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Yang Y, Miao C, Wang Y, He J. The long-term effect of bariatric/metabolic surgery versus pharmacologic therapy in type 2 diabetes mellitus patients: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3830. [PMID: 38873748 DOI: 10.1002/dmrr.3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/24/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024]
Abstract
Metabolic/bariatric surgery as a treatment for obesity and related diseases, such as type 2 diabetes mellitus (T2DM), has been increasingly recognised in recent years. However, compared with conventional pharmacologic therapy, the long-term effect (≥ 5 years) of metabolic surgery in T2DM patients is still unclear. This study aimed to evaluate the diabetes remission rate, incidence of diabetic microvascular complications, incidence of macrovascular complications, and mortality in T2DM patients who received metabolic surgery versus pharmacologic therapy more than 5 years after the surgery. Searching the database, including PubMed, Embase, Web of Science, and Cochrane Library from the inception to recent (2024), for randomised clinical trials (RCTs) or cohort studies comparing T2DM patients treated with metabolic surgery versus pharmacologic therapy reporting on the outcomes of the diabetes remission rate, diabetic microvascular complications, macrovascular complications, or mortality over 5 years or more. A total of 15 articles with a total of 85,473 patients with T2DM were eligible for review and meta-analysis in this study. There is a significant long-term increase in diabetes remission for metabolic surgery compared with conventional medical therapy in the overall pooled estimation and RCT studies or cohort studies separately (overall: OR = 4.58, 95% CI: 1.89-11.07, P < 0.001). Significant long-term decreases were found in the pooled results of microvascular complications incidence (HR = 0.57, 95% CI: 0.41-0.78, P < 0.001), macrovascular complications incidence (HR = 0.59, 95% CI: 0.50-0.70, P < 0.001) and mortality (HR = 0.53, 95% CI: 0.53-0.79, P = 0.0018). Metabolic surgery showed more significant long-term effects than pharmacologic therapy on diabetes remission, macrovascular complications, microvascular complications incidence, and all-cause mortality in patients with T2DM using currently available evidence. More high-quality evidence is needed to validate the long-term effects of metabolic surgery versus conventional treatment in diabetes management.
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Affiliation(s)
- Yumeng Yang
- Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chuhan Miao
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Yingli Wang
- Department of Rehabilitation Medicine, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianxun He
- Department of Neurosurgery, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
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Laville M, Robert M, Segrestin B. Barriers to metabolic surgery and how to address them. Metabolism 2024; 152:155764. [PMID: 38135182 DOI: 10.1016/j.metabol.2023.155764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
After bariatric surgery, patients with obesity achieve sustainable weight loss, gain in mobility, quality of life and life expectancy. Bariatric surgery can lead to remission of type 2 diabetes or to long term glycaemic control for patients with type 2 diabetes, while medical treatment has a preventive efficacy on micro and macrovascular complications. This has led to the concept of metabolic surgery to treat type 2 diabetes. Despite the benefits, only a small proportion of eligible patients undergo bariatric/metabolic surgery. Powerful antidiabetic medications, self-estimated lack of knowledge by medical professionals and fear of surgical complications are some of the arguments to prefer medical treatment of type 2 diabetes obesity versus metabolic surgery. We have reviewed in this paper the barriers which explain the low referral rate to metabolic surgery. With the point of view of the diabetologist, the general practitioner and the patient, we have addressed them to help clinicians and patients model an evidenced-based patient-oriented medical plan.
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Affiliation(s)
- Martine Laville
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France; Department of Endocrinology, Diabetes and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré de L'Obésité de Lyon, Hospices Civils de Lyon, Pierre Bénite, France
| | - Maud Robert
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France; Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré de L'Obésité de Lyon, Hospices Civils de Lyon, Pierre Bénite, France
| | - Bérénice Segrestin
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France; Department of Endocrinology, Diabetes and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré de L'Obésité de Lyon, Hospices Civils de Lyon, Pierre Bénite, France.
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Wen S, Gong M, Wang T, Zhou M, Dong M, Li Y, Xu C, Yuan Y, Zhou L. The Rapid Changes in Bodyweight and Glycemic Control Are Determined by Pre-status After Bariatric Surgery in Both Genders in Young Chinese Individuals. Cureus 2023; 15:e46603. [PMID: 37937018 PMCID: PMC10626214 DOI: 10.7759/cureus.46603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
PURPOSES The primary aim of this clinical study is to identify the factors associated with rapid glycemic, bodyweight, and lipid profile remission in young obese patients following bariatric surgery. MATERIALS AND METHODS In a total of 131 Chinese in-patients at Shanghai Pudong Hospital, China, we retrospectively analyzed in-patient data of metabolic parameters, including BMI, waist circumference, blood pressure (BP), and blood laboratory tests, such as plasma lipids and lipoprotein, hemoglobulin A1c (HbA1c), and oral glucose tolerance tests (OGTT) before bariatric surgery. We followed up these indices at the first month, third months, half-year, and one year later. RESULTS The results showed that bodyweight, BP, fasting plasma glucose (FPG), HbA1c, and triglyceride (TG) levels decreased significantly in one to three months following surgery in both male and female patients (p<0.05). We demonstrated that age (male: β=-0.181; female: β=-0.292) and the pre-operation HbA1c levels (male: β=0.935; female: β=0.919) were independent predictors of HbA1c reduction in both young obese male and female patients in three months after surgery. For body weight loss, age (β=-0.229) and pre-operation bodyweight (β=0.735) are the predictors in females, but only pre-operation body weight (β=0.798) is the independent predictor in obese young male patients. CONCLUSION This study discovered that changes in bodyweight were determined by age, pre-operation status of bodyweight, and HbA1C in obese young Chinese.
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Affiliation(s)
- Song Wen
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
| | - Min Gong
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
| | | | - Mingyue Zhou
- Gynecology, University of California San Francisco, San Francisco, USA
| | - Meiyuan Dong
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
| | - Yanyan Li
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
| | - Chenglin Xu
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
| | - Yue Yuan
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
| | - Ligang Zhou
- Endocrinology, Shanghai Pudong Hospital, Shanghai, CHN
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Alsayed Hasan M, Schwartz S, McKenna V, Ing R. An Imbalance of Pathophysiologic Factors in Late Postprandial Hypoglycemia Post Bariatric Surgery: A Narrative Review. Obes Surg 2023; 33:2927-2937. [PMID: 37530920 DOI: 10.1007/s11695-023-06758-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
With a rise in obesity and more patients opting for bariatric surgery, it becomes crucial to understand associated complications like postprandial hypoglycemia (PPH). After bariatric surgery, significant changes are seen in insulin sensitivity, beta cell function, glucagon-like peptide 1 (GLP-1) levels, the gut microbiome, and bile acid metabolism. And in a small subset of patients, exaggerated imbalances in these functional and metabolic processes lead to insulin-glucose mismatch and hypoglycemia. The main treatment for PPH involves dietary modifications. For those that do not respond, medications or surgical interventions are considered to reverse some of the imbalances. We present a few case reports of patients that safely tolerated GLP-1 agonists. However, larger randomized control trials are needed to further characterize PPH and understand its treatment.
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Affiliation(s)
- Marah Alsayed Hasan
- Department of Internal Medicine, Main Line Health System/Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
| | - Stanley Schwartz
- Affiliate, Main Line Health System, Emeritus, University of Pennsylvania, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA
| | - Victoria McKenna
- Main Line Health Bariatric Surgery - Bryn Mawr, 830 Old Lancaster Road Suite 300, Bryn Mawr, PA, 19010, USA
| | - Richard Ing
- Bariatric Center of Bryn Mawr Hospital, Main Line Health System, Bryn Mawr Medical Building North, 830 Old Lancaster Road, Bryn Mawr, PA, 19010, USA
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Scheen AJ. Use of SGLT2 inhibitors after bariatric/metabolic surgery: Risk/benefit balance. DIABETES & METABOLISM 2023; 49:101453. [PMID: 37245675 DOI: 10.1016/j.diabet.2023.101453] [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: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
Bariatric/metabolic surgery and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are becoming increasingly popular for the management of overweight/obese patients with type 2 diabetes mellitus (T2DM). Consequently, the chance that a patient undergoing bariatric/metabolic surgery is also treated with an SGLT2i would be rather common in clinical practice. Both risks and benefits have been reported. On the one hand, several cases of euglycemic diabetic ketoacidosis have been reported within the few days/weeks after bariatric/metabolic surgery. The causes are diverse but a drastic reduction in caloric (carbohydrate) intake most probably plays a crucial role. Thus, SGLT2is should be stopped a few days (and even more if a pre-operative restricted diet is prescribed to reduce liver volume) before the intervention and reintroduced only when the caloric (carbohydrate) intake is sufficient. On the other hand, SGLT2is may exert a favorable effect to reduce the risk of postprandial hypoglycemia, a complication reported among patients who have been treated with bariatric/metabolic surgery. An increased hepatic glucose production and a reduced production of interleukin-1β have been proposed as possible underlying mechanisms for this protective effect. Finally, whether SGLT2is could prolong diabetes remission following surgery and improve the prognosis of patients with T2DM who benefit from bariatric/metabolic surgery remains to be investigated.
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Affiliation(s)
- André J Scheen
- Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), Liège University, Liège, Belgium; Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, Liège, Belgium.
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Cardoso S, Pereira SS, Almeida RF, Osório C, Silva D, Nora M, Monteiro MP, Guimarães M. Accuracy of prediction models for long-term type 2 diabetes remission after gastric bypass. Acta Diabetol 2023:10.1007/s00592-023-02092-1. [PMID: 37085634 DOI: 10.1007/s00592-023-02092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/07/2023] [Indexed: 04/23/2023]
Abstract
AIM To evaluate the accuracy of DiaBetter, DiaRem, Ad-DiaRem and 5y-Ad-DiaRem scores' at predicting T2D remission 10 or more years after surgery. METHODS Patients with obesity and T2D (n = 126) submitted to RYGB with 10 or more years of follow-up. It was a unicentric trial. Pre-operative anthropometric and clinical data was retrieved to calculate DiaRem, DiaBetter, Ad-DiaRem and 5y-Ad-DiaRem scores, while a hospital visit was conducted to assess current diabetes status. The area under the receiver operating characteristic (AUROC) curve was calculated as estimate of the scores' accuracy to predict long-term T2D remission. RESULTS Among the entire cohort (n = 126), 70 subjects (55.6%) achieved and maintained T2D remission 10 or more years after RYGB. The 5y-Ad-DiaRem score was the one that depicted the highest discriminative power (AUROC = 0.838) to predict long-term T2D remission when compared to DiaBetter (AUROC = 0.735), DiaRem (AUROC = 0.721) and Ad-DiaRem (AUROC = 0.720). CONCLUSION The score with highest accuracy to predict long-term T2D remission after RYGB surgery was the 5y-Ad-DiaRem. Yet, the available scores accuracy to predict T2D remission in the long term is still suboptimal, highlighting the unmet need for a better scoring system.
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Affiliation(s)
- Samuel Cardoso
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Universidade Do Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Sofia S Pereira
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Universidade Do Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Rui F Almeida
- Department of General Surgery, Centro Hospitalar de Entre O Douro E Vouga, Cândido Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Catarina Osório
- Department of General Surgery, Centro Hospitalar de Entre O Douro E Vouga, Cândido Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Diogo Silva
- Department of General Surgery, Centro Hospitalar de Entre O Douro E Vouga, Cândido Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Mário Nora
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Universidade Do Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Department of General Surgery, Centro Hospitalar de Entre O Douro E Vouga, Cândido Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Universidade Do Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Marta Guimarães
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Universidade Do Porto, Porto, Portugal.
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
- Department of General Surgery, Centro Hospitalar de Entre O Douro E Vouga, Cândido Pinho, 4520-211, Santa Maria da Feira, Portugal.
- Department of Anatomy of Institute of Biomedical Sciences Abel, Salazar - University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal.
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The Effect of Bariatric Surgery on Circulating Levels of Monocyte Chemoattractant Protein-1: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11237021. [PMID: 36498595 PMCID: PMC9738353 DOI: 10.3390/jcm11237021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background: MCP-1 (monocyte chemoattractant protein) plays an important role in early phases of atherogenesis as well as in plaque destabilization, which causes cardiovascular events to play an important role in low-grade inflammation. Obesity, particularly extreme obesity, is a pivotal risk factor for atherosclerosis and many other diseases. In the early stages, bariatric surgery might stop or slow atherogenesis by suppressing inflammation, but also in later stages, preventing plaque destabilization. The aim of this meta-analysis was to provide an answer as to whether bariatric surgery has a significant effect on circulating MCP-1 level or not. Methods: A systematic literature search in PubMed, Scopus, Embase, and Web of Science was performed from inception to 1 January 2022. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. In order to heterogeneity compensation of studies in terms of study design and treatment duration, the characteristics of the studied populations random-effects model and the generic inverse variance weighting method were used. To investigate the relationship with the estimated effect size, a random-effect meta-regression model was used. To assess the exitance of publication bias in the meta-analysis, the funnel plot, Begg's rank correlation, and Egger's weighted regression tests were used. Results: Meta-analysis of 25 studies with 927 subjects included demonstrated a significant decrease of MCP-1 concentration after bariatric surgery. The data of meta-regression did not indicate any association between the alterations in body mass index (BMI) and absolute difference in MCP-1 levels, but a linear relationship between the changes in MCP-1 and length of follow-up was proven. Conclusions: Bariatric surgery significantly decreases MCP-1 concentration, but there was no association between the changes in BMI and absolute difference in MCP-1 levels before and after the surgery.
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Richter LR, Albert BI, Zhang L, Ostropolets A, Zitsman JL, Fennoy I, Albers DJ, Hripcsak G. Data assimilation on mechanistic models of glucose metabolism predicts glycemic states in adolescents following bariatric surgery. Front Physiol 2022; 13:923704. [PMID: 36518108 PMCID: PMC9744230 DOI: 10.3389/fphys.2022.923704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Type 2 diabetes mellitus is a complex and under-treated disorder closely intertwined with obesity. Adolescents with severe obesity and type 2 diabetes have a more aggressive disease compared to adults, with a rapid decline in pancreatic β cell function and increased incidence of comorbidities. Given the relative paucity of pharmacotherapies, bariatric surgery has become increasingly used as a therapeutic option. However, subsets of this population have sub-optimal outcomes with either inadequate weight loss or little improvement in disease. Predicting which patients will benefit from surgery is a difficult task and detailed physiological characteristics of patients who do not respond to treatment are generally unknown. Identifying physiological predictors of surgical response therefore has the potential to reveal both novel phenotypes of disease as well as therapeutic targets. We leverage data assimilation paired with mechanistic models of glucose metabolism to estimate pre-operative physiological states of bariatric surgery patients, thereby identifying latent phenotypes of impaired glucose metabolism. Specifically, maximal insulin secretion capacity, σ, and insulin sensitivity, SI, differentiate aberrations in glucose metabolism underlying an individual's disease. Using multivariable logistic regression, we combine clinical data with data assimilation to predict post-operative glycemic outcomes at 12 months. Models using data assimilation sans insulin had comparable performance to models using oral glucose tolerance test glucose and insulin. Our best performing models used data assimilation and had an area under the receiver operating characteristic curve of 0.77 (95% confidence interval 0.7665, 0.7734) and mean average precision of 0.6258 (0.6206, 0.6311). We show that data assimilation extracts knowledge from mechanistic models of glucose metabolism to infer future glycemic states from limited clinical data. This method can provide a pathway to predict long-term, post-surgical glycemic states by estimating the contributions of insulin resistance and limitations of insulin secretion to pre-operative glucose metabolism.
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Affiliation(s)
- Lauren R. Richter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Benjamin I. Albert
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Jeffrey L. Zitsman
- Division of Pediatric Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Metabolism, and Diabetes, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - David J. Albers
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States,Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: George Hripcsak,
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9
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Silverman JR. Obesity, Bariatric Surgery, and Postoperative Nutritional Management. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li JZ, Broderick RC, Huang EY, Serra J, Wu S, Genz M, Sandler BJ, Jacobsen GR, Horgan S. Post Sleeve Reflux: indicators and impact on outcomes. Surg Endosc 2022; 37:3145-3153. [PMID: 35948805 DOI: 10.1007/s00464-022-09454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Post-operative gastroesophageal reflux disease (GERD) remains a significant morbidity following sleeve gastrectomy (SG). We aim to evaluate the incidence and impact within a single center experience. MATERIALS AND METHODS A retrospective review of a prospectively maintained database was performed identifying laparoscopic or robotic SG patients. Primary outcomes included weight loss, rates of post-operative GERD (de-novo or aggravated), and re-intervention. Subgroup analysis was performed between patients with (Group 1) and without (Group 2) post-operative GERD. De-novo GERD and aggravated was defined as persistent GERD complaints or new/increased PPI usage in GERD naive or prior GERD patients, respectively. RESULTS 392 patients were identified between 2014 and 2019. Average demographics: age 42.3 (18-84) years, Charlson Comorbidity Index (CCI) 1.12 (0-10), and body mass index (BMI) 47.7 (28-100). 98% were performed laparoscopically. Average excess weight loss (EWL) was 51.0% and 46.4% at 1 and 2 years post-operatively. Average follow up was 516 (6-2694) days. 69 (17%) patients developed post operative de-novo or aggravated GERD. Group 1 had significantly higher EWL at 9 months (57% vs 47%, p 0.003). 13 (3%) patients required operative re-intervention for GERD and other morbidities: 4 RYGB conversions, 4 diagnostic laparoscopies, 3 HHR, 1 MSA placement. Group 1 had higher rates of post-operative intervention (14% vs 1%, p 0.0001). Subanalysis demonstrated that Group 1 had elevated preoperative DeMeester scores on pH testing (34.8 vs 18.9, p 0.03). De-novo GERD had an elevated post-operative total acid exposure when compared to aggravated GERD (12.7% vs 7.0% p 0.03). No significant differences were found between preoperative endoscopy findings, pre and postoperative total acid exposure, post-operative DeMeester scores, and high-resolution manometry values regarding de-novo/aggravated GERD development. CONCLUSION Preoperative DeMeester scores may serve as risk indicators regarding post-operative GERD. Outcomes such as reintervention remain elevated in post-operative GERD patients.
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Affiliation(s)
- Jonathan Z Li
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Estella Y Huang
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Joaquin Serra
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Samantha Wu
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Michael Genz
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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Mika A, Janczy A, Waleron K, Szymanski M, Kaska L, Sledzinski T. The impact of the interplay of the intestinal microbiome and diet on the metabolomic and health outcomes of bariatric surgery. Obes Rev 2022; 23:e13455. [PMID: 35393734 DOI: 10.1111/obr.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Abstract
Obesity has evolved into a global epidemic. Bariatric surgery, the most effective treatment for obesity, keeps many comorbidities of obesity at bay for a prolonged period of time. However, complications, including metabolic alterations, are inherent in bariatric surgery. Surgical intervention in the structure of the digestive tract, especially during bariatric bypass procedures, also causes significant changes in the composition of the microbiome, which may affect the composition and quantity of various metabolites produced by intestinal bacteria. The composition of the intestinal microbiome is connected to human metabolism via metabolites that are produced and secreted by bacterial cells into the intestinal lumen and then absorbed into the host's bloodstream. Bariatric surgery causes changes in the composition and quantity of many circulating metabolites. Metabolic disorders may be affected after bariatric surgery by changes in the composition of the microbiome and metabolites produced by bacteria.
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Affiliation(s)
- Adriana Mika
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Agata Janczy
- Department of Clinical Nutrition, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Waleron
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Michal Szymanski
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Lukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Sledzinski
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
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12
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Pineda-García G, Serrano-Medina A, Cornejo-Bravo JM, Andrade-Soto VH, Armenta-Rojas E, González-Sánchez DL. Self-care model and body image in adults after a bariatric surgery. Rev Lat Am Enfermagem 2022; 30:e3586. [PMID: 35830125 DOI: 10.1590/1518-8345.5592.3587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/13/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE the aim of the present article was to test a self-care model explained by the relationship between self-efficacy, body image, obsessive-compulsive disorder, and depression in people with bariatric surgery in the city of Tijuana, Baja California, Mexico. METHOD this was a correlational cross-sectional study carried out between August and December 2020. Validated instruments were administered to 102 participants to measure their self-care capacity, general self-efficacy, psychopathological symptoms, and body image perception and satisfaction. The variables of interest were analyzed using descriptive statistics and the Pearson and Spearman correlation coefficients were used to develop a model using path analysis. RESULT a significant model was obtained with adequate goodness-of-fit indicators (chi-square χ2 (8) = 11.451, p = .177; root mean square error of approximation (RMSEA)= 0.000; goodness-of-fit index (GFI)= 0.965; comparative fit index (CFI)= 0.985; parsimonious normed fit index (PNFI)= 0.509, and Akaike information criterion (AIC)= 37.451). Self-efficacy (Zβ=0.294) and body image dissatisfaction (So= -0.376) were shown to influence self-care abilities while psychopathological symptoms influenced body dissatisfaction: obsessive-compulsive disorder (Zβ=0.370) and depression (Zβ=0.320). CONCLUSION adequate levels of self-efficacy and body satisfaction predict a high capacity for self-care.
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Affiliation(s)
- Gisela Pineda-García
- Universidad Autónoma de Baja Califonia, Facultad de Medicina y Psicología, Tijuana, Baja California, México
| | - Aracely Serrano-Medina
- Universidad Autónoma de Baja Califonia, Facultad de Medicina y Psicología, Tijuana, Baja California, México
| | - José Manuel Cornejo-Bravo
- Universidad Autónoma de Baja Califonia, Facultad de Ciencias Químicas e Ingeniería, Tijuana, Baja California, México
| | - Víctor Hugo Andrade-Soto
- Universidad Autónoma de Baja Califonia, Facultad de Ciencias de la Salud, Tijuana, Baja California, México
| | - Efraín Armenta-Rojas
- Universidad Autónoma de Baja Califonia, Facultad de Ciencias Químicas e Ingeniería, Tijuana, Baja California, México.,Bolsista do Consejo Nacional de Ciencia y Tecnología, México
| | - Daniela Lilian González-Sánchez
- Universidad Autónoma de Baja Califonia, Facultad de Medicina y Psicología, Tijuana, Baja California, México.,Bolsista do Sindicato de Profesores Superación Universitaria de la Universidad Autónoma de Baja California, México
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13
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Is Sleeve Gastrectomy as Effective in Older Patients as in Younger Patients? A Comparative Analysis of Weight Loss, Related Comorbidities, and Medication Requirements. Obes Surg 2022; 32:1909-1917. [PMID: 35411452 PMCID: PMC9072441 DOI: 10.1007/s11695-022-05940-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022]
Abstract
Background Bariatric surgery in the older population has been the subject of ongoing debate but several studies have recently demonstrated its short-term advantages in this age group. It is not yet clear, however, whether these benefits are long-lasting. Methods We retrospectively analyzed patients with morbid obesity who underwent laparoscopy sleeve gastrectomy (LSG). These patients were divided into two groups: those above 60 years of age (older group) and those of 60 years or under (younger group). Variables evaluated included demographics and anthropometrics data, comorbidities, and daily medication requirements. Results Two hundred fifty-two patients underwent LSG, 57 in the older group and 195 in the younger group. Outcomes related to weight loss in the older subjects were modest compared to those in the younger population (older group %EWL 41.6 vs younger group %EWL 51.1, p < 0.05, older group %TWL 24.9% vs younger group %TWL 25.2%, p < 0.05). During follow-up, both older and younger patients showed an improvement in all the comorbidities: hypertension (older 82.5% vs 38.1%, younger 52.6% vs 29.2%, p < 0.05), type 2 diabetes mellitus (older 38.6% vs 27.3%, 34.9% vs 23.9%, p < 0.05), hyperlipidemia (older 75.4% vs 42.9%, younger 35.9% vs 21.1%, p < 0.05), and OSAHS (older 57.9% vs 30%, younger 40.4% vs 7.1%, p < 0.05). The average number of daily medications used to manage comorbidities decreased in both groups. Conclusion LSG in older patients is effective in terms of weight loss, improvement of comorbidities, and lower daily medication requirements up to 5 years of follow-up. Graphical abstract ![]()
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14
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Sweet L, Vasilevski V. Women's experiences of pregnancy and lactation after bariatric surgery: A scoping review. Midwifery 2022; 110:103338. [DOI: 10.1016/j.midw.2022.103338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/10/2022] [Accepted: 04/08/2022] [Indexed: 12/17/2022]
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15
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Wei W, Wang X, Wei Y, Liu S, Gao S, Tian H, Su D. lncRNA TUG1 protects intestinal epithelial cells from damage induced by high glucose and high fat via AMPK/SIRT1. Mol Med Rep 2022; 25:139. [PMID: 35211764 DOI: 10.3892/mmr.2022.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
he incidence of obesity and type 2 diabetes mellitus (T2DM) is increasing year by year and shows a trend towards younger age groups worldwide. It has become a disease that endangers the health of individuals all over the world. Among numerous weight loss surgeries, sleeve gastrectomy (SG) has become one of the most common surgical strategies for the treatment of T2DM. However, SG‑mediated alterations to the molecular mechanism of metabolism require further investigation. Thus, reverse transcription‑quantitative PCR was used to detect the expression levels of long non‑coding (lnc)RNA taurine‑upregulated gene 1 (TUG1), Sirtuin 1 (SIRT1), AMP‑activated protein kinase (AMPK) and uncoupling protein 2 (UCP2) in the serum of T2DM patients, as well as in HIEC‑6 and SW480 cells following treatment with high glucose and high fat (HGHF). Protein expression was detected by western blotting. Cell Counting Kit‑8 assays were performed to analyze cell viability, and flow cytometry and a TUNEL assay was performed to evaluate cell apoptosis. The secretion of ILs in the culture medium was detected by conducting ELISAs. The results showed that lncRNA TUG1 and UCP2 expression was upregulated, SIRT1 and AMPK expression levels were decreased by SG. Under HGHF conditions, HIEC‑6 and SW480 cell viability was inhibited, apoptosis was promoted, TUG1 expression was downregulated, and SIRT1 and AMPK expression levels were upregulated. The secretory levels of IL‑1β, IL‑6 and IL‑8 were increased, whereas the secretion of IL‑10 was decreased under HGHF conditions. lncRNA TUG1 overexpression significantly reversed the effects of HGHF on cell viability, apoptosis and SIRT1, AMPK, UCP2 and Bcl‑2 expression levels. Together, the findings of the present study demonstrated that lncRNA TUG1 alleviated the damage induced by HGHF in intestinal epithelial cells by downregulating SIRT1 and AMPK expression, and upregulating UCP2 expression. Thus, the lncRNA TUG1/AMPK/SIRT1/UCP2 axis may serve an important role in the treatment of T2DM.
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Affiliation(s)
- Weiwei Wei
- Department of General Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154002, P.R. China
| | - Xingquan Wang
- Department of General Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154002, P.R. China
| | - Yaqing Wei
- Department of Infectious Diseases, The Central Hospital of Jiamusi City, Jiamusi, Heilongjiang 154002, P.R. China
| | - Shilin Liu
- Department of General Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154002, P.R. China
| | - Shengyu Gao
- Department of General Surgery, Jiamusi University, Jiamusi, Heilongjiang 154002, P.R. China
| | - Hao Tian
- Department of General Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154002, P.R. China
| | - Dewang Su
- Department of General Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154002, P.R. China
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16
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de Carvalho TR, Blume CA, Alessi J, Schaan BD, Telo GH. Polysomnography in pre-operative screening for obstructive sleep apnea in patients undergoing bariatric surgery: a retrospective cohort study. Int J Obes (Lond) 2022; 46:802-808. [PMID: 34983957 DOI: 10.1038/s41366-021-01055-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To assess the impact of obstructive sleep apnea (OSA) screening with polysomnography on preventing cardiovascular and pulmonary complications in the postoperative period of bariatric surgery. SUBJECTS/METHODS This was a single-center retrospective cohort study, including 522 adults who underwent bariatric surgery between August 2010 and May 2019. Electronic medical records were accessed to obtain variables of interest. Screening for OSA was performed as a medical indication and registered as positive if apnea-hypopnea index was ≥5 events/hour in patients who did not have previous OSA diagnosis. The primary outcome was the presence of cardiac or pulmonary events in the 30-day postoperative period. Secondary outcomes included length of stay (days), need for an intensive care unit (ICU) after surgery, length of mechanical ventilation, and time from mechanical ventilation withdrawal. Statistical analyses were performed with χ2, Fisher's exact test, Student's t-test, Mann-Whitney U test, and Poisson regression. RESULTS Most participants (n = 326) did not have OSA screening with polysomnography, while 196 had performed this screening. There was no difference in cardiopulmonary events between the screening and non-screening groups (4.2% vs. 2.8%; P = 0.45). Polysomnography screening could not reduce cardiovascular or pulmonary complications in the postoperative period, RR = 1.73 (95% CI: 0.68-4.14). There was no difference in ICU admission, length of stay, and time from mechanical ventilation between groups in secondary outcomes. CONCLUSIONS Our study suggests that OSA screening with polysomnography in the pre-operative care of bariatric surgery is a dispensable procedure, as it does not change postoperative cardiopulmonary outcomes. Indications for polysomnography should be made at the individual level.
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Affiliation(s)
- Taíse Rosa de Carvalho
- Post-graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Carina Andriatta Blume
- Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Post-graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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17
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Zhou M, Wang L, Zhou L, Chang X, Zhu X. Novel Insight into the Mechanism of Metabolic Surgery Causing the Diversity in Glycemic Status in Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2022; 130:484-492. [PMID: 34979572 DOI: 10.1055/a-1708-3214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Metabolic surgery results in diverse glycemic status in patients with type 2 diabetes (T2D), including hyperglycemia without remission, significant amelioration of hyperglycemia with partial remission, complete restoration of euglycemia, or with prolonged remission, hyperglycemia recurrence in relapses after remission, or post-bariatric hypoglycemia. Unfortunately, it is not known how metabolic surgery leads to this diverse consequence. Here, we discuss the diversity of glycemic status associated with metabolic surgery and the potential mechanisms of T2D remission. We also highlight the relationship between the change in low-grade inflammation and T2D remission after metabolic surgery. We hypothesize that the level of inflammatory and anti-inflammatory cytokines controls the efficacy of metabolic surgery in patients with T2D. This hypothesis may provide further insight into the mechanism of the beneficial effects of metabolic surgery patients with T2D.
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Affiliation(s)
- Mengxiao Zhou
- Key Laboratory of Clinical Diagnostics, North University of Hebei, Zhangjiakou, China.,Department of Blood Transfusion, Forth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Lijuan Wang
- Department of Day Care Unit, Gansu Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Lujin Zhou
- Key Laboratory of Clinical Diagnostics, North University of Hebei, Zhangjiakou, China
| | - Xiaotong Chang
- Key Laboratory of Clinical Diagnostics, North University of Hebei, Zhangjiakou, China
| | - Xiaobo Zhu
- Key Laboratory of Clinical Diagnostics, North University of Hebei, Zhangjiakou, China
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18
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Liang Y, Yu R, He R, Sun L, Luo C, Feng L, Chen H, Yin Y, Zhang W. Lower ghrelin levels does not impact the metabolic benefit induced by Roux-en-Y gastric bypass. Front Endocrinol (Lausanne) 2022; 13:891379. [PMID: 36082078 PMCID: PMC9445200 DOI: 10.3389/fendo.2022.891379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/01/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Roux-en-Y gastric bypass is an effective intervention for metabolic disorder. We aim to elucidate whether ghrelin contributes to weight reduction, and glycemic and lipid control after Roux-en-Y gastric bypass (RYGB). DESIGN Four-week-old WT and Ghrl-TSC1-/- mice were fed high fat diet for 12 weeks before surgery, and continued to be on the same diet for 3 weeks after surgery. Body weight, food intake, glycemic and lipid metabolism were analyzed before and after surgery. RESULTS Gastric and circulating ghrelin was significantly increased in mice with RYGB surgery. Hypoghrelinemia elicited by deletion of TSC1 to activate mTOR signaling in gastric X/A like cells demonstrated no effect on weight reduction, glycemic and lipid control induced by Roux-en-Y gastric bypass surgery. CONCLUSION Lower ghrelin levels does not impact the metabolic benefit induced by Roux-en-Y gastric bypass.
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Affiliation(s)
- Yuan Liang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
| | - Ruili Yu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
- Department of Pathology, Henan Provincial People’s Hospital; People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui He
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Lijun Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
| | - Chao Luo
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
| | - Lu Feng
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
| | - Hong Chen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
| | - Yue Yin
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
- *Correspondence: Yue Yin,
| | - Weizhen Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University, Beijing, China
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, United States
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19
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Pineda-García G, Serrano-Medina A, Cornejo-Bravo JM, Andrade-Soto VH, Armenta-Rojas E, González-Sánchez DL. Self-care model and body image in adults after a bariatric surgery. Rev Lat Am Enfermagem 2022. [PMID: 35830125 PMCID: PMC9264863 DOI: 10.1590/1518-8345.5592.3536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: the aim of the present article was to test a self-care model explained by the relationship between self-efficacy, body image, obsessive-compulsive disorder, and depression in people with bariatric surgery in the city of Tijuana, Baja California, Mexico. Method: this was a correlational cross-sectional study carried out between August and December 2020. Validated instruments were administered to 102 participants to measure their self-care capacity, general self-efficacy, psychopathological symptoms, and body image perception and satisfaction. The variables of interest were analyzed using descriptive statistics and the Pearson and Spearman correlation coefficients were used to develop a model using path analysis. Result: a significant model was obtained with adequate goodness-of-fit indicators (chi-square χ2 (8) = 11.451, p = .177; root mean square error of approximation (RMSEA)= 0.000; goodness-of-fit index (GFI)= 0.965; comparative fit index (CFI)= 0.985; parsimonious normed fit index (PNFI)= 0.509, and Akaike information criterion (AIC)= 37.451). Self-efficacy (Zβ=0.294) and body image dissatisfaction (So= -0.376) were shown to influence self-care abilities while psychopathological symptoms influenced body dissatisfaction: obsessive-compulsive disorder (Zβ=0.370) and depression (Zβ=0.320). Conclusion: adequate levels of self-efficacy and body satisfaction predict a high capacity for self-care.
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Affiliation(s)
| | | | | | | | - Efraín Armenta-Rojas
- Universidad Autónoma de Baja Califonia, Mexico; Consejo Nacional de Ciencia y Tecnología, México
| | - Daniela Lilian González-Sánchez
- Universidad Autónoma de Baja Califonia, Mexico; Sindicato de Profesores Superación Universitaria de la Universidad Autónoma de Baja California, México
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20
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Pineda-García G, Serrano-Medina A, Cornejo-Bravo JM, Andrade-Soto VH, Armenta-Rojas E, González-Sánchez DL. Modelo de autocuidado e imagen corporal en adultos post-cirugía bariátrica. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5592.3586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivo: probar un modelo de autocuidado explicado por la relación entre autoeficacia, imagen corporal, obsesión-compulsión y depresión en personas con cirugía bariátrica de la ciudad de Tijuana, B.C. Método: estudio transversal correlacional realizado entre agosto y diciembre de 2020. Se aplicaron instrumentos validados a 102 participantes para medir su capacidad de autocuidado, autoeficacia general, síntomas psicopatológicos, percepción y satisfacción de la imagen corporal. Las variables de interés fueron analizadas mediante estadística descriptiva y correlaciones de Pearson y Spearman para finalmente elaborar un modelo mediante análisis de ruta (Path Analysis). Resultados: se obtuvo un modelo significativo con buenos indicadores de bondad de ajuste (chi-cuadrado χ 2 (8)= 11.451, p = .177; error de aproximación raíz-media-cuadrada (RMSEA)= 0.000; índice de bondad de ajuste (GFI)= 0.965; índice de ajuste comparativo (CFI)= 0.985; índice de ajuste normado parsimonioso (PNFI)= 0.509 y criterio de información de Akaike (AIC)= 37.451). Se demostró que la autoeficacia (Zβ= 0.294) y la insatisfacción de la imagen corporal (Zβ= -0.376) tienen un efecto sobre las capacidades de autocuidado mientras que los síntomas psicopatológicos influyen sobre la insatisfacción corporal: obsesión-compulsión (Zβ= 0.370) y depresión (Zβ= 0.320). Conclusión: los niveles adecuados de autoeficacia y satisfacción corporal predicen una alta capacidad de autocuidado.
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Affiliation(s)
| | | | | | | | - Efraín Armenta-Rojas
- Universidad Autónoma de Baja Califonia, Mexico; Consejo Nacional de Ciencia y Tecnología, México
| | - Daniela Lilian González-Sánchez
- Universidad Autónoma de Baja Califonia, Mexico; Sindicato de Profesores Superación Universitaria de la Universidad Autónoma de Baja California, México
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21
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Remission of Type II Diabetes Mellitus 1-Year Postoperative Following One Anastomosis Gastric Bypass in Correlation with ABCD, DiaRem, and DRS Scores. Obes Surg 2021; 32:450-456. [PMID: 34780027 DOI: 10.1007/s11695-021-05793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a debilitating chronic illness. Roux en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) present a potential solution to type II DM. Several scoring systems predict DM remission as ABCD score, DiaRem score, and diabetes remission score (DRS). STUDY DESIGN This was a retrospective study that included 138 patients with DM and underwent OAGB. BMI, HbA1C, insulin, and oral hypoglycemics need were recorded pre- and postoperatively with calculation of ABCD, DiaRem, and DRS scores. Effects of OAGB on DM were observed and correlated with the scoring systems to detect their sensitivity and specificity. RESULTS Age, preoperative, and postoperative BMI were 47.38 ± 7.632, 45.096 ± 4.465, and 31.173 ± 3.799 respectively. The preoperative and stimulated C-peptides were 3.357 ± 0.995 and 4.158 ± 0.897 ng/ml respectively. The preoperative and postoperative HbA1C were 7.396 ± 0.743% and 6.564 ± 0.621% respectively. Patients with complete remission were 32 patients (23.2%) and with partial remission were 46 patients (33.3%) adding to 56.5% considered in remission. There was significant decrease of BMI, HbA1C, insulin, and oral hypoglycemic use postoperatively. Receiver operator characteristics (ROC) curve showed that ABCD, DiaRem, and DRS scores had AUC of 0.853 with cut-off > 5, 0.921 with cut-off ≤ 8, and 0.805 with cut-off ≤ 8 respectively. The DiaRem score had the highest AUC followed by ABCD score then DRS score. CONCLUSION OAGB significantly reduced BMI and HbA1C values 1 year postoperatively with 56.5% DM remission. DiaRem score had more remission predictive value following OAGB than ABCD and DRS scores especially when ≤ 8 with 90.6% sensitivity and 83% specificity.
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22
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Singh D, Baksi A, Ramana P, Singla V, Aggarwal S. Five-Year Outcomes of Sleeve Gastrectomy in Patients with Class I Obesity and Type 2 Diabetes Mellitus. Obes Surg 2021; 32:96-102. [PMID: 34669109 DOI: 10.1007/s11695-021-05718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies have reported short and medium-term outcomes of laparoscopic sleeve gastrectomy (LSG) in patients with class I obesity and type 2 diabetes mellitus (T2DM). However, literature on outcomes beyond three years is scarce. The present study discusses the 5-year results of a previously reported cohort of 20 patients with class I obesity and T2DM, who had undergone LSG between March 2012 and March 2015. MATERIALS AND METHODS Patients were followed up in the bariatric clinic at yearly intervals as per institute protocol. Primary outcome was proportion of patients with a glycated haemoglobin (HbA1c) level of 6.5% or less, 5 years after LSG. Secondary outcomes were percentage total weight loss (%TWL), excess weight loss (EWL), weight regain and complications. RESULTS Out of 20 patients, 9 (45%) were male and 11 (55%) were female. Mean age was 41.6 ± 9.5 years. Mean pre-operative weight and BMI were 94.8 ± 14.4 kg and 33.4 ± 1.2 kg/m2, respectively. Median duration of diabetes was 42 months. Mean pre-operative fasting plasma glucose (FPG) and HbA1c were 171.1 ± 56.8 mg/dL and 8.7 ± 1.6%, respectively. Of the 17 patients available for follow-up at 5 years, 9 (52.9%) achieved HbA1c < 6.5% without medication, while 7 (41.2%) patients had improvement of their glycaemic status. One patient had recurrence of diabetes after initial remission. Mean %TWL and %EWL were 18% and 65.1%, respectively. CONCLUSION Laparoscopic sleeve gastrectomy is a reasonable option as a metabolic procedure for patients with T2DM and class I obesity.
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Affiliation(s)
- Devender Singh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Aditya Baksi
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Prasanna Ramana
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Vitish Singla
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, New Delhi, India.
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Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13103568. [PMID: 34684569 PMCID: PMC8537443 DOI: 10.3390/nu13103568] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death worldwide and obesity is a major risk factor that increases the morbidity and mortality of CVDs. Lifestyle modifications (e.g., diet control, physical exercise and behavioral changes) have been the first-line managements of obesity for decades. Nonetheless, when such interventions fail, pharmacotherapies and bariatric surgery are considered. Interestingly, a sudden weight loss (e.g., due to bariatric surgery) could also increase mortality. Thus, it remains unclear whether the bariatric surgery-associated weight reduction in patients with obesity and CVDs is beneficial for the reduction of Major Adverse Cardiovascular Events (MACE). Here, we performed a systematic literature search and meta-analysis of published studies comparing MACE in patients with obesity and CVDs who underwent bariatric surgery with control patients (no surgery). Eleven studies, with a total of 1,772,305 patients, which consisted of 74,042 patients who underwent any form of bariatric surgery and 1,698,263 patients with no surgery, were included in the systematic review. Next, the studies' data, including odds ratio (OR) and adjusted hazard ratio (aHR), were pooled and analyzed in a meta-analysis using a random effect model. The meta-analysis of ten studies showed that the bariatric surgery group had significantly lower odds of MACE as compared to no surgery (OR = 0.49; 95% CI 0.40-0.60; p < 0.00001; I2 = 93%) and the adjustment to confounding variables in nine studies revealed consistent results (aHR = 0.57; 95% CI 0.49-0.66; p < 0.00001; I2 = 73%), suggesting the benefit of bariatric surgery in reducing the occurrence of MACE in patients with obesity and CVDs (PROSPERO ID: CRD42021274343).
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Sasaki H, Saisho Y, Inaishi J, Itoh H. Revisiting Regulators of Human β-cell Mass to Achieve β-cell-centric Approach Toward Type 2 Diabetes. J Endocr Soc 2021; 5:bvab128. [PMID: 34405128 PMCID: PMC8361804 DOI: 10.1210/jendso/bvab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes (T2DM) is characterized by insulin resistance and β-cell dysfunction. Because patients with T2DM have inadequate β-cell mass (BCM) and β-cell dysfunction worsens glycemic control and makes treatment difficult, therapeutic strategies to preserve and restore BCM are needed. In rodent models, obesity increases BCM about 3-fold, but the increase in BCM in humans is limited. Besides, obesity-induced changes in BCM may show racial differences between East Asians and Caucasians. Recently, the developmental origins of health and disease hypothesis, which states that the risk of developing noncommunicable diseases including T2DM is influenced by the fetal environment, has been proposed. It is known in rodents that animals with low birthweight have reduced BCM through epigenetic modifications, making them more susceptible to diabetes in the future. Similarly, in humans, we revealed that individuals born with low birthweight have lower BCM in adulthood. Because β-cell replication is more frequently observed in the 5 years after birth, and β cells are found to be more plastic in that period, a history of childhood obesity increases BCM. BCM in patients with T2DM is reduced by 20% to 65% compared with that in individuals without T2DM. However, since BCM starts to decrease from the stage of borderline diabetes, early intervention is essential for β-cell protection. In this review, we summarize the current knowledge on regulatory factors of human BCM in health and diabetes and propose the β-cell–centric concept of diabetes to enhance a more pathophysiology-based treatment approach for T2DM.
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Affiliation(s)
- Hironobu Sasaki
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Saisho
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Inaishi
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Moriconi D, Manca ML, Anselmino M, Rebelos E, Bellini R, Taddei S, Ferrannini E, Nannipieri M. Predictors of type 2 diabetes relapse after Roux-en-Y Gastric Bypass: a ten-year follow-up study. DIABETES & METABOLISM 2021; 48:101282. [PMID: 34547450 DOI: 10.1016/j.diabet.2021.101282] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/27/2022]
Abstract
AIMS To assess the impact of bariatric surgery on remission and relapse of type 2 diabetes mellitus (T2DM) at 10 years of follow-up and analyze predictive factors. MATERIALS AND METHODS Eighty-eight obese subjects undergoing Roux-en-Y gastric bypass (RYGB) and 25 subjects assigned to medical therapy (MT) were evaluated every year for 10 years. T2DM remission was defined by the American Diabetes Association criteria. RESULTS Body mass index (BMI), fasting glucose, and hemoglobin A1c (HbA1c) improved more markedly in RYGB than MT patients throughout the 10-year period. Post-surgery remission rates were 74% and 53% at 1 and 10 years, respectively, while remission did not occur in MT patients. One-year post-surgery, BMI decreased more in subjects with remission than in those without, but no further decrease was observed thereafter. By partial-least-squares analysis, T2DM duration, baseline HbA1c, and ensuing insulin therapy were the strongest predictors of remission. Remission was achieved at one year in 91% of patients with T2DM duration < 4 years, and 79% of them remained in remission at 10 years. On the contrary only 42% of patients with T2DM duration ≥ 4 years achieved remission, which was maintained only in 6% at the end of 10 years. By survival analysis, patients with T2DM duration < 4 years had higher remission rates than those with duration ≥ 4 years (hazards ratio (HR) 3.1 [95%CI 1.8-5.7]). Relapse did not occur before two years post-surgery and was much less frequent in patients with < 4- vs ≥ 4-year duration (HR 11.8 [4.9-29.4]). CONCLUSIONS Short T2DM duration and good glycemic control before RYGB surgery were the best requisites for a long-lasting T2DM remission, whereas weight loss had no impact on the long-term relapse of T2DM.
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Affiliation(s)
- Diego Moriconi
- Dpt. Surgical, Medical, Molecular Pathology and Critical Care Medicine
| | | | - Marco Anselmino
- Bariatric Surgery Unit. Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Eleni Rebelos
- Dpt.Clinical and Experimental Medicine, University of Pisa, Italy
| | - Rosario Bellini
- Bariatric Surgery Unit. Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Stefano Taddei
- Dpt.Clinical and Experimental Medicine, University of Pisa, Italy
| | - Ele Ferrannini
- Institute of Clinical Physiology, National Research Council (CNR) Pisa, Italy
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Fultang J, Chinaka U, Rankin J, Bakhshi A, Ali A. Preoperative Bariatric Surgery Predictors of Type 2 Diabetes Remission. J Obes Metab Syndr 2021; 30:104-114. [PMID: 33436532 PMCID: PMC8277586 DOI: 10.7570/jomes20084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
Obesity represents a significant proportion of the global public health burden, with the World Health Organization (WHO) estimating more than 600 million people are affected worldwide. Unfortunately, the epidemic of obesity is linked to the increased prevalence of associated metabolic diseases such as type 2 diabetes mellitus (T2DM). Bariatric surgery as an intervention has been shown to provide sustainable weight loss, and also leads to superior short- and long-term metabolic benefits including T2DM remission. Despite this added advantage conferred by bariatric surgery, emerging evidence has shown that not all patients with T2DM achieve remission postoperatively. As such, to improve patient selection and optimize preoperative counselling, research has focused on the preoperative predictors of T2DM remission following bariatric surgery. Herein, we provide a critical review of the current literature addressing preoperative predictors of T2DM remission and highlight the current gaps in the literature. The review comprised a multistage advanced electronic search of the Ovid/Medline, Embase, and Cochrane online libraries to identify available studies published over the last decade.
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Affiliation(s)
- Joshua Fultang
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Ugochukwu Chinaka
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Jean Rankin
- School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Andisheh Bakhshi
- School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Abdulmajid Ali
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
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Bhandari V, Kosta S, Bhandari M, Bhandari M, Mathur W, Fobi M. Bariatric metabolic surgery: An effective treatment of type 2 diabetes. J Minim Access Surg 2021; 18:396-400. [PMID: 34259204 PMCID: PMC9306138 DOI: 10.4103/jmas.jmas_325_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Bariatric metabolic surgery is evolving as an option for the treatment of type 2 diabetes mellitus (T2DM) in patients with obesity and T2DM, warranting more studies on the efficacy of bariatric metabolic surgery on T2DM. Objective: To determine T2DM remission in patients with obesity and T2DM with up to two years follow-up after bariatric metabolic surgery. Materials and Methods: A retrospective review of prospectively maintained data was undertaken to identify patients who had T2DM and underwent bariatric surgery at a single centre in 2016. Data collected included age, gender, body mass index (BMI), fasting plasma glucose, haemoglobin A1c, hypertension, (HTN), Obstructive sleep apnea (OSA), initial weight and the weight at intervals of 6, 12, and 24 months. Data on the treatment of T2DM before the surgery was also collected. The criteria of the American Diabetes Association were used for the definition of T2DM remission. Only the data on patients in this study who had more than 12 months’ follow-up information was analysed. Results: Two hundred and eighty patients with T2DM were identified. 191 patients had more than 12 months’ follow-up information. Mean age and BMI were 49.58 ± 10.64 years and 44.03 ± 7.86 kg/m2 respectively. There were 29 patients on insulin, 21 (10.9%) on insulin only and 8 (4.2%) on insulin and oral hypoglycaemic agents (OHA). One hundred and forty-six patients (76.4%) were on OHA, 134 on a single OHA and 12 on more than one OHA. Twenty-six patients (13.6%) were newly diagnosed with T2DM when they came in for bariatric metabolic surgery. One hundred and fifty-six patients (81.7%) achieved complete remission. 14 (7.3%) of these patients used to be on insulin with or without OHA and 142 (74.3%) were patients either on OHA or no OHA. There were 12 (6.4%) patients in partial remission. There was improvement in 23 (12.04%). Eight patients were on insulin but at lower doses and 15 were on a single OHA. The average percentage of total weight loss at 6, 12 and 24 months was 29.7%, 33.9% and 35.6% respectively. Patients with shorter duration of T2DM had higher remission rates as compared to patients with longer duration (r = −0.874, P = 0.001). There was also a significant resolution of HTN (81.8%) and OSA (82.3%) after bariatric metabolic surgery. Conclusion: This study collaborates reports that there is significant remission of T2DM after bariatric metabolic surgery in patients with obesity and T2DM. There is a need for prospective, multi-centre, and long-term studies on bariatric metabolic surgery to treat patients with obesity and T2DM.
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Affiliation(s)
- Vinod Bhandari
- Department of Surgery, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
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Mateo-Gavira I, Sánchez-Toscano E, Mayo-Ossorio MÁ, Pacheco-García JM, Prada-Oliveira JA, Vílchez-López FJ. Evaluation of Clinical Factors Predictive of Diabetes Remission Following Bariatric Surgery. J Clin Med 2021; 10:jcm10091945. [PMID: 34062745 PMCID: PMC8124312 DOI: 10.3390/jcm10091945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Bariatric surgery is an effective treatment for achieving significant weight loss and improving metabolic comorbidities such as type 2 diabetes mellitus (T2DM). The aim of our study was to investigate clinical factors related to T2DM remission in obese patients who had undergone bariatric surgery. METHODS A cohort of patients with T2DM and a minimum of class II obesity undergoing bariatric surgery had their clinical and anthropometric variables assessed. The statistical evaluation included multivariate analyses of clinical factors predicting a T2DM remission two years post-surgery. RESULTS 83 patients were included (mean age 44.13 ± 10.38 years). Two years post-surgery, the percentage of excess weight lost was 63.43 ± 18.59%, and T2DM was resolved in 79.5% of the patients. T2DM remission was directly related to a high body mass index (BMI) (OR: 1.886; p = 0.022) and the absence of macro-vascular complications (OR: 34.667; p = 0.002), while it was inversely associated with T2DM with a duration longer than 5 years (OR: 0.022; p = 0.040) and baseline insulin treatment (OR: 0.001; p = 0.009). 15.6% of the patients presented early complications and 20.5% developed late complications. CONCLUSION In our study sample, bariatric surgery proved to be an effective and safe technique for sustained medium-term weight loss and the resolution of T2DM. A higher baseline BMI, a shorter T2DM duration, non-insulin treatment, and the absence of macro-vascular complications are factors predictive of T2DM remission.
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Affiliation(s)
- Isabel Mateo-Gavira
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (I.M.-G.); (E.S.-T.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
| | - Esteban Sánchez-Toscano
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (I.M.-G.); (E.S.-T.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
| | - Mª Ángeles Mayo-Ossorio
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- General Surgery Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - José Manuel Pacheco-García
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- General Surgery Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - Jose Arturo Prada-Oliveira
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- School of Medicine, Cadiz University (UCA), 11003 Cádiz, Spain
| | - Francisco Javier Vílchez-López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (I.M.-G.); (E.S.-T.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- Correspondence: ; Tel.: +34-956-003-095
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Vennapusa A, Bhargav Panchangam R, Kesara C, Vyshnavi Vanta GR, Madivada MS. Metabolic efficacy following laparoscopic sleeve gastrectomy with loop duodenal switch surgery for type 2 diabetes in Indian patients with severe obesity. Diabetes Metab Syndr 2021; 15:581-587. [PMID: 33706190 DOI: 10.1016/j.dsx.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Metabolic surgery improves glycemic control in patients with type 2 diabetes (T2DM) and severe obesity. Sleeve gastrectomy with loop duodenal switch (SLDS), a loop modification of biliopancreatic diversion with duodenal switch, is aimed to reduce the malabsorption, without compromising the efficacy. This study was designed to analyze the metabolic efficacy following SLDS. METHODS Eighty patients, who underwent SLDS for T2DM and severe obesity between January 2014 and February 2020 were retrospectively analyzed. Complete T2DM remission was defined as HbA1C < 6% in the absence of anti-diabetic medications. T2DM remission was analyzed at the 6-month and 1-year follow-ups in terms of various predictors. Prediction of T2DM remission by ABCD, DiaRem and IMS scores was analyzed. Lower ABCD scores and higher DiaRem and IMS scores indicate severe T2DM. RESULTS Following SLDS, HbA1C significantly reduced from 8.7% to 5.5% at the 6-month and 5.1% at the 1-year follow-ups. T2DM remission was 82.5% at the 6-month and 90.8% at the 1-year follow-ups. Preoperative glycemic control positively predicted, while T2DM duration and preoperative insulin use negatively predicted T2DM remission. Higher ABCD score, lower DiaRem and IMS scores predicted higher T2DM remission. Severe hypoalbuminemia was 20% in patients with 250 cm common channel and 02% in patients with ≥300 cm common channel at the 1-year follow-up. CONCLUSIONS SLDS is an effective surgery to treat T2DM with severe obesity. Shorter T2DM duration, better preoperative glycemic control and the absence of insulin use were associated with better T2DM remission. Malabsorption was significantly lesser, when common channel was ≥300 versus 250 cm.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Jubilee Hills, Hyderabad, Telangana, India.
| | | | - Charita Kesara
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Jubilee Hills, Hyderabad, Telangana, India.
| | - Gitika Raj Vyshnavi Vanta
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Jubilee Hills, Hyderabad, Telangana, India.
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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study. Surg Obes Relat Dis 2021; 17:1349-1358. [PMID: 33762128 DOI: 10.1016/j.soard.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery among patients with obesity and type 2 diabetes (T2D) can induce complete remission. However, it remains unclear whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has better T2D remission within a population-based daily practice. OBJECTIVES To compare patients undergoing RYGB and SG on the extent of T2D remission at the 1-year follow-up. SETTING Nationwide, population-based study including all 18 hospitals in the Netherlands providing metabolic and bariatric surgery. METHODS Patients undergoing RYGB and SG between October 2015 and October 2018 with 1 year of complete follow-up data were selected from the mandatory nationwide Dutch Audit for Treatment of Obesity (DATO). The primary outcome is T2D remission within 1 year. Secondary outcomes include ≥20% total weight loss (TWL), obesity-related co-morbidity reduction, and postoperative complications with a Clavien-Dindo (CD) grade ≥III within 30 days. We compared T2D remission between RYGB and SG groups using propensity score matching to adjust for confounding by indication. RESULTS A total of 5015 patients were identified from the DATO, and 4132 (82.4%) had completed a 1-year follow-up visit. There were 3350 (66.8%) patients with a valid T2D status who were included in the analysis (RYGB = 2623; SG = 727). RYGB patients had a lower body mass index than SG patients, but were more often female, with higher gastroesophageal reflux disease and dyslipidemia rates. After adjusting for these confounders, RYGB patients had increased odds of achieving T2D remission (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.14-2.1; P < .01). Groups were balanced after matching 695 patients in each group. After matching, RYGB patients still had better odds of T2D remission (OR, 1.91; 95% CI, 1.27-2.88; P < .01). Also, significantly more RYGB patients had ≥20%TWL (OR, 2.71; 95% CI, 1.96-3.75; P < .01) and RYGB patients had higher dyslipidemia remission rates (OR, 1.96; 95% CI, 1.39-2.76; P < .01). There were no significant differences in CD ≥III complications. CONCLUSION Using population-based data from the Netherlands, this study shows that RYGB leads to better T2D remission rates at the 1-year follow-up and better metabolic outcomes for patients with obesity and T2D undergoing bariatric surgery in daily practice.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands; Dutch Obesity Clinic, The Hague, Netherlands
| | | | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands; Dutch Obesity Clinic South, Heerlen, Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
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Zhang T, Linghu KG, Lou R, Li Z, Liu J, Li R, Qin ZH, Guo B, Lin L. Autophagy-regulating miRNAs: potential targets for obesity and related metabolic disorders. Drug Discov Today 2021; 26:1532-1538. [PMID: 33549825 DOI: 10.1016/j.drudis.2021.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Tian Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China
| | - Ke-Gang Linghu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China
| | - Ruohan Lou
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China
| | - Zhengqiu Li
- School of Pharmacy, Jinan University, Guangzhou 510630, China
| | - Jingxin Liu
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518000, Guangdong, China
| | - Rongsong Li
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen 518000, Guangdong, China
| | - Zheng-Hong Qin
- Department of Pharmacology, Laboratory of Aging and Nervous Diseases, Jiangsu Key Laboratory of Neuropsychiatric Diseases, College of Pharmaceutical Sciences, Soochow University, Suzhou 215123, China
| | - Bing Guo
- Guizhou Provincial Key Laboratory of Pathogenesis and Drug Research on Common Chronic Diseases, Guizhou Medical University, Guiyang 550025, China
| | - Ligen Lin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China.
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Vennapusa A, Panchangam RB, Kesara C, Madivada MSS. Metabolic Efficacy and Diabetes Remission Predictors Following 'Sleeve Gastrectomy with Loop Duodenojejunal Bypass' Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2020; 9:33-41. [PMID: 36688116 PMCID: PMC9847657 DOI: 10.17476/jmbs.2020.9.2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 06/17/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB. MATERIALS AND METHODS Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1c level <6% with cessation of insulin and oral hypoglycemic agents. RESULTS Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1c levels negatively predicted complete remission, but was significant only at the 3-year follow-up. CONCLUSION SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India
| | | | - Charita Kesara
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India
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Koliaki C, Liatis S, Dalamaga M, Kokkinos A. The Implication of Gut Hormones in the Regulation of Energy Homeostasis and Their Role in the Pathophysiology of Obesity. Curr Obes Rep 2020; 9:255-271. [PMID: 32647952 DOI: 10.1007/s13679-020-00396-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review provides an update on the role of gut hormones and their interactions in the regulation of energy homeostasis, describes gut hormone adaptations in obesity and in response to weight loss, and summarizes the current evidence on the role of gut hormone-based therapies for obesity treatment. RECENT FINDINGS Gut hormones play a key role in regulating eating behaviour, energy and glucose homeostasis. Dysregulated gut hormone responses have been proposed to be pathogenetically involved in the development and perpetuation of obesity. Summarizing the major gut hormone changes in obesity, obese individuals are characterized by blunted postprandial ghrelin suppression, loss of premeal ghrelin peaks, impaired diurnal ghrelin variability and reduced fasting and postprandial levels of anorexigenic peptides. Adaptive alterations of gut hormone levels are implicated in weight regain, thus complicating hypocaloric dietary interventions, and can further explain the profound weight loss and metabolic improvement following bariatric surgery. A plethora of compounds mimicking gut hormone changes after bariatric surgery are currently under investigation, introducing a new era in the pharmacotherapy of obesity. The current trend is to combine different gut hormone receptor agonists and target multiple systems simultaneously, in order to replicate as closely as possible the gut hormone milieu after bariatric surgery and circumvent the counter-regulatory adaptive changes associated with dietary energy restriction. An increasing number of preclinical and early-phase clinical trials reveal the additive benefits obtained with dual or triple gut peptide receptor agonists in reducing body weight and improving glycaemia. Gut hormones act as potent regulators of energy and glucose homeostasis. Therapeutic strategies targeting their levels or receptors emerge as a promising approach to treat patients with obesity and hyperglycaemia.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece.
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
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Anti-Inflammatory Strategies Targeting Metaflammation in Type 2 Diabetes. Molecules 2020; 25:molecules25092224. [PMID: 32397353 PMCID: PMC7249034 DOI: 10.3390/molecules25092224] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 02/06/2023] Open
Abstract
One of the concepts explaining the coincidence of obesity and type 2 diabetes (T2D) is the metaflammation theory. This chronic, low-grade inflammatory state originating from metabolic cells in response to excess nutrients, contributes to the development of T2D by increasing insulin resistance in peripheral tissues (mainly in the liver, muscles, and adipose tissue) and by targeting pancreatic islets and in this way impairing insulin secretion. Given the role of this not related to infection inflammation in the development of both: insulin resistance and insulitis, anti-inflammatory strategies could be helpful not only to control T2D symptoms but also to treat its causes. This review presents current concepts regarding the role of metaflammation in the development of T2D in obese individuals as well as data concerning possible application of different anti-inflammatory strategies (including lifestyle interventions, the extra-glycemic potential of classical antidiabetic compounds, nonsteroidal anti-inflammatory drugs, immunomodulatory therapies, and bariatric surgery) in the management of T2D.
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Gimeno RE, Briere DA, Seeley RJ. Leveraging the Gut to Treat Metabolic Disease. Cell Metab 2020; 31:679-698. [PMID: 32187525 PMCID: PMC7184629 DOI: 10.1016/j.cmet.2020.02.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/23/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
25 years ago, the future of treating obesity and diabetes focused on end organs known to be involved in energy balance and glucose regulation, including the brain, muscle, adipose tissue, and pancreas. Today, the most effective therapies are focused around the gut. This includes surgical options, such as vertical sleeve gastrectomy and Roux-en-Y gastric bypass, that can produce sustained weight loss and diabetes remission but also extends to pharmacological treatments that simulate or amplify various signals that come from the gut. The purpose of this Review is to discuss the wealth of approaches currently under development that seek to further leverage the gut as a source of novel therapeutic opportunities with the hope that we can achieve the effects of surgical interventions with less invasive and more scalable solutions.
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Affiliation(s)
- Ruth E Gimeno
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46225, USA
| | - Daniel A Briere
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46225, USA
| | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
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Koliaki C, Tzeravini E, Papachristoforou E, Severi I, El Deik E, Karaolia M, Noutsou M, Thanopoulou A, Kountouri A, Balampanis K, Lambadiari V, Tentolouris N, Kokkinos A. Eligibility and Awareness Regarding Metabolic Surgery in Patients With Type 2 Diabetes Mellitus in the Real-World Clinical Setting; Estimate of Possible Diabetes Remission. Front Endocrinol (Lausanne) 2020; 11:383. [PMID: 32582036 PMCID: PMC7292012 DOI: 10.3389/fendo.2020.00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to "consider" or "recommend" BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Severi
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elina El Deik
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Karaolia
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Alexander Kokkinos
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