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Dietrich JW, Dasgupta R, Anoop S, Jebasingh F, Kurian ME, Inbakumari M, Boehm BO, Thomas N. SPINA Carb: a simple mathematical model supporting fast in-vivo estimation of insulin sensitivity and beta cell function. Sci Rep 2022; 12:17659. [PMID: 36271244 PMCID: PMC9587026 DOI: 10.1038/s41598-022-22531-3] [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: 06/11/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
Modelling insulin-glucose homeostasis may provide novel functional insights. In particular, simple models are clinically useful if they yield diagnostic methods. Examples include the homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI). However, limitations of these approaches have been criticised. Moreover, recent advances in physiological and biochemical research prompt further refinement in this area. We have developed a nonlinear model based on fundamental physiological motifs, including saturation kinetics, non-competitive inhibition, and pharmacokinetics. This model explains the evolution of insulin and glucose concentrations from perturbation to steady-state. Additionally, it lays the foundation of a structure parameter inference approach (SPINA), providing novel biomarkers of carbohydrate homeostasis, namely the secretory capacity of beta-cells (SPINA-GBeta) and insulin receptor gain (SPINA-GR). These markers correlate with central parameters of glucose metabolism, including average glucose infusion rate in hyperinsulinemic glucose clamp studies, response to oral glucose tolerance testing and HbA1c. Moreover, they mirror multiple measures of body composition. Compared to normal controls, SPINA-GR is significantly reduced in subjects with diabetes and prediabetes. The new model explains important physiological phenomena of insulin-glucose homeostasis. Clinical validation suggests that it may provide an efficient biomarker panel for screening purposes and clinical research.
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Affiliation(s)
- Johannes W. Dietrich
- grid.5570.70000 0004 0490 981XDiabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany ,Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, NRW Germany ,grid.5570.70000 0004 0490 981XCentre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, NRW Germany ,Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, NRW, Germany
| | - Riddhi Dasgupta
- grid.11586.3b0000 0004 1767 8969Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, 632004 India
| | - Shajith Anoop
- grid.11586.3b0000 0004 1767 8969Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, 632004 India
| | - Felix Jebasingh
- grid.11586.3b0000 0004 1767 8969Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, 632004 India
| | - Mathews E. Kurian
- grid.11586.3b0000 0004 1767 8969Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, 632004 India
| | - Mercy Inbakumari
- grid.11586.3b0000 0004 1767 8969Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, 632004 India
| | - Bernhard O. Boehm
- grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore, 308232 Singapore ,grid.6582.90000 0004 1936 9748Department of Internal Medicine I, Ulm University Medical Centre, Ulm University, 89070 Ulm, Germany ,grid.240988.f0000 0001 0298 8161Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nihal Thomas
- grid.11586.3b0000 0004 1767 8969Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, 632004 India
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Evaluation of Persistent Efficacy of Diabetes Remission and Decline of Cardiovascular Risk After Laparoscopic Sleeve Gastrectomy: a Preliminary 1-Year Study. Obes Surg 2022; 32:3289-3297. [DOI: 10.1007/s11695-022-06201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023]
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Casas-Tapia C, Araujo-Castillo RV, Saavedra-Tafur L, Bert-Dulanto A, Piscoya A, Casas-Lucich A. Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI≥35kg/m 2 after vertical gastrectomy. Cir Esp 2020; 98:328-335. [PMID: 32000981 DOI: 10.1016/j.ciresp.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 11/22/2019] [Accepted: 12/01/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. METHODS Retrospective cohort including patients ≥18 years old with BMI≥35kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. RESULTS Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038). CONCLUSIONS There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.
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Affiliation(s)
| | | | - Lil Saavedra-Tafur
- Cirugía General, Endoscópica y Bariátrica, Clínica de Día Avendaño, Lima, Perú
| | - Aimeé Bert-Dulanto
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Alejandro Piscoya
- Dirección de Investigación, Universidad San Ignacio de Loyola, Lima, Perú; Servicio de Gastroenterología, Hospital Guillermo Kaelin de la Fuente, Lima, Perú
| | - Alberto Casas-Lucich
- Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Lima, Perú
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Sysko R, Devlin MJ, Schebendach J, Tanofsky-Kraff M, Zimmerli E, Korner J, Yanovski JA, Zitsman JL, Walsh BT. Hormonal responses and test meal intake among obese teenagers before and after laparoscopic adjustable gastric banding. Am J Clin Nutr 2013; 98:1151-61. [PMID: 23985807 PMCID: PMC3798074 DOI: 10.3945/ajcn.113.061762] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/25/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Relatively little is known about changes in eating behavior or hormonal responses to food after bariatric surgery in adolescents. OBJECTIVE This study compared eating behavior and hormones among adolescents in a bariatric surgery program with those in nonoverweight control adolescents and evaluated changes before and after laparoscopic adjustable gastric banding (LAGB). DESIGN Fasting leptin, peptide YY (PYY), and ghrelin concentrations were obtained, and postprandial ghrelin and PYY area under the curve (AUC) were assessed after a single-item breakfast. Intake from an ad libitum lunchtime multi-item meal was measured. RESULTS Compared with controls (n = 9), all presurgical candidates (n = 20) had significantly greater fasting leptin, lower fasting ghrelin, and lower AUC ghrelin but similar PYY and AUC PYY. Preoperative candidates did not differ from controls in total energy consumed during the test meal. Postoperatively, among the 11 participants with data both before and after surgery, BMI (in kg/m(2)) decreased by 3.5 (P < 0.001), significantly less energy was consumed in the test meal, and a smaller number of foods were selected. AUC ghrelin and PYY did not significantly change before or after LAGB. CONCLUSIONS Few significant short-term changes were observed in appetitive hormones after LAGB. It is unclear whether objective measures of eating behavior will prove useful in evaluating the impact of bariatric surgery on outcomes. This trial was registered at clinicaltrials.gov as CT00764127.
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Affiliation(s)
- Robyn Sysko
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY (RS, MJD, JS, EZ, BTW); the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY (RS, MJD, JS, EZ, BTW); the Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences, Bethesda, MD (MT-K); the Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (MT-K and JAY); the Department of Medicine, Columbia University, New York, NY (JK); and the Center for Adolescent Bariatric Surgery, Department of Surgery, Division of Pediatric Surgery, Columbia University Medical Center, New York, NY (JLZ)
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Duodenal–Jejunal Bypass Surgery Up-Regulates the Expression of the Hepatic Insulin Signaling Proteins and the Key Regulatory Enzymes of Intestinal Gluconeogenesis in Diabetic Goto–Kakizaki Rats. Obes Surg 2013; 23:1734-42. [DOI: 10.1007/s11695-013-0985-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology 2012; 143:897-912. [PMID: 22885332 PMCID: PMC3462491 DOI: 10.1053/j.gastro.2012.07.114] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 12/19/2022]
Abstract
Obesity is an important risk factor for type 2 diabetes mellitus (T2DM). Weight loss improves the major factors involved in the pathogenesis of T2DM, namely insulin action and beta cell function, and is considered a primary therapy for obese patients who have T2DM. Unfortunately, most patients with T2DM fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2DM in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2DM than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early postprandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2DM once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2DM. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2DM.
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Martin MJ. Comment on: Postprandial hypertriglyceridemia predicts improvement in insulin resistance in obese patients after bariatric surgery. Surg Obes Relat Dis 2011; 9:219-20. [PMID: 22055388 DOI: 10.1016/j.soard.2011.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 09/27/2011] [Indexed: 11/15/2022]
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Cho EY, Kemmet O, Frenken M. Biliopancreatic diversion with duodenal switch in patients with type 2 diabetes mellitus: is the chance of complete remission dependent on therapy and duration of insulin treatment? Obes Facts 2011; 4 Suppl 1:18-23. [PMID: 22027285 PMCID: PMC6444525 DOI: 10.1159/000327037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Rapid resolution of type 2 diabetes mellitus (T2DM) is a common feature after intestinal bypass surgery bypassing the duodenum and parts of the jejunum. However, the parameters determining the individual chance of remission are imprecisely defined. METHODS Biliopancreatic diversion with duodenal switch and sleeve gastrectomy (BPD-DS) was performed in n = 86 patients with T2DM (mean age 50 years, range 26-68, 51 females; BMI 47 kg/m(2), range 26-71). The patients were retrospectively divided into 4 groups according to the treatment modality and the duration of insulin treatment preoperatively: n = 18 patients were treated with oral antidiabetic drugs only (group 1); n = 32, n = 24, and n = 12 patients were treated with insulin for less than 5 years, for 5-10 years, and for more than 10 years (groups 2, 3, and 4), respectively. RESULTS At discharge from hospital, all patients of groups 1 and 2 were free of insulin usage, 30% and 75% of the patients of groups 3 and 4 used up to 48 units of insulin per day (mean 24, n = 16). After 1 year, only 4 patients of group 4 permanently required small amounts of insulin (mean 17 units per day) to keep blood glucose below 200 mg/dl. These 4 patients had been using insulin preoperatively for 13, 15, 22, and 25 years. In 3 of these 4 patients, fasting C-peptide was measured and found to be low (<1.2 ng/ml). The rate of complete remission of diabetes for the whole study population was 91%. CONCLUSION BPD-DS reliably causes rapid and complete remission of T2DM in all patients on oral antidiabetic drugs and in patients with insulin treatment for less than 5 years. In patients with insulin treatment longer than 5 or 10 years, complete remission rates decline to 88 and 66%, respectively. A low C-peptide preoperatively might be a specific adverse prognostic parameter for the chance of diabetes remission.
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Affiliation(s)
| | | | - Michael Frenken
- *Chirurgische Abteilung, St. Josef Krankenhaus Monheim, Alte Schulstrase 21–23, 40789 Monheim, Germany,
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Frenken M, Cho EY. Metabolic intestinal bypass surgery for type 2 diabetes in patients with a BMI <35 kg/m2: comparative analysis of 16 patients undergoing either BPD, BPD-DS, or RYGB. Obes Facts 2011; 4 Suppl 1:13-7. [PMID: 22027284 PMCID: PMC6444621 DOI: 10.1159/000327038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Metabolic surgery for type 2 diabetes mellitus in patients with low body mass index (BMI) is a novel concept. Early studies show the surgery to be safe and effective but are inconclusive regarding the most effective procedure. METHODS Metabolic intestinal bypass surgery was performed in n = 16 patients with type 2 diabetes and a BMI < 35 kg/m(2) (mean age 56 years, range 36-68; 8 females; mean BMI 32 kg /m(2), range 26-34.5). Biliopancreatic diversion with duodenal switch (BPD-DS), biliopancreatic diversion according to Scopinaro (BPD), and Roux-en-Y gastric bypass (RYGB) were performed in 7, 5, and 4 diabetic patients, respectively. Mean preoperative duration of medical antidiabetic therapy was 16 years (range 4-40). Thirteen patients used insulin on average for 6 years (range 1-12), the mean insulin requirement was 92 IU per day (range 30-140). The analysis was accomplished retrospectively from data prospectively collected in our data base. RESULTS At discharge from hospital, only 3 of the 13 patients who used insulin preoperatively required small amounts of insulin (mean 21 IU per day, range 15-30) to keep fasting and postprandial plasma glucose levels below 200 mg/dl. After 1 year, none of the patients used insulin or oral antidiabetic drugs. The HbA1c level decreased for the total patient population from 8.6% (range 5.8-12.1) preoperatively to 6.0% (range 4.3-7.8), 5.7% (range 4.1-7.6), and 5.6% (range 4.1-7.8) after 3, 6, and 12 months, respectively. The HbA1c levels at 1 year were significantly lower after BPD-DS and BPD than after RYGB (5.2%, range 4.1-6.4 versus 6.7%, range 5.8-7.8, p < 0.01, DHbA1c 1.4%, 95% confidence interval 0.5-2.4). CONCLUSION Metabolic intestinal bypass surgery for type 2 diabetes in low BMI patients is effective, with HbA1c levels at 1 year after the operation being significantly lower after BPD-DS or BPD than after RYGB.
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Affiliation(s)
- Michael Frenken
- Department of Surgery, St Josef Krankenhaus Monheim, Germany.
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