought to determine the usefulness of anthropometric correlates of VAT and associations with dysglycemia. METHODS VAT volume was estimated using multi-slice computer tomography; anthropometric surrogates included sagittal abdominal diameter (SAD), waist circumference (WC) and BMI. Insulin sensitivity (Si), and beta-cell dysfunction, measured by insulin secretion (AIRg) and the disposition index (DI), were determined by frequently sampled intravenous glucose tolerance test. RESULTS Compared to fasting normoglycemic women, individuals with dysglycemia had greater VAT (P < 0.001) and SAD (P = 0.04), but BMI, total adiposity and Si were similar. VAT was inversely associated with AIRg and DI after controlling for ancestry, Si, and total adiposity (standardized beta, -0.32 and -0.34, both P < 0.05). In addition, SAD (beta = 0.41, P = 0.02) was found to be a better estimate of VAT volume than WC (beta = 0.32, P = 0.08) after controlling for covariates. Receiver operating characteristic analysis showed that VAT volume, followed by SAD, outperformed WC and BMI in identifying dysglycemic participants. CONCLUSIONS Increasing VAT is associated with beta-cell dysfunction and dysglycemia in very obese women. In the presence of severe obesity, SAD is a simple surrogate of VAT, and an indicator of glucose dysregulation.
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Affiliation(s)
- Nana Gletsu-Miller
- Department of Nutrition Sciences, Purdue University, 700 W. State Street, Stone Hall, West Lafayette, IN 47907, USA.
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31
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Abstract
Bariatric surgery is the most effective treatment for weight loss and glycaemic control. The focus of clinical studies and clinical experience has predominantly been on the numerical reductions of bodyweight and glucose after surgery. In this Series paper, we examine evidence on the efficacy of bariatric surgery for pancreatic, renal, retinal, peripheral nervous, cardiovascular, hepatic, and reproductive end-organ damage or disease. The overall conclusions are that, in most cases, patients' end-organ damage is expected to either stabilise or improve postoperatively. However, some of these clinical outcomes have not been assessed with robust methods and, in many cases, do not have support from randomised controlled clinical trials comparing bariatric surgery with non-surgical interventions. Such trials are urgently needed to inform patients and clinicians on whether the risks of surgery outweigh the significant benefits for end-organ health.
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Affiliation(s)
- Alexander D Miras
- Molecular and Metabolic Imaging group, Institute of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, UK.
| | - Carel W le Roux
- Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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32
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Dirksen C, Bojsen-Møller KN, Jørgensen NB, Jacobsen SH, Kristiansen VB, Naver LS, Hansen DL, Worm D, Holst JJ, Madsbad S. Exaggerated release and preserved insulinotropic action of glucagon-like peptide-1 underlie insulin hypersecretion in glucose-tolerant individuals after Roux-en-Y gastric bypass. Diabetologia 2013; 56:2679-87. [PMID: 24048673 DOI: 10.1007/s00125-013-3055-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/03/2013] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Roux-en-Y gastric bypass (RYGB) improves glycaemic control in part by increasing postprandial insulin secretion through exaggerated glucagon-like peptide (GLP)-1 release. However, it is unknown whether islet cell responsiveness to i.v. glucose, non-glucose (arginine) and incretin hormones, including GLP-1, is altered. METHODS Eleven severely obese glucose-tolerant individuals underwent three hyperglycaemic clamps with arginine bolus and co-infusion of either GLP-1, glucose-dependent insulinotropic polypeptide (GIP) or saline before, and at 1 week and 3 months after RYGB. In addition, an OGTT was performed before and 3 months after surgery. RESULTS After RYGB, insulin sensitivity improved at 1 week and 3 months, while insulin stimulation and glucagon suppression in response to the clamp with saline co-infusion were largely unaltered. The influence of i.v. GLP-1 and GIP on insulin and glucagon secretion was also unchanged postoperatively. In response to the postoperative OGTT at 3 months, insulin and GLP-1, but not GIP, secretion increased. Furthermore, the glucose profile during the OGTT was altered, with a substantial reduction in 2 h plasma glucose and a paradoxical hypersecretion of glucagon. CONCLUSIONS/INTERPRETATION After RYGB, insulin hypersecretion is linked to the oral, but not the i.v., route of administration and is associated with exaggerated release and preserved insulinotropic action of GLP-1, while both the secretion and action of GIP are unchanged. The results highlight the importance of increased GLP-1 secretion for improving postoperative glucose metabolism. TRIAL REGISTRATION ClinicalTrials.gov NCT01559779.
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Affiliation(s)
- Carsten Dirksen
- Department of Endocrinology, Hvidovre Hospital, Kettegaard Allé 30, 2650, Hvidovre, Denmark,
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33
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Vix M, Diana M, Liu KH, D'Urso A, Mutter D, Wu HS, Marescaux J. Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass: results of a prospective randomized clinical trial. Obes Surg 2013. [PMID: 23207829 DOI: 10.1007/s11695-012-0827-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aims to report glycolipid changes after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) in the setting of a prospective randomized clinical trial. METHODS One hundred patients were randomly assigned to RYGB (n = 45) and SG (n = 55). Fasting glucose, insulin, glycated hemoglobin (HbA1c%), triglycerides, and serum cholesterol (total, HDL, and LDL) were evaluated at inclusion and after 1, 3, 6, and 12 months. The index for homeostasis model assessment of insulin resistance (HOMA-IR) and β cell function (HOMA-B) were assessed. RESULTS Mean postoperative 1-, 3-, 6-, and 12-month excess weight loss was 25.39, 43.47, 63.75, and 80.38 % after RYGB and 25.25, 51.32, 64.67, and 82.97 % after SG, respectively. Mean fasting glucose and fasting serum insulin were similarly and statistically significantly reduced in both RYGB and SG. Mean HOMA-IR improved in both groups, particularly in case of high preoperative values, and mean HOMA-B improved at 1 year after RYGB. HbA1c% dropped from 5.66 % (SD = 0.61) to 5.57 % (SD = 0.32) after RYGB and from 5.64 % (SD = 0.43) to 5.44 % (SD = 0.43) after SG. Total cholesterol was significantly higher at 1 month (p = 0.04), 3 months (p = 0.03), and 1 year (p = 0.005) after SG as compared to RYGB. LDL cholesterol decreased significantly after RYGB at 1 month (p = 0.03), 3 months (p = 0.0001), and 1 year (p = 0.0004) as compared to SG. HDL cholesterol was increased at 1 year in the RYGB group but not in the SG group. Triglycerides decreased similarly in both groups. CONCLUSIONS Short-term glycemic control was comparable after SG and RYGB. An improved lipid profile was noted after RYGB in patients with abnormal preoperative values.
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Affiliation(s)
- Michel Vix
- IRCAD-IHU, University of Strasbourg, Strasbourg, France.
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34
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Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, McMahon DJ, Korner J. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell Function in type 2 diabetic patients. Diabetes 2013; 62:3027-32. [PMID: 23610060 PMCID: PMC3749351 DOI: 10.2337/db12-1762] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Marked improvement in glycemic control occurs in patients with type 2 diabetes mellitus shortly after Roux-en-Y gastric bypass surgery (RYGB) and before there is major weight loss. The objective of this study was to determine whether the magnitude of this change is primarily due to caloric restriction or is unique to the surgical procedure. We studied eleven subjects who underwent RYGB and fourteen subjects mean-matched for BMI, HbA1c, and diabetes duration who were admitted to our inpatient research unit and given a very low-calorie diet (VLCD) of 500 kcal/day with a macronutrient content similar to that consumed by patients after RYGB. Frequently sampled intravenous glucose tolerance tests were performed before and after interventions. Both groups lost an equivalent amount of weight over a mean study period of 21 days. Insulin sensitivity, acute insulin secretion after intravenous glucose administration, and β-cell function as determined by disposition index improved to a similar extent in both groups. Likewise, changes in fasting glucose and fructosamine levels were similar. Based on these data, VLCD improves insulin sensitivity and β-cell function just as well as RYGB in the short term.
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Affiliation(s)
- Clifton Jackness
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Gerardo Febres
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Irene M. Conwell
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Leaque Ahmed
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J. McMahon
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Judith Korner
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Corresponding author: Judith Korner,
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35
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Jørgensen NB, Dirksen C, Bojsen-Møller KN, Jacobsen SH, Worm D, Hansen DL, Kristiansen VB, Naver L, Madsbad S, Holst JJ. Exaggerated glucagon-like peptide 1 response is important for improved β-cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes 2013; 62:3044-52. [PMID: 23649520 PMCID: PMC3749359 DOI: 10.2337/db13-0022] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
β-Cell function improves in patients with type 2 diabetes in response to an oral glucose stimulus after Roux-en-Y gastric bypass (RYGB) surgery. This has been linked to the exaggerated secretion of glucagon-like peptide 1 (GLP-1), but causality has not been established. The aim of this study was to investigate the role of GLP-1 in improving β-cell function and glucose tolerance and regulating glucagon release after RYGB using exendin(9-39) (Ex-9), a GLP-1 receptor (GLP-1R)-specific antagonist. Nine patients with type 2 diabetes were examined before and 1 week and 3 months after surgery. Each visit consisted of two experimental days, allowing a meal test with randomized infusion of saline or Ex-9. After RYGB, glucose tolerance improved, β-cell glucose sensitivity (β-GS) doubled, the GLP-1 response greatly increased, and glucagon secretion was augmented. GLP-1R blockade did not affect β-cell function or meal-induced glucagon release before the operation but did impair glucose tolerance. After RYGB, β-GS decreased to preoperative levels, glucagon secretion increased, and glucose tolerance was impaired by Ex-9 infusion. Thus, the exaggerated effect of GLP-1 after RYGB is of major importance for the improvement in β-cell function, control of glucagon release, and glucose tolerance in patients with type 2 diabetes.
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Affiliation(s)
- Nils B Jørgensen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark.
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36
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Meyvis K, De Block C, Van Gaal LF. Can Bariatric Surgery be Considered Standard Therapy to Treat Type 2 Diabetes? EUROPEAN ENDOCRINOLOGY 2013; 9:86-91. [PMID: 29922359 DOI: 10.17925/ee.2013.09.02.86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/16/2013] [Indexed: 12/22/2022]
Abstract
With the rapid increase in obesity there has been a pronounced increase in obesity-related metabolic disorders including type 2 diabetes, cardiovascular disease, dyslipidaemia and hypertension. Bariatric surgery is a highly effective treatment for achieving long-term weight loss and is increasingly recognised to have benefits in diabetes treatment and cause improvement in other metabolic factors. Recent small randomised trials reported better glycaemic control after surgical intervention compared to pharmacological therapy. Physiological studies suggest a surgery-specific, weight-independent effect on glucose homeostasis. Long-term efficacy is to be proven. Consensus on definition of diabetes and diabetes remission must be achieved. Larger multicentre, randomised trials need to be done to clarify the place of metabolic surgery in diabetes treatment algorithms.
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Affiliation(s)
| | | | - Luc F Van Gaal
- Professor of Medicine and Head, Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Belgium
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37
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Faria G, Preto J, da Costa EL, Guimarães JT, Calhau C, Taveira-Gomes A. Acute improvement in insulin resistance after laparoscopic Roux-en-Y gastric bypass: is 3 days enough to correct insulin metabolism? Obes Surg 2013; 23:103-10. [PMID: 23114971 DOI: 10.1007/s11695-012-0803-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although medium- to long-term improvement in insulin resistance and T2DM after Roux-en-Y gastric bypass (RYGB) is well documented, few studies have analyzed the acute effects after surgery. Understanding these effects might help explain the physiologic adjustments after surgery and help in managing insulin resistance and controlling the hypoglycemic treatment for bariatric patients. METHODS We recruited a prospective cohort of 55 consecutive female patients that underwent primary laparoscopic RYGB between January and June/2011. Blood samples were collected preoperatively and at the first, third, and fifth post-operative days after an overnight fast. RESULTS There was a significant increase in homeostasis model assessment for insulin resistance (HOMA-IR) on day 1 (2.36 vs 3.12; p = 0.032), followed by a rapid decrease from day 3 onward (3.12 vs 1.70; <0.001). We found a statistically significant difference (p < 0.05) at all time points compared with baseline. HOMA-IR levels at POD5 were 47 % lower than baseline values and were not significantly different from values at 6 months (1.24 vs 0.93; p = 0.09). The blood levels of glucose and insulin closely matched those of HOMA-IR. CONCLUSIONS RYGB results in a rapid improvement in insulin resistance and a clinically significant decrease in fasting glucose and insulin levels. This improvement is significant at the 3rd post-operative day, and by the 5th day, patients express insulin resistance levels that are similar to those expressed at 6 months after surgery. This work highlights the acute metabolic impact of surgery. Understanding the behavior of insulin and glucose after surgery might improve our knowledge of the pathophysiology of diabetes and lead to novel therapies and tailored surgical approaches.
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Affiliation(s)
- Gil Faria
- Department of Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
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Insulin Sensitivity and Secretion Changes After Gastric Bypass in Normotolerant and Diabetic Obese Subjects. Ann Surg 2013; 257:462-8. [DOI: 10.1097/sla.0b013e318269cf5c] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology 2012; 143:897-912. [PMID: 22885332 PMCID: PMC3462491 DOI: 10.1053/j.gastro.2012.07.114] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 12/19/2022]
Abstract
Obesity is an important risk factor for type 2 diabetes mellitus (T2DM). Weight loss improves the major factors involved in the pathogenesis of T2DM, namely insulin action and beta cell function, and is considered a primary therapy for obese patients who have T2DM. Unfortunately, most patients with T2DM fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2DM in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2DM than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early postprandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2DM once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2DM. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2DM.
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The Effect of Gastrointestinal Surgery on Insulin Resistance and Insulin Secretion. Curr Atheroscler Rep 2012; 14:624-30. [DOI: 10.1007/s11883-012-0284-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Stefater MA, Wilson-Pérez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev 2012; 33:595-622. [PMID: 22550271 PMCID: PMC3410227 DOI: 10.1210/er.2011-1044] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite considerable scientific progress on the biological systems that regulate energy balance, we have made precious little headway in providing new treatments to curb the obesity epidemic. Diet and exercise are the most popular treatment options for obesity, but rarely are they sufficient to produce long-term weight loss. Bariatric surgery, on the other hand, results in dramatic, sustained weight loss and for this reason has gained increasing popularity as a treatment modality for obesity. At least some surgical approaches also reduce obesity-related comorbidities including type 2 diabetes and hyperlipidemia. This success puts a premium on understanding how these surgeries exert their effects. This review focuses on the growing human and animal model literature addressing the underlying mechanisms. We compare three common procedures: Roux-en-Y Gastric Bypass (RYGB), vertical sleeve gastrectomy (VSG), and adjustable gastric banding (AGB). Although many would group together VSG and AGB as restrictive procedures of the stomach, VSG is more like RYGB than AGB in its effects on a host of endpoints including intake, food choice, glucose regulation, lipids and gut hormone secretion. Our strong belief is that to advance our understanding of these procedures, it is necessary to group bariatric procedures not on the basis of surgical similarity but rather on how they affect key physiological variables. This will allow for greater mechanistic insight into how bariatric surgery works, making it possible to help patients better choose the best possible procedure and to develop new therapeutic strategies that can help a larger portion of the obese population.
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Affiliation(s)
- Margaret A Stefater
- Metabolic Diseases Institute, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA
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Jørgensen NB, Jacobsen SH, Dirksen C, Bojsen-Møller KN, Naver L, Hvolris L, Clausen TR, Wulff BS, Worm D, Lindqvist Hansen D, Madsbad S, Holst JJ. Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance. Am J Physiol Endocrinol Metab 2012; 303:E122-31. [PMID: 22535748 DOI: 10.1152/ajpendo.00073.2012] [Citation(s) in RCA: 243] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Our aim was to study the potential mechanisms responsible for the improvement in glucose control in Type 2 diabetes (T2D) within days after Roux-en-Y gastric bypass (RYGB). Thirteen obese subjects with T2D and twelve matched subjects with normal glucose tolerance (NGT) were examined during a liquid meal before (Pre), 1 wk, 3 mo, and 1 yr after RYGB. Glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), glucose-dependent-insulinotropic polypeptide (GIP), and glucagon concentrations were measured. Insulin resistance (HOMA-IR), β-cell glucose sensitivity (β-GS), and disposition index (D(β-GS): β-GS × 1/HOMA-IR) were calculated. Within the first week after RYGB, fasting glucose [T2D Pre: 8.8 ± 2.3, 1 wk: 7.0 ± 1.2 (P < 0.001)], and insulin concentrations decreased significantly in both groups. At 129 min, glucose concentrations decreased in T2D [Pre: 11.4 ± 3, 1 wk: 8.2 ± 2 (P = 0.003)] but not in NGT. HOMA-IR decreased by 50% in both groups. β-GS increased in T2D [Pre: 1.03 ± 0.49, 1 wk: 1.70 ± 1.2, (P = 0.012)] but did not change in NGT. The increase in DI(β-GS) was 3-fold in T2D and 1.5-fold in NGT. After RYGB, glucagon secretion was increased in response to the meal. GIP secretion was unchanged, while GLP-1 secretion increased more than 10-fold in both groups. The changes induced by RYGB were sustained or further enhanced 3 mo and 1 yr after surgery. Improvement in glycemic control in T2D after RYGB occurs within days after surgery and is associated with increased insulin sensitivity and improved β-cell function, the latter of which may be explained by dramatic increases in GLP-1 secretion.
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Affiliation(s)
- N B Jørgensen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark.
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Dirksen C, Jørgensen NB, Bojsen-Møller KN, Jacobsen SH, Hansen DL, Worm D, Holst JJ, Madsbad S. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Diabetologia 2012; 55:1890-901. [PMID: 22538359 DOI: 10.1007/s00125-012-2556-7] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/21/2012] [Indexed: 12/13/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.
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Affiliation(s)
- C Dirksen
- Department of Endocrinology 541, Hvidovre Hospital, University of Copenhagen, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
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Gletsu-Miller N, Broderius M, Frediani JK, Zhao VM, Griffith DP, Davis SS, Sweeney JF, Lin E, Prohaska JR, Ziegler TR. Incidence and prevalence of copper deficiency following roux-en-y gastric bypass surgery. Int J Obes (Lond) 2012; 36:328-35. [PMID: 21876546 PMCID: PMC3748601 DOI: 10.1038/ijo.2011.159] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass (RYGB) surgery is not yet clear. Objectives were to determine the prevalence and incidence of copper deficiency in patients who have undergone RYGB. DESIGN AND METHODS We sought to determine the number of RYGB patients undergoing medical and nutritional follow-up visits at the Emory Bariatric Center who experienced copper deficiency and associated hematological and neurological complaints (n=136). Separately, in patients followed longitudinally before and during 6 and 24 months following RYGB surgery, we obtained measures of copper status (n=16). Systemic blood cell counts and measures of copper, zinc and ceruloplasmin were determined using standardized assays in reference laboratories including atomic absorption spectrometry and immunoassays. RESULTS Thirteen patients were identified to have copper deficiency suggesting a prevalence of copper deficiency of 9.6%, and the majority of these had concomitant complications including anemia, leukopenia and various neuro-muscular abnormalities. In the longitudinal study, plasma copper concentrations and ceruloplasmin activity decreased over 6 and 24 months following surgery, respectively (P<0.05), but plasma zinc concentrations did not change. A simultaneous decrease in white blood cells was observed (P<0.05). The incidence of copper deficiency in these subjects was determined to be 18.8%. CONCLUSIONS The prevalence and incidence of copper deficiency following RYGB surgery was determined to be 9.6% and 18.8%, respectively, with many patients experiencing mild-to-moderate symptoms. Given that copper deficiency can lead to serious and irreversible complications if untreated, frequent monitoring of the copper status of RYGB patients is warranted.
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Affiliation(s)
- N Gletsu-Miller
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.
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Camastra S, Gastaldelli A, Mari A, Bonuccelli S, Scartabelli G, Frascerra S, Baldi S, Nannipieri M, Rebelos E, Anselmino M, Muscelli E, Ferrannini E. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia 2011; 54:2093-102. [PMID: 21614570 DOI: 10.1007/s00125-011-2193-6] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/22/2011] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Bariatric surgery consistently induces remission of type 2 diabetes. We tested whether there are diabetes-specific mechanisms in addition to weight loss. METHODS We studied 25 morbidly obese patients (BMI 51.7 ± 1.5 kg/m(2) [mean ± SEM]), 13 with non-insulin-treated type 2 diabetes (HbA(1c) 7.1 ± 0.5% [54 ± 5 mmol/mol]), before and at 2 weeks and 1 year after Roux-en-Y gastric bypass (RYGB). Lean (n = 8, BMI 23.0 ± 0.5 kg/m(2)) and obese (n = 14) volunteers who were BMI-matched (36.0 ± 1.2) to RYGB patients at 1 year after surgery served as controls. We measured insulin-stimulated glucose disposal (M) and substrate utilisation (euglycaemic clamp/indirect calorimetry), endogenous glucose production (EGP) by 6,6-[(2)H(2)]glucose, lipolysis (rate of appearance of [(2)H(5)]glycerol) and beta cell function (acute insulin response to i.v. glucose [AIR] as determined by C-peptide deconvolution). RESULTS At baseline, all obese groups showed typical metabolic abnormalities, with M, glucose oxidation and non-oxidative disposal impaired, and EGP, lipolysis, lipid oxidation and energy expenditure increased. Early after RYGB plasma glucose and insulin levels, and energy expenditure had decreased, while lipid oxidation increased, with M, EGP and AIR unchanged. At 1 year post-RYGB (BMI 34.4 ± 1.1 kg/m(2)), all diabetic patients were off glucose-lowering treatment and mean HbA(1c) was 5.4 ± 0.14% (36 ± 2 mmol/mol) (p = 0.03 vs baseline); AIR also improved significantly. In all RYGB patients, M, substrate oxidation, EGP, energy expenditure and lipolysis improved in proportion to weight loss, and were therefore similar to values in obese controls, but still different from those in lean controls. CONCLUSIONS/INTERPRETATION In morbidly obese patients, RYGB has metabolic effects on liver, adipose tissue, muscle insulin sensitivity and pattern of substrate utilisation; these effects can be explained by energy intake restriction and weight loss, the former prevailing early after surgery, the latter being dominant in the longer term.
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Affiliation(s)
- S Camastra
- Department of Internal Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.
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Abstract
PURPOSE OF REVIEW To review the basic mechanisms of caloric intake reduction of bariatric surgery and its clinical and metabolic outcomes. To describe novel bariatric procedures, their effects on glucose homeostasis and insulin sensitivity and to explain the proposed mechanisms for type 2 diabetes mellitus (T2DM) resolution. RECENT FINDINGS The effects of surgically induced weight loss on T2DM have elucidated in part the role of proximal and distal gastrointestinal bypass on insulin sensitivity. A dual mechanism for improvement in glucose homeostasis after bariatric surgery has been proposed that appears to be weight loss independent. SUMMARY Bariatric surgery is the most effective therapy for obesity and obesity-related comorbidities today that provide high rates of resolution of T2DM with improvements in insulin resistance and β-cell function. Novel bariatric procedures offer a unique opportunity to understand the pathophysiology of T2DM and to identify potential pharmacologic targets for effective T2DM treatments and a potential cure.
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Affiliation(s)
- J Esteban Varela
- Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110, USA.
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Curry TB, Roberts SK, Basu R, Basu A, Schroeder D, Joyner MJ, Miles JM. Gastric bypass surgery is associated with near-normal insulin suppression of lipolysis in nondiabetic individuals. Am J Physiol Endocrinol Metab 2011; 300:E746-51. [PMID: 21304064 PMCID: PMC3074944 DOI: 10.1152/ajpendo.00596.2010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We hypothesized that individuals who have undergone gastric bypass have greater insulin sensitivity that obese subjects but less compared with lean. We measured free fatty acid (FFA) and glucose kinetics during a two-step, hyperinsulinemic euglycemic clamp in nondiabetic subjects who were 38 ± 5 mo post-gastric bypass surgery (GB; n = 15), in lean subjects (L; n = 15), and in obese subjects (O; n = 16). Fasting FFAa were not significantly different between the three study groups but during both doses of insulin were significantly higher in O than in either GB or L. The effective insulin concentration resulting in half-maximal suppression of FFA was similar in L and GB and significantly less in both groups compared with O. Glucose infusion rates during low-dose insulin were not significantly different in GB compared with either L or O. During high-dose insulin, glucose infusion rates were significantly greater in GB than in O but less than in L. Endogenous glucose production in GB was significantly lower than O only during low dose of insulin. We conclude that gastric bypass is associated with improvements in adipose tissue insulin sensitivity to levels similar to lean, healthy persons and also with improvements in the response of glucose metabolism to insulin. These changes may be due to preferential reduction in visceral fat and decreased FFA availability. However, some differences in insulin sensitivity in GB remain compared with L. Residual insulin resistance may be related to excess total body fat or abnormal lipolysis and requires further study.
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Affiliation(s)
- Timothy B Curry
- Depts. of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
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