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Erbakan AN, Arslan Bahadir M, Kaya FN, Güleç B, Vural Keskinler M, Faydaliel Ö, Mesçi B, Oğuz A. The effect of close and intensive therapeutic monitoring of patients with poorly controlled type 2 diabetes with different glycemic background. Medicine (Baltimore) 2023; 102:e36680. [PMID: 38115271 PMCID: PMC10727544 DOI: 10.1097/md.0000000000036680] [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: 10/12/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
Patients with type 2 diabetes who have HbA1c values ≥ 10% have different previous glycemic trends, including new diagnosis of diabetes. We aimed to assess the efficacy of 3 months of intensive and facilitated antihyperglycemic treatment in patients with different glycemic backgrounds. In this observational study, patients with type 2 diabetes and poor glycemic control (indicated by an HbA1c level of > = 10%) were divided into groups based on their previous HbA1c levels (group 1; newly diagnosed type 2 diabetics, group 2; patients with previously controlled but now deteriorated HbA1c levels, group 3; patients whose HbA1c was not previously in the target range but was now above 10%, and group 4; patients whose HbA1c was above 10% from the start). Patients received intensive diabetes management with close monitoring and facilitated hospital visits. For further analysis, patients who were known to have previously had good metabolic control (either did not have diabetes or had previously had an HbA1c value < =7) and patients who had prior poor metabolic control were analyzed separately. Of the 195 participants [female, n = 84 (43.1%)], the median age was 54 years (inter-quantile range [IQR] = 15, min = 29, max = 80) and the median baseline HbA1c was 11.8% (IQR = 2.6%, min = 10%, max = 18.3%). The median duration of diabetes was 10 years (IQR = 9, min = 1, max = 35) when newly diagnosed patients were excluded. The ≥ 20% reduction in HbA1c at month 3 was observed in groups 1 to 4 in 97%, 88.1%, 69.1%, and 55.4%, respectively. The percentage of patients who achieved an HbA1c level of 7% or less was 60.6%, 38.1%, 16.4%, and 6.2% in the groups, respectively. The rate of those who achieved an HbA1c of 7% or less was nearly 50% of patients with type 2 diabetes mellitus who had previously had good metabolic control, whereas successful control was achieved in only 1 in 10 patients with persistently high HbA1c levels. Patients' glycemic history played an important role in determining their HbA1c levels at 3 months, suggesting that previous glycemic management patterns may indicate future success in diabetes control.
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Affiliation(s)
- Ayşe Naciye Erbakan
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Müzeyyen Arslan Bahadir
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatoş Nimet Kaya
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Büşra Güleç
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Miraç Vural Keskinler
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özge Faydaliel
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Banu Mesçi
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Aytekin Oğuz
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Amani-Beni R, Darouei B, Zefreh H, Sheikhbahaei E, Sadeghi M. Effect of Obesity Duration and BMI Trajectories on Cardiovascular Disease: A Narrative Review. Cardiol Ther 2023; 12:307-326. [PMID: 37154885 DOI: 10.1007/s40119-023-00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
Obesity is an important risk factor for cardiovascular diseases (CVDs). It is crucial to understand the impact of its duration due to the more extended exposure period and the higher frequency of overweight/obesity at younger ages. In the last decade, various studies have discovered that the duration of obesity, in addition to its severity, might have an impact. Therefore, this study aimed to summarize the current literature to investigate the effect of body mass index (BMI) trajectories and overweight/obesity duration on cardiovascular outcomes. To retrieve related articles, we searched PubMed, EMBASE, Google Scholar, Web of Science, Scopus, and Cochrane electronic databases. The duration of overweight/obesity is significantly associated with CVDs, especially heart failure and atrial fibrillation. However, there are contradictory results regarding the association between coronary heart disease and stroke with the duration of obesity. Additionally, no association with peripheral vascular disease has yet to be reported. The absence of this association may be brought on by covariates or various follow-up times. Nevertheless, it seems that both stable overweight and remarkably stable obesity increase the risk of CVDs, as does both stable overweight and notably stable obesity. Metrics showing both the severity and the duration of overweight/obesity are more effective than each alone, and it is recommended to be used for assessing the risk of various CVDs. There are few studies in these areas, and studies with more extended follow-up periods, with a wide age range, while adjusting for some specific covariates, are needed.
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Affiliation(s)
- Reza Amani-Beni
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Mushtaq 3rd St, Shahid Rahmani Alley, Isfahan, Iran
| | - Bahar Darouei
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Mushtaq 3rd St, Shahid Rahmani Alley, Isfahan, Iran
| | - Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Mushtaq 3rd St, Shahid Rahmani Alley, Isfahan, Iran.
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Peng G, Yan Z, Liu Y, Li J, Ma J, Tong N, Wang Y. The effects of first-line pharmacological treatments for reproductive outcomes in infertile women with PCOS: a systematic review and network meta-analysis. Reprod Biol Endocrinol 2023; 21:24. [PMID: 36869381 PMCID: PMC9983155 DOI: 10.1186/s12958-023-01075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is one of the most common causes of infertility in reproductive-age women. However, the efficacy and optimal therapeutic strategy for reproductive outcomes are still under debate. We conducted a systematic review and network meta-analysis to compare the efficacy of different first-line pharmacological therapies in terms of reproductive outcomes for women with PCOS and infertility. METHODS A systematic retrieval of databases was conducted, and randomized clinical trials (RCTs) of pharmacological interventions for infertile PCOS women were included. The primary outcomes were clinical pregnancy and live birth, and the secondary outcomes were miscarriage, ectopic pregnancy and multiple pregnancy. A network meta-analysis based on a Bayesian model was performed to compare the effects of the pharmacological strategies. RESULTS A total of 27 RCTs with 12 interventions were included, and all therapies tended to increase clinical pregnancy, especially pioglitazone (PIO) (log OR 3.14, 95% CI 1.56 ~ 4.70, moderate confidence), clomiphene citrate (CC) + exenatide (EXE) (2.96, 1.07 ~ 4.82, moderate confidence) and CC + metformin (MET) + PIO (2.82, 0.99 ~ 4.60, moderate confidence). Moreover, CC + MET + PIO (2.8, -0.25 ~ 6.06, very low confidence) could increase live birth most when compared to placebo, even without a significant difference. For secondary outcomes, PIO showed a tendency to increase miscarriage (1.44, -1.69 ~ 5.28, very low confidence). MET (-11.25, -33.7 ~ 0.57, low confidence) and LZ + MET (-10.44, -59.56 ~ 42.11, very low confidence) were beneficial for decreasing ectopic pregnancy. MET (0.07, -4.26 ~ 4.34, low confidence) showed a neutral effect in multiple pregnancy. Subgroup analysis demonstrated no significant difference between these medications and placebo in obese participants. CONCLUSIONS Most first-line pharmacological treatments were effective in improving clinical pregnancy. CC + MET + PIO should be recommended as the optimal therapeutic strategy to improve pregnancy outcomes. However, none of the above treatments had a beneficial effect on clinical pregnancy in obese PCOS. TRIAL REGISTRATION CRD42020183541; 05 July 2020.
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Affiliation(s)
- Ge Peng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
- Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhe Yan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
- Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuqi Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
- Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Juan Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
- Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jinfang Ma
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
- Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yan Wang
- Department of Gynaecology and Obstetrics, West China 2nd University Hospital, Sichuan University, Chengdu, 610041, China.
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Liu FG, Chang SW, Hsu KF, Chen YJ, Pan HM, Liao GS, Lin CH, Wang SC. Revisional One Anastomosis Gastric Bypass (OAGB) for Poor Response of Duodenal-Jejunal Bypass with Sleeve Gastrectomy (DJB-SG) (Video Report). Obes Surg 2023; 33:1616-1619. [PMID: 36856990 DOI: 10.1007/s11695-023-06529-y] [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: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Bariatric surgery has actually focused not only on obesity but also more on the improvements or remission of the metabolic diseases. Therefore, revisional surgery is indicated for patients with poor response to the primary bariatric surgery to control weight and obesity-associated medical conditions. METHOD In this video report, the patient was a 27-year-old Asian female with an initial BMI of 36.5 kg/m2 and poorly controlled type 2 diabetes (HbA1c: 11.9%). She underwent primary bariatric surgery of laparoscopic duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG) in June 2019. She had a nadir BMI of 28.8 kg/m2 (corresponding body weight of 72 kg) in June 2020. However, she regained weight (BMI: 34 kg/m2) and had a relapse of diabetes with an HbA1c of 12.0% at the time of consultation for revisional bariatric surgery (RBS) in September 2022. After a multidisciplinary team evaluation, laparoscopic procedures of one anastomosis gastric bypass (OAGB) with resizing the gastric tube, removal of duodenal-jejunal anastomosis, and lengthening of the biliopancreatic limb were performed. RESULTS The operative time was 186 min and blood loss was 50 ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 5. At the 3-month follow-up after RBS, the patient had lost 13 kg (weight dropped from 85 to 72 kg) and achieve remission of diabetes with HbA1c of 5.7%. CONCLUSION Laparoscopic OAGB is technically feasible and practical as a revisional procedure for poor response of DJB-SG.
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Affiliation(s)
- Fa-Guang Liu
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Shu-Wei Chang
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| | - Yen-Ju Chen
- Research Assistant Center, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Hsin-Mei Pan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Guo-Shiou Liao
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chien-Hua Lin
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,IRCAD Taiwan, Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Sheng-Chun Wang
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
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Salman AA, Salman MA, Aon MH, Mahdy RE, Abdallah A, Shemy GG, Hassan AM, Amin FAS, Labib S. Impact of Weight Loss on the Severity of Albuminuria in Obese Diabetic Patients Undergoing Laparoscopic Sleeve Gastrectomy and One-Anastomosis Gastric Bypass. Int J Gen Med 2022; 15:6405-6413. [PMID: 35957758 PMCID: PMC9359793 DOI: 10.2147/ijgm.s365113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To examine the effect of weight-loss induced bariatric procedures on albuminuria levels among diabetic patients suffering from obesity. Methods Adults patients who suffer from morbid obesity and type 2 diabetes mellitus (T2DM) were included in a prospective cohort study. Subjects were scheduled to undergo laparoscopic sleeve gastrectomy (LSG) or one-anastomosis gastric bypass (OAGB). The albumin-to-creatinine ratio (ACR) was adopted to assess the degree of albuminuria. Microalbuminuria was determined as a ratio of >2.5-30 mg/mmol and >3.5-30 mg/mmol for males and females, respectively, while macroalbuminuria was diagnosed when the ACR exceeded >30 mg/mmol. Results The mean uACR decreased significantly from 20.95±16.89 to 9.92±12.69mg/mmol in LSG cohort (p <0.001), and from 19.52±16.65 to 9.34±11.77mg/mmol in the OAGB cohort, with no statistically considerable differences between both cohorts at the end of follow-up (p = 0.78). Twelve months after the procedures, the percentages of cases with microalbuminuria decreased significantly to 23.8% and 23.9%, respectively (p < 0.001); likewise, the percentages of cases with macroalbuminuria significantly decreased to 7.9% and 7.5% in the LSG and OAGB groups, respectively (p < 0.001). There were no statistically considerable differences between LSG and OAGB regarding the percentages of patients with micro or macroalbuminuria at the end of follow-up. Besides, there were no significant associations between the degree of weight loss and improvement (p = 0.959) or remission (p = 0.73) of microalbuminuria. Conclusion Bariatric surgery significantly reduced the severity of albuminuria 1-year after the procedure, with no preference for one procedure over the other.
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Affiliation(s)
| | | | - Mohamed H Aon
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem Ezzat Mahdy
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Abdallah
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Galal Shemy
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Ahmed M Hassan
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | | | - Safa Labib
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wahab M, Bhatti A, John P. Evaluation of Antidiabetic Activity of Biogenic Silver Nanoparticles Using Thymus serpyllum on Streptozotocin-Induced Diabetic BALB/c Mice. Polymers (Basel) 2022; 14:polym14153138. [PMID: 35956652 PMCID: PMC9370869 DOI: 10.3390/polym14153138] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Type 2 Diabetes Mellitus is one of the most common metabolic disorders, and is characterized by abnormal blood sugar level due to impaired insulin secretion or impaired insulin action—or both. Metformin is the most commonly used drug for the treatment of Type 2 Diabetes Mellitus, but due to its slow mode of action and various side effects it shows poor and slow therapeutic response in patients. Currently, scientists are trying to tackle these limitations by developing nanomedicine. This research reports novel synthesis of silver nanoparticles using aqueous extract of Thymus serpyllum and aims to elucidate its therapeutic potential as an antidiabetic agent on streptozotocin induced diabetic BALB/c mice. Thymus serpyllum mediated silver nanoparticles were characterized through UV, SEM, XRD, and FTIR. The alpha amylase inhibition and antioxidant activity were checked through α amylase and DPPH radical scavenging assay, respectively. To check the effect of silver nanoparticles on blood glucose levels FBG, IPGTT, ITT tests were employed on STZ induced BALB/c mice. To assess the morphological changes in the anatomy of liver, pancreas, and kidney of BALB/c mice due to silver nanoparticles, histological analysis was done through H&E staining system. Finally, AMPK and IRS1 genes expression analysis was carried out via real time PCR. Silver nanoparticles were found to be spherical in shape with an average size of 42 nm. They showed an IC50 of 8 μg/mL and 10 μg/mL for α amylase and DPPH assay, respectively. Our study suggests that silver nanoparticles—specifically 10 mg/kg—cause a significant increase in the expression of AMPK and IRS1, which ultimately increase the glucose uptake in cells. Thymus serpyllum mediated silver nanoparticles possess strong antioxidant and antidiabetic potential and can further be explored as an effective and cheaper alternative option for treatment of Type 2 Diabetes Mellitus.
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Affiliation(s)
- Maryam Wahab
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (M.W.); (P.J.)
- Department of Dairy and Food Science, South Dakota State University, Brookings, SD 57007, USA
| | - Attya Bhatti
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (M.W.); (P.J.)
- Correspondence: ; Tel.: +92-51-886-6128
| | - Peter John
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (M.W.); (P.J.)
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Zhang X, Wang Y, Hu S. Editorial: Novel Insights Into Obesity-Related Diseases. Front Physiol 2022; 13:952682. [PMID: 35812312 PMCID: PMC9261280 DOI: 10.3389/fphys.2022.952682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Xiang Zhang, ; Sanyuan Hu,
| | - Yanmin Wang
- California Medical Innovations Institute, San Diego, CA, United States
| | - Sanyuan Hu
- First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Shandong University, Jinan, China
- *Correspondence: Xiang Zhang, ; Sanyuan Hu,
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Luo P, Cao Y, Li P, Wang G, Song Z, Li W, Su Z, Zhou H, Yi X, Fu Z, Sun X, Tang H, Cui B, Yu Q, Zhu L, Zhu S. Insulin Resistance Remission Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Chinese Type 2 Diabetes Mellitus Patients With a Body Mass Index of 27.5-32.5 kg/m 2. Front Physiol 2021; 12:772577. [PMID: 34819878 PMCID: PMC8606571 DOI: 10.3389/fphys.2021.772577] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Insulin resistance (IR) is closely associated with the pathogenesis of type 2 diabetes mellitus (T2DM). However, remission of insulin sensitivity after bariatric surgery in patients with T2DM and a body mass index (BMI) of 27.5–32.5 kg/m2 has not been fully elucidated. Methods: Thirty-six T2DM patients with a BMI of 27.5–32.5 kg/m2 were prospectively consecutively recruited for laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). Hyperinsulinemic euglycemic clamp, oral glucose tolerance test (OGTT), and other indicators were tested at baseline and 6 months postoperative. Glucose disposal rate (GDR), time to reach euglycemia, homeostatic model assessment of IR, quantitative insulin sensitivity check index (QUICKI), triglyceride glucose (TyG) index, 30-min insulinogenic index (IGI30), and disposition index (DI) were calculated at baseline and 6 months after surgery. The criterion for remission in T2DM patients was the achievement of the triple composite endpoint. Results: Anthropometric and glucolipid metabolism parameters significantly improved following surgery. The GDR increased significantly from baseline to 6 months after LRYGB (from 4.28 ± 1.70 mg/kg/min to 8.47 ± 1.89 mg/kg/min, p < 0.0001) and LSG (from 3.18 ± 1.36 mg/kg/min to 7.09 ± 1.69 mg/kg/min, p < 0.001). The TyG index decreased after surgery (RYGB group, from 9.93 ± 1.03 to 8.60 ± 0.43, p < 0.0001; LSG group, from 10.04 ± 0.79 to 8.72 ± 0.65, p = 0.0002). There was a significant reduction in the IGI30 (RYGB group, from 2.04 ± 2.12 to 0.83 ± 0.47, p = 0.005; LSG group, from 2.12 ± 1.73 to 0.92 ± 0.66, p = 0.001). The mean DI significantly increased from 1.14 ± 1.35 to 7.11 ± 4.93 in the RYGB group (p = 0.0001) and from 1.25 ± 1.78 to 5.60 ± 4.58 in the LSG group (p = 0.003). Compared with baseline, HOMR-IR, QUICKI, area under the curve-C-peptide release test (AUC-CRT), and AUC-OGTT were significantly changed at 6 months postoperative. Overall, 52.63% of patients in the LRYGB group versus 29.41% of patients in the LSG group achieved the triple composite endpoint. Conclusion: Both LRYGB and LSG effectively induced remission of IR in patients with T2DM and a BMI of 27.5–32.5 kg/m2.
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Affiliation(s)
- Ping Luo
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yaoquan Cao
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhihong Su
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Hui Zhou
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xianhao Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhibing Fu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Beibei Cui
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Qianqian Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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Zeng Q, Li N, Pan XF, Chen L, Pan A. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol 2021; 9:393-405. [PMID: 34022157 DOI: 10.1016/s2213-8587(21)00047-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023]
Abstract
China has one of the largest populations with obesity in the world, and obesity has become a major challenge for the country's health-care system. Current guidelines for obesity management are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (ie, medications and surgery) among both health-care providers and the general public. Large, well designed, and well implemented clinical trials are needed to strengthen the evidence base for the clinical management of obesity in China. Obesity management can be improved through use of a tiered system involving health management centres, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies. Resource mobilisation, support from major stakeholders for people with overweight or obesity, and education and changes to social norms among the wider public are also needed. National health policies should prioritise both obesity prevention and improvement of the treatment and management of obesity.
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Affiliation(s)
- Qiang Zeng
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Naishi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China.
| | - An Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Syn NL, Cummings DE, Wang LZ, Lin DJ, Zhao JJ, Loh M, Koh ZJ, Chew CA, Loo YE, Tai BC, Kim G, So JBY, Kaplan LM, Dixon JB, Shabbir A. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet 2021; 397:1830-1841. [PMID: 33965067 DOI: 10.1016/s0140-6736(21)00591-2] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metabolic-bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy-especially stratified by pre-existing diabetes status-are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic-bariatric surgery versus usual care. METHODS We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic-bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic-bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472. FINDINGS Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic-bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3-51·9, p<0·0001) and median life expectancy was 6·1 years (95% CI 5·2-6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370-0·453, p<0·0001) or without (0·704, 0·588-0·843, p<0·0001) baseline diabetes who underwent metabolic-bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup I2 95·7%, p<0·0001). Median life expectancy was 9·3 years (95% CI 7·1-11·8) longer for patients with diabetes in the surgery group than the non-surgical group, whereas the life expectancy gain was 5·1 years (2·0-9·3) for patients without diabetes. The numbers needed to treat to prevent one additional death over a 10-year time frame were 8·4 (95% CI 7·8-9·1) for adults with diabetes and 29·8 (21·2-56·8) for those without diabetes. Treatment effects did not appear to differ between gastric bypass, banding, and sleeve gastrectomy (I2 3·4%, p=0·36). By leveraging the results of this meta-analysis and other published data, we estimated that every 1·0% increase in metabolic-bariatric surgery utilisation rates among the global pool of metabolic-bariatric candidates with and without diabetes could yield 5·1 million and 6·6 million potential life-years, respectively. INTERPRETATION Among adults with obesity, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without. FUNDING None.
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Affiliation(s)
- Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore
| | - David E Cummings
- UW Medicine Diabetes Institute, Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, and Weight Management Program, Veteran Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Louis Z Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingHealth Internal Medicine Residency Programme, Singapore General Hospital, Singapore
| | - Daryl J Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marie Loh
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zong Jie Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Claire Alexandra Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Ying Ern Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bee Choo Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Guowei Kim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Jimmy Bok-Yan So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute and Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Asim Shabbir
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore.
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11
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Wang C, Zhang H, Yu H, Bao Y, Zhang P, Di J. Roux-en-Y Gastric Bypass for T2D Treatment in Chinese Patients with Low BMI: 5-Year Outcomes. Obes Surg 2021; 30:2588-2597. [PMID: 32157522 DOI: 10.1007/s11695-020-04520-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND RYGB was considered as an effective treatment for obese patients with T2D. However, 5-year outcomes including T2D remission after surgery have not been adequately studied in Chinese patients. OBJECTIVES Our aim is to evaluate metabolic outcomes of RYGB in 5-year follow-up. METHODS We retrospectively divided 59 Chinese patients into two groups, namely BMI groups (group A: BMI < 28 kg/m2; group B: BMI ≥ 28 kg/m2) and A1C groups (group C: A1C < 7%; group D: A1C ≥ 7%). Their medical records were collected and cardiovascular risk and medications were evaluated in 5 years after RYGB. RESULTS Thirty patients were female (30/59, 50.85%). RYGB was performed laparoscopically without mortality or major complications. The mean BMI in 59 patients decreased from 30.89 ± 3.12 to 25.04 ± 3.48 in the fifth year. No one was lost to follow-up in 5 years. There were significant reductions in BMI, A1C, and oral medication or insulin in all groups. Diabetes remission rates in the first, third, and fifth years postoperation were 77.97, 61.02, and 49.15%. T2D relapse and requirement for antihypertensive agents increased in the third and fifth years. Larger quantity of subcutaneous fat area (SFA) and shorter duration of T2D preoperation were more likely to achieve remission of T2D postoperation. CONCLUSIONS This study has confirmed that RYGB is an effective treatment for obese Chinese patients with T2D, resulting in diabetes remission, metabolic disorder control, and cardiovascular risk reduction.
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Affiliation(s)
- Chen Wang
- Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hongwei Zhang
- Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Haoyong Yu
- Department of Endocrinology, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yuqian Bao
- Department of Endocrinology, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jianzhong Di
- Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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12
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Laparoscopic Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy for Type 2 Diabetes Mellitus in Nonseverely Obese Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Obes Surg 2021; 30:1660-1670. [PMID: 31912466 DOI: 10.1007/s11695-019-04378-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, randomized controlled trials (RCTs) have indicated that bariatric surgery in nonseverely obese patients with a body mass index (BMI) less than 35 kg/m2 might be even superior to medical therapy with regard to type 2 diabetes mellitus (T2DM) remission, but the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) in nonseverely obese patients has not been conclusively determined. The objective of this study is to compare LRYGB versus LSG for T2DM in nonseverely obese patients. METHODS A meta-analysis identifying RCTs evaluating LRYGB versus LSG for T2DM in nonseverely obese patients was conducted. The primary outcome was T2DM remission. Additional analyses comprised percent excess weight loss (%EWL), BMI, waist circumference, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum lipid level, medication use, quality of life, and adverse events. RESULTS Four RCTs concerning total 296 patients were included. T2DM remission rate and %EWL were of no difference between the two bariatric procedures. LRYGB was associated with lower BMI, waist circumference, low-density lipoprotein, and higher high-density lipoprotein than LSG. However, HbA1c, FPG, total cholesterol, and triglyceride were not significantly different between the two surgical groups. The medication use and quality of life were improved in both two groups. The gastroesophageal reflux diseases of LRYGB group were less than that of LSG group. Dumping syndromes were noted more frequently in the LRYGB group. CONCLUSIONS Both LRYGB and LSG have comparative effect on resolving T2DM in nonseverely obese patients at midterm follow-up. Further RCTs should address the potential risks and long-term effects of LRYGB and LSG in nonseverely obese patients.
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13
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Ji G, Li W, Li P, Tang H, Yu Z, Sun X, Li R, Zhu L, Zhu S. Effect of Roux-en-Y Gastric Bypass for Patients with Type 2 Diabetes Mellitus and a BMI < 32.5 kg/m2: a 6-Year Study in Chinese Patients. Obes Surg 2021; 30:2631-2636. [PMID: 32157520 DOI: 10.1007/s11695-020-04534-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbidly obese patients to improve type 2 diabetes mellitus (T2DM). Recently, T2DM patients with a lower body mass index (BMI) have been receiving more attention, and these patients could benefit from RYGB. METHODS Fifty-two patients with T2DM underwent RYGB between October 2008 and December 2012 in our hospital. Weight, BMI, oral glucose tolerance test (OGTT), insulin release test (IRT), C-peptide release test (CRT), glycosylated hemoglobin (HbA1c), and lipid metabolic parameters were measured at baseline and at 3 and 6 months and 1, 2, 3, 4, 5, and 6 years after surgery. RESULTS The mean age of the 52 patients was 46.8 ± 9.5 years, and 57.7% were male. The mean duration of T2DM was 6.5 ± 4.6 years. Compared with the baseline values, weight and BMI were significantly decreased at several time points after surgery. HbA1c decreased from 8.2 ± 1.7% at baseline to 6.5 ± 1.4% at 3 months, 6.5 ± 1.4% at 6 months, 7.2 ± 1.3% at 4 years, and 7.5 ± 1.2% at 6 years. OGTT, OGTT-IRT, and OGTT-CRT improved after surgery. There was a decrease in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein (LDL) and an increase in high-density lipoprotein (HDL). At 6 years after surgery, 16.7% of patients achieved complete remission of T2DM, and 66.7% achieved improvement in T2DM. CONCLUSION RYGB may be a safe and effective treatment for T2DM patients with a BMI < 32.5 kg/m2 in China. However, a long-term study without loss to follow-up is necessary for better evaluation.
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Affiliation(s)
- Guangnian Ji
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhaomei Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Rao Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
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14
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Impact of metabolic surgery on 10-year cardiovascular disease risk in Chinese individuals with type 2 diabetes. Surg Obes Relat Dis 2020; 17:498-507. [PMID: 33358863 DOI: 10.1016/j.soard.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/22/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years, many reports have highlighted that metabolic surgery may ameliorate the cardiovascular risk in morbidly obese patients with or without type 2 diabetes (T2D). However, few studies have evaluated the long-term cardiovascular disease (CVD) risk after metabolic surgery in T2D patients with a low body mass index (BMI). OBJECTIVES To use the Prediction for ASCVD Risk in China (China-PAR) equations and United Kingdom Prospective Diabetes Study (UKPDS) risk engine to assess the 10-year CVD risk in low-BMI T2D patients after metabolic surgery. SETTING University hospital, China. METHODS We retrospectively reviewed our prospectively collected data of T2D patients who underwent metabolic surgery at our hospital between 2010 and 2018. We included patients who met the criteria for calculating a 10-year cardiovascular risk score by the China-PAR equations and UKPDS risk engine. Demographic characteristics, anthropometric variables, and glycolipid metabolic parameters were assessed preoperatively and during a 4-year follow-up period. Patients with a BMI < 30 kg/m2 were compared with those with a BMI > 30 kg/m2. RESULTS We evaluated 117 patients, of whom 62 (53%) had a BMI < 30 kg/m2 and 55 (47%) had a BMI > 30 kg/m2. Patients with a BMI < 30 kg/m2 were significantly older and had a longer duration of diabetes. The rate of complete T2D remission in the group of patients with BMIs < 30 kg/m2 was significantly lower than that in the group with BMIs > 30 kg/m2 (35.2% versus 56.1%, respectively; P = .042). The overall 10-year and lifetime atherosclerotic cardiovascular disease risks were reduced from 4.2% to 2.3% and 25.3% to 13.9%, respectively (both P < .05), at 1 year postoperatively using the China-PAR equation. The overall 10-year coronary heart disease (CHD) and fatal CHD risks were reduced by 48.1% and 53.1%, respectively, at 1 year after surgery using the UKPDS risk engine. The advantages of metabolic surgery in reducing CVD risks are similar in both BMI groups, whether using the China-PAR equation or the UKPDS risk engine. CONCLUSION The 10-year CVD risk in T2D patients with BMIs < 30 kg/m2 and BMIs > 30 kg/m2 were significantly reduced after metabolic surgery, although the rate of complete T2D remission T2Din patients with BMIs < 30 kg/m2 was lower than that in patients with BMIs > 30 kg/m2. The China-PAR equation is a reliable and useful clinical tool for CVD risk evaluation in Chinese patients after metabolic surgery.
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15
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Jiménez JM, Carbajo MA, López M, Cao MJ, Rúiz-Tovar J, García S, Castro MJ. Changes in Lipid Profile, Body Weight Variables and Cardiovascular Risk in Obese Patients Undergoing One-Anastomosis Gastric Bypass. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165858. [PMID: 32823485 PMCID: PMC7460060 DOI: 10.3390/ijerph17165858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
Morbid obesity has a direct impact on the development of cardiovascular disease. One-anastomosis gastric bypass (OAGB) is an effective surgical technique for the control of body weight and the reduction of cardiovascular risk. This work examines the change in weight loss, lipid profile and cardiovascular risk in 100 patients (71 women, 29 men), mean age 42.61 ± 11.33 years at 3, 6, 9, 12, 18 and 24 months after OAGB. At 24 months post-surgery, mean body weight was significantly reduced compared to pre-operative values (116.75 ± 22.19 kg vs. 69.66 ± 13.07 kg), as were mean total cholesterol (201.86 ± 44.60 mg/dL vs. 172.99 ± 32.26 mg/dL), LDL (Low-Density Lipoprotein) cholesterol (126.90 ± 39.81 mg/dL vs. 96.28 ± 26.99 mg/dL), triglycerides (138.05 ± 78.45 mg/dL vs. 76.04 ± 30.34 mg/dL) and cardiovascular risk (total cholesterol/HDL (High-Density Lipoprotein) cholesterol: 4.32 ± 1.24 vs. 2.93 ± 0.71), while the mean HDL cholesterol concentration was significantly higher (49.09 ± 14.16 mg/dL vs. 61.98 ± 14.86 mg/dL) (all p < 0.001). In conclusion, OAGB surgery led to significant reductions in body weight, a significant improvement in the lipid profile, and a reduction in cardiovascular risk.
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Affiliation(s)
- Jose-Maria Jiménez
- Center of Excellence for the Study and Treatment of Diabetes and Obesity, 47004 Valladolid, Spain; (M.-A.C.); (J.R.-T.); (M.-J.C.)
- Nursing Faculty, University of Valladolid, 47005 Valladolid, Spain; (M.-J.C.); (S.G.)
- Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid, 47005 Valladolid, Spain
- Correspondence: (J.-M.J.); (M.L.); Tel.: +34-98-31-840 (J.-M.J. & M.L.)
| | - Miguel-Angel Carbajo
- Center of Excellence for the Study and Treatment of Diabetes and Obesity, 47004 Valladolid, Spain; (M.-A.C.); (J.R.-T.); (M.-J.C.)
| | - María López
- Nursing Faculty, University of Valladolid, 47005 Valladolid, Spain; (M.-J.C.); (S.G.)
- Correspondence: (J.-M.J.); (M.L.); Tel.: +34-98-31-840 (J.-M.J. & M.L.)
| | - María-José Cao
- Nursing Faculty, University of Valladolid, 47005 Valladolid, Spain; (M.-J.C.); (S.G.)
- Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid, 47005 Valladolid, Spain
| | - Jaime Rúiz-Tovar
- Center of Excellence for the Study and Treatment of Diabetes and Obesity, 47004 Valladolid, Spain; (M.-A.C.); (J.R.-T.); (M.-J.C.)
| | - Sara García
- Nursing Faculty, University of Valladolid, 47005 Valladolid, Spain; (M.-J.C.); (S.G.)
| | - María-José Castro
- Center of Excellence for the Study and Treatment of Diabetes and Obesity, 47004 Valladolid, Spain; (M.-A.C.); (J.R.-T.); (M.-J.C.)
- Nursing Faculty, University of Valladolid, 47005 Valladolid, Spain; (M.-J.C.); (S.G.)
- Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid, 47005 Valladolid, Spain
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16
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Ding L, Fan Y, Li H, Zhang Y, Qi D, Tang S, Cui J, He Q, Zhuo C, Liu M. Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta-analysis of randomized controlled trials. Obes Rev 2020; 21:e13030. [PMID: 32286011 PMCID: PMC7379237 DOI: 10.1111/obr.13030] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 12/30/2022]
Abstract
A network meta-analysis of randomized controlled trials (RCTs) was performed to determine the hierarchies of different bariatric surgeries in patients with obesity and type 2 diabetes mellitus (T2DM), in terms of diabetes remission and cardiometabolic outcomes. Seventeen RCTs and six bariatric surgeries, including single anastomosis (mini) gastric bypass (mini-GBP), biliopancreatic diversion without duodenal switch (BPD), laparoscopic-adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGBP), greater curvature plication (GCP) and nonsurgical treatments (NST) were included. Mini-GBP, BPD, LSG, RYGBP and LAGB (from best to worst), as compared with NST, were all significantly associated with the remission of T2DM. For the follow-up period > 3 years, BPD, mini-GBP, RYGBP and LSG (from best to worst) were significantly superior to NST in achieving the remission of T2DM. For secondary outcomes, the overall ranking for bariatric surgeries was RYGBP > BPD > LSG > LAGB after comprehensively weighting glucose, weight, systolic and diastolic pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Mini-GBP has the greatest probability of achieving diabetes remission in adults with obesity and T2DM, yet BPD was the most effective in long-term diabetes remission. RYGBP appears to be the most favourable alternative treatment to manage patients with cardiometabolic conditions.
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Affiliation(s)
- Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yalan Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongwang Qi
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Shaofang Tang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Chuanjun Zhuo
- Department of School of Mental Health, Jining Medical University, Jining, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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17
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Implications of Professional Occupation Related to Obesity in Patients Undergoing Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155557. [PMID: 32752140 PMCID: PMC7432479 DOI: 10.3390/ijerph17155557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Obesity is an epidemic with severe consequences on the professional development of patients. Bariatric surgery has proven to be a safe treatment with effective results in weight control. The aim of this study is to assess the implications of professional occupation in relation to the development of obesity and weight changes after bariatric surgery. We analyzed 500 obese patients (77.8% women, 22.2% men) who underwent one anastomosis gastric bypass surgery at the Centre of Excellence for the Study and Treatment of Obesity and Diabetes (2014–2019), assessing the influence of professional occupation on body composition and evolution of weight loss up to two years after surgery. Preoperative obesity type III and IV was higher in men than in women (45.9–19.8% vs. 43.7–9.5%; respectively). Prevalent clinical history in women was depression (46.7%), varicose veins (35.6%), and thyroid disease (9.7%), while in men it was respiratory failure (98.2%), high blood pressure (56.8%), hepatic steatosis (82%). Postoperative weight loss was effective in every professional field, reaching normal weight values from 12 months after surgery.
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18
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Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study. Obes Surg 2020; 30:4834-4839. [PMID: 32578178 DOI: 10.1007/s11695-020-04782-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a recommended treatment for type 2 diabetes mellitus (T2DM) in patients with obesity, with superiority over medical therapy. While diabetes remission is achieved initially in 60-90% of patients following surgery, many may experience relapse of diabetes on the long-term. Data on long-term follow-up of bariatric surgery is scarce. We report this 12-year follow-up study of glycaemic control following RYGB. METHODS Two hundred seventeen patients with obesity (109 diabetic, 108 matched nondiabetic) who underwent RYGB between 2000 and 2008 were identified. Data was recorded prospectively for these patients at baseline and 2 years postoperatively. The long-term data was obtained via direct contact with the patients cross-checked with our hospital/national patients' electronic databases. RESULTS The follow-up rate was 88% (initial age 44 ± 9 years, female 79%). The mean (± SD) percentage total weight loss was 28% (± 15%) and 27% (± 17%) at 2 years and 12 years, respectively. Diabetes remission rate was 69% at 2 years, but decreased to 36% at 12 years following surgery. The 12-year incidence of new-onset T2DM in the control group was 4.3%. On univariate analysis, age, preoperative duration of diabetes and use of insulin were associated with less chance of diabetes remission at long-term (p value 0.06, 0.01 and 0.03, respectively). However, on multivariate regression analysis, only the duration of diabetes preoperatively remained significant (p = 0.025). CONCLUSION This study shows a high relapse of diabetes 12-year post-RYGB despite the durability of weight loss. This affects preoperative counselling and indicates a need for a longer follow-up to detect relapse.
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19
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Nautiyal HK, Guan W, Lin S, Liang H. Preoperative predictors of early relapse/no-remission of type-2 diabetes after metabolic surgery in Chinese patients. Clin Obes 2020; 10:e12350. [PMID: 31909571 DOI: 10.1111/cob.12350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 10/20/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
Remission of type 2 diabetes mellitus (T2DM) after metabolic surgery in some patients is not sustained. There is limited data regarding the preoperative factors predicting early relapse of T2DM in Chinese patients. The objective of this study is to look for preoperative predictors of early T2DM relapse/no remission in patients with obesity and diabetes who underwent Roux-en-Y gastric bypass (RYGB) or loop duodeno-jejunal bypass with sleeve gastrectomy (LDJB-SG). This is a retrospective study of 113 patients who underwent RYGB or LDJB-SG for T2DM. All T2DM patients with BMI 27.5 to 37.5 kg/m2 , having uncontrolled diabetes and T2DM patients with BMI > 37.5 were included in the study. A multivariate analysis with a logistic regression model was used for analysed factors. Nineteen patients (16.8%) had early relapse and 12 (10.6%) did not have remission. Mean age of patients was significantly more who relapsed/no-remission (44.9 vs 40.3 years). On univariate analysis, base line weight (86 vs 96.7 kg) was significantly lower in patients who relapsed/no-remission. Patients with sustained remission had statistically significant low glycosylated haemoglobin (P < .030), plasma glucose (120 minutes) (P < .002) on OGTT, area under curve glucose (P < .011) values and more C-peptide (P < .006) on univariate analysis. Only duration of diabetes (OR 2.78, 95% CI 1.56-4.97, P < .001) was found to be independent preoperative factor associated with early relapse/no-remission. Two years of diabetes duration was the cut-off point to predict relapse/no-remission (sensitivity 78.9, specificity 63.4, receiver operating characteristic curve 0.71). Duration of diabetes is the most probable, independent preoperative predictor of early T2DM relapse/no-remission in patient with obesity and diabetes undergoing metabolic surgery.
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Affiliation(s)
- Hemant K Nautiyal
- Department of General Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Wei Guan
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Shibo Lin
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
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Umemura A, Sasaki A, Nitta H, Nikai H, Baba S, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Ishigaki Y. Prognostic factors and a new preliminary scoring system for remission of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy. Surg Today 2020; 50:1056-1064. [PMID: 32170427 DOI: 10.1007/s00595-020-01990-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/11/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the early remission rate of type 2 diabetes mellitus (T2DM) after laparoscopic sleeve gastrectomy (LSG) and establish a preliminary scoring system that predicts T2DM remission. METHODS We assessed the outcomes of 49 morbidly obese patients with T2DM who underwent LSG between 2008 and 2018. The prognostic factors for T2DM remission 1 year post-LSG were identified and an original scoring system was established. We validated our scoring system by comparing it with the individualized metabolic surgery score and the ABCD score. RESULTS The patients' mean body weight loss and percentage of excess weight loss were 34.4 kg and 59.4%, respectively, while the T2DM remission rate was 77.5%. The serum insulin level and the T2DM duration were independent predictive factors, the receiver-operating characteristic (ROC) curves for which revealed cutoff values of 12.7 ng/mL and 72 months, respectively. We set our system's score range at 0-2, whereby patients with higher scores have a good T2DM remission prognosis, as higher insulin levels, and/or shorter T2DM duration. Our scoring system had accuracy levels similar to those of the ABCD score with a simple stratification. CONCLUSION Our preliminary scoring system attains a good level of accuracy for predicting T2DM remission.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shigeaki Baba
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, 020-8505, Japan
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Luo Y, Guo Z, He H, Yang Y, Zhao S, Mo Z. Predictive Model of Type 2 Diabetes Remission after Metabolic Surgery in Chinese Patients. Int J Endocrinol 2020; 2020:2965175. [PMID: 33488705 PMCID: PMC7787854 DOI: 10.1155/2020/2965175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Metabolic surgery is an effective treatment for type 2 diabetes (T2D). At present, there is no authoritative standard for predicting postoperative T2D remission in clinical use. In general, East Asian patients with T2D have a lower body mass index and worse islet function than westerners. We aimed to look for clinical predictors of T2D remission after metabolic surgery in Chinese patients, which may provide insights for patient selection. METHODS Patients with T2D who underwent metabolic surgery at the Third Xiangya Hospital between October 2008 and March 2017 were enrolled. T2D remission was defined as an HbA1c level below 6.5% and an FPG concentration below 7.1 mmol/L for at least one year in the absence of antidiabetic medications. RESULTS (1) Independent predictors of short-term T2D remission (1-2 years) were age and C-peptide area under the curve (C-peptide AUC); independent predictors of long-term T2D remission (4-6 years) were C-peptide AUC and fasting plasma glucose (FPG). (2) The optimal cutoff value for C-peptide AUC in predicting T2D remission was 30.93 ng/ml, with a specificity of 67.3% and sensitivity of 75.8% in the short term and with a specificity of 61.9% and sensitivity of 81.5% in the long term, respectively. The areas under the ROC curves are 0.674 and 0.623 in the short term and long term, respectively. (3) We used three variables (age, C-peptide AUC, and FPG) to construct a remission prediction score (ACF), a multidimensional 9-point scale, along which greater scores indicate a better chance of T2D remission. We compared our scoring system with other reported models (ABCD, DiaRem, and IMS). The ACF scoring system had the best distribution of patients and prognostic significance according to the ROC curves. CONCLUSION Presurgery age, C-peptide AUC, and FPG are independent predictors of T2D remission after metabolic surgery. Among these, C-peptide AUC plays a decisive role in both short- and long-term remission prediction, and the optimal cutoff value for C-peptide AUC in predicting T2D remission was 30.93 ng/ml, with moderate predictive values. The ACF score is a simple reliable system that can predict T2D remission among Chinese patients.
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Affiliation(s)
- Yufang Luo
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Zi Guo
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Honghui He
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Youbo Yang
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Shaoli Zhao
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
| | - Zhaohui Mo
- Department of Endocrinology, Third Xiangya Hospital of Central South University & Diabetic Foot Research Center of Central South University, Changsha, Hunan Province 410013, China
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Impacts of Different Modes of Bariatric Surgery on Plasma Levels of Hepassocin in Patients with Diabetes Mellitus. REPORTS 2019. [DOI: 10.3390/reports2040024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Hepassocin is a liver-derived protein and its serum concentrations significantly increase in diabetes and fatty liver patients. Hepassocin is also a biomarker for diabetes and fatty liver; therefore, we aimed to investigate the impacts of different types of bariatric surgery on hepassocin plasma levels in obese patients with diabetes, and to determine if hepassocin could be a potential new marker for monitoring the effects of bariatric surgery and a treatment target. Methods: Overall, 12 patients undergoing gastric bypass (GB), 10 patients undergoing sleeve gastrectomy (SG) and 11 patients undergoing duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) were enrolled. Fasting hepassocin levels were measured at baseline, three, 12, and 24 months after surgery. Results: All the three groups significantly decreased their body mass index, waist-to-hip ratio, a body shape index (ABSI), triglycerides, fasting blood sugar, hemoglobin A1c, C-peptide levels and homeostasis model assessment of insulin resistance 24 months after surgery. There were no significant changes in hepassocin levels, even 24 months after the three surgeries. Hepassocin had a significant negative relationship with the ABSI (p< 0.001) 24 months after the SG. Conclusions: Neither GB, SG, nor DJB-SG altered plasma hepassocin levels in diabetic patients up to 24 months after surgery. The use of hepassocin in clinical settings requires more investigation.
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Wu WC, Lee WJ, Yeh C, Chen SC, Chen CY. WITHDRAWN: Do different bariatric surgery procedures impact hepassocin plasma levels in patients with type 2 diabetes mellitus? LIVER RESEARCH 2019. [DOI: 10.1016/j.livres.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Yan Y, Sha Y, Huang X, Yuan W, Wu F, Hong J, Fang S, Huang B, Hu C, Wang B, Zhang X. Roux-en-Y Gastric Bypass Improves Metabolic Conditions in Association with Increased Serum Bile Acids Level and Hepatic Farnesoid X Receptor Expression in a T2DM Rat Model. Obes Surg 2019; 29:2912-2922. [DOI: 10.1007/s11695-019-03918-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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English WJ, Williams DB. Metabolic and Bariatric Surgery: An Effective Treatment Option for Obesity and Cardiovascular Disease. Prog Cardiovasc Dis 2018; 61:253-269. [PMID: 29953878 DOI: 10.1016/j.pcad.2018.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 01/07/2023]
Abstract
Obesity is a chronic and debilitating disease that has become a global epidemic. Especially severe in the Unites States, obesity currently affects almost 40% of the population. Obesity has a strong causal relationship with numerous serious comorbidities that impair quality of life, shorten life expectancy, and carry a major economic burden. Obesity has particular relevance to cardiologists because it contributes directly to several major cardiovascular diseases and, consequently, increases overall cardiovascular mortality. Multiple treatment options are available, but metabolic and bariatric surgery offers the most effective and durable treatment for obesity. Moreover, metabolic and bariatric operations alleviate and often completely eliminate numerous comorbidities, particularly type 2 diabetes and other cardiovascular risk factors, such as hypertension and dyslipidemia. With their low risk of complications and morbidity, metabolic and bariatric operations significantly improve quality of life and overall survival, particularly reducing death due to cardiovascular disease.
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Affiliation(s)
- Wayne J English
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Room D5203 MCN, Nashville, TN 37232-2577, United States of America.
| | - D Brandon Williams
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Room D5203 MCN, Nashville, TN 37232-2577, United States of America.
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Liang H, Cao Q, Liu H, Guan W, Wong C, Tong D. The Predictive Factors for Diabetic Remission in Chinese Patients with BMI > 30 kg/m2 and BMI < 30 kg/m2 Are Different. Obes Surg 2018; 28:1943-1949. [DOI: 10.1007/s11695-017-3106-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hady HR, Olszewska M, Czerniawski M, Groth D, Diemieszczyk I, Pawluszewicz P, Kretowski A, Ladny JR, Dadan J. Different surgical approaches in laparoscopic sleeve gastrectomy and their influence on metabolic syndrome: A retrospective study. Medicine (Baltimore) 2018; 97:e9699. [PMID: 29369197 PMCID: PMC5794381 DOI: 10.1097/md.0000000000009699] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 02/05/2023] Open
Abstract
Obesity is a growing health, social, and economic issue and became an epidemic, according to recent report of World Health Organization.The only method with scientifically proved efficiency of body mass loss is a surgical treatment. Laparoscopic sleeve gastrectomy (LSG) is recently a leading method in metabolic surgery. There are no standards of operative technique for LSG so far. The influence of technique modification on metabolic effect has not been described clearly.The aim of this study was to evaluate metabolic effects in patients with morbid obesity who underwent various surgical approaches of LSG.The study included 120 patients who were randomly divided into 3 groups: Group I, where bougie size was 32 French (Fr), Group II-36 Fr and Group III-40 Fr. Each group was divided into 2 subgroups, based on the distance of resection beginning from the pylorus-2 or 6 cm. Statistical analysis of: body mass index (BMI), the Percentage of Excess Weight Loss (%EWL), the Percentage of Excess BMI Loss (%EBMIL), levels of glucose and insulin on an empty stomach, glycated hemoglobin (HbA1c), insulin resistance (Homeostatic Model Assessment of Insulin Resistance Index-HOMA-IR), aspartate transaminase (AST), alanine transaminase (ALT), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and C-reactive protein (CRP) were under investigation.Statistically significant decrease in body mass, BMI, %EWL, %EBL, glucose, and insulin concentrations has been observed in all studied groups. It was the highest when the smallest calibration tube has been used (32 Fr). Similar results were observed in HOMA-IR and HbA1c levels. Statistically significant decrease of total cholesterol, LDL, and TG concentrations have been observed. Significant increase of HDL in every group has been also noted. Postoperative CRP values were the lowest when the smallest bougie was used.LSG is effective method of obesity treatment. Metabolic effects of LSG are the most noticeable when a small bougie size is used.
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Affiliation(s)
| | | | | | - Dawid Groth
- 1st Department of General and Endocrinological Surgery
| | | | | | - Adam Kretowski
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Jerzy Robert Ladny
- Department of Emergency Medicine and Disasters, Medical University of Bialystok, Bialystok, Podlaskie, Poland
| | - Jacek Dadan
- 1st Department of General and Endocrinological Surgery
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Serum Leptin and Adiponectin Concentration in Type 2 Diabetes Patients in the Short and Long Term Following Biliopancreatic Diversion. Obes Surg 2017; 26:2442-8. [PMID: 26989058 DOI: 10.1007/s11695-016-2126-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A deranged adipokine system is implicated in obesity and in type 2 diabetes mellitus (T2DM), and the lack of remission of T2DM after bariatric surgery could be also accounted for by the postoperative persistence of this condition. METHODS Thirty T2DM patients undergoing biliopancreatic diversion (BPD) with a wide range of baseline body mass index (BMI) were evaluated prior to and at 1 and 5 years following BPD. Besides the usual clinical evaluations, acute insulin response (AIR) to intravenous glucose load as a parameter of insulin secretion and the serum leptin and adiponectin concentration were measured throughout the follow-up period in all patients. RESULTS A long-term T2DM remission was observed in 21 patients (70 %). Serum leptin level reduced at the first year and remained substantially unchanged at a long term in both the remitter and non-remitter patients, while following the operation, a progressive significant increase of serum adiponectin level was observed only in remitter patients (from 9.2 to 12.3 μg/mL at 1 year and to 15.18 μg/mL at 5 years in the remitters and from 8.8 to 8.75 μg/mL at 1 year and to 11.8 μg/mL at 5 years in the non-remitters). Serum leptin mean values were positively associated with the BMI ones both prior to and following BPD (p < 0.005), while serum adiponectin values were positively related (p < 0.04) to the postoperative AIR data. CONCLUSIONS The improvement of the pattern of cytokine production, as evidenced by postoperative rise in serum adiponectin concentration, might play a role in T2DM remission after bariatric surgery.
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Zhang H, Han X, Yu H, Di J, Zhang P, Jia W. Effect of Roux-en-Y Gastric Bypass on Remission of T2D: Medium-Term Follow-up in Chinese Patients with Different BMI Obesity Class. Obes Surg 2017; 27:134-142. [PMID: 27312346 DOI: 10.1007/s11695-016-2262-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes mellitus (T2D) with obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with different obesity classes. The purpose of this study is to evaluate the medium-term metabolic results of RYGB in T2D patients with body mass index (BMI) >25 kg/m2 compared by obesity class. METHODS We retrospectively divided 120 Chinese patients with T2D and BMI >25 kg/m2 into four groups from overweight to obesity class III and reviewed their medical records for metabolic outcomes 36 months after RYGB. T2D remission was defined as glycated hemoglobin <6.0 % and no current medications. Hypertension, dyslipidemia, cardiovascular risk, and medications were also evaluated. RESULTS Sixty-two patients (62/120, 51.6 %) were female. All surgeries were performed laparoscopically without mortality or major complications. Mean follow-up duration was 38.7 ± 9.1 months and follow-up compliance was 86.7 %. Patients with BMI ≥28 kg/m2 benefitted more from weight loss following RYGB. Medication and remission results for hypertension and dyslipidemia did not differ significantly between groups. There was a significant reduction in the need for oral medication or insulin in all four groups. T2D remission occurred in 44-66.7 % of all patients at 36 months with no significant difference between groups. Initial BMI was correlated with A1C 36 months after surgery (r = -0.217, P = 0.027). CONCLUSIONS RYGB effectively treated T2D patients in our study, even in low-BMI patients, and resulted in diabetes remission and metabolic disorder control, reducing cardiovascular risk.
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Affiliation(s)
- Hongwei Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Xiaodong Han
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jianzhong Di
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Pin Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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Results of Laparoscopic Sleeve Gastrectomy in 541 Consecutive Patients with Low Baseline Body Mass Index (30-35 kg/m 2). Obes Surg 2017; 26:2824-2828. [PMID: 27185176 DOI: 10.1007/s11695-016-2224-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is currently the leading bariatric procedure and targets, among other obesity classes, patients with BMI 30-35 kg/m2, which are reaching alarming proportions. METHODS Between February 2010 and August 2015, data on 541 consecutive patients with BMI 30-35 kg/m2 undergoing LSG were prospectively collected and analyzed. RESULTS Mean age was 32 ± 8 years (13-65) and 419 (77.4 %) were women. Preoperative weight was 92.0 ± 8.8 kg (65-121) and BMI was 32.6 ± 1.5 kg/m2 (30-35). Comorbidities were detected in 210 (39 %) patients. Operative time was 74 ± 12 min (40-110) and postoperative stay was 1.7 ± 0.22 days (1-3). There were no deaths, leaks, abscesses or strictures and the rate of hemorrhage was 1.2 %. At 1 year, 98 % were followed and BMI decreased to 24.7 ± 1.6, the percentage of total weight loss (% TWL) was 24.1 ± 4.7 while the percentage of excess BMI loss (%EBMIL) reached 106.1 ± 24.1. At 5 years, 76 % of followed patients achieved a ≥50 % EBMIL. CONCLUSION With appropriate surgical expertise, LSG in patients with BMI 30-35 kg/m2 achieved excellent outcomes with a zero fistula rate.
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Abstract
The treatment of type 2 diabetes mellitus has evolved in the present century toward safer and maybe more effective drugs, which in some cases can also reduce the risk of cardiovascular and renal outcomes. Nevertheless, we still need better strategies to reduce excess body weight in order to achieve diabetes remission, which is now a feasible target, as has been demonstrated with bariatric surgery. This review focuses on the significant advances in the management of blood glucose in type 2 diabetes mellitus, including the current understanding of the mechanisms of drug action but keeping in mind that the treatment of the disease is multifactorial.
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Affiliation(s)
- Pablo Aschner
- Javeriana University and San Ignacio University Hospital, Bogota, Colombia
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Effects of Laparoscopic Roux-en-Y Gastric Bypass on Chinese Type 2 Diabetes Mellitus Patients with Different Levels of Obesity: Outcomes After 3 Years’ Follow-Up. Obes Surg 2017; 28:702-711. [DOI: 10.1007/s11695-017-2903-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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A prospective 4-year study of insulin resistance and adipokines in morbidly obese diabetic and non-diabetic patients after gastric banding. Wideochir Inne Tech Maloinwazyjne 2017; 12:147-153. [PMID: 28694900 PMCID: PMC5502336 DOI: 10.5114/wiitm.2017.67207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/22/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction There are insufficient data regarding the changes in adipokine levels after laparoscopic adjustable gastric banding (LAGB) in diabetic and non-diabetic patients and their effects on insulin resistance and type 2 diabetes remission. Aim To assess leptin, adiponectin, and insulin resistance changes after LAGB in diabetic and non-diabetic morbidly obese patients. Material and methods One hundred and three patients (37 with and 66 without type 2 diabetes) underwent LAGB from January 2009 to January 2010. Glycated hemoglobin, insulin, adipokine levels and insulin resistance were evaluated preoperatively, and 1 and 4 years after LAGB. Results The mean patient age was 45.9 ±11.7 years and mean preoperative body mass index was 47.5 ±7.3 kg/m2. A total of 80 of 103 patients (77.6%) completed the 4-year follow-up. After 4 years the mean excess weight loss was 38.8% and 39.5% in diabetic and non-diabetic patients respectively. Leptin levels decreased significantly in both groups at 1 year, but after 4 years this was noted only in non-diabetic patients. After 1 year adiponectin levels increased significantly only in non-diabetic patients (p = 0.003) and remained almost the same at 4 years. A significant decrease in insulin resistance was noted in both groups 1 year after LAGB and diabetes remission was observed in 23 (62.1%) patients. There was a negative correlation between preoperative insulin resistance and adiponectin levels throughout the follow-up period. Leptin levels positively correlated with BMI throughout the study period (baseline r = 0.45; p < 0.001; after 1 year r = 0.71; p < 0.001; after 4 years r = 0.68; p < 0.001). There was no significant correlation between leptin and adiponectin concentrations preoperatively or after 1 year; however, at 4 years it was significant (r = 0.27; p < 0.02). Conclusions The most significant metabolic changes occurred within 1 year after LAGB. The 4-year follow-up revealed stabilization in metabolic indices rather than significant improvement.
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Trastulli S, Desiderio J, Grandone I, Fontana L, Paolini L, Altomare M, D'Angelo P, Palazzi M, Cirocchi R, Leotta S, Fatati G, Parisi A. Rationale and design of the Early Sleeve gastrectomy In New Onset Diabetic Obese Patients (ESINODOP) trial. Endocrine 2017; 55:748-753. [PMID: 27259508 DOI: 10.1007/s12020-016-0996-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/19/2016] [Indexed: 01/06/2023]
Abstract
No randomized clinical trials (RCTs) have yet evaluated the bariatric surgery's efficacy and safety in patients newly diagnosed with type 2 diabetes mellitus (T2DM). The aim of this multicenter RCT is to compare bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), with conventional medical therapy (CMT) in obese patients (body mass index between 30 and 42 kg/m2) newly diagnosed with T2DM and without any diabetes-related complications at any stage. A total of 100 eligible patients will be randomized at a 1:1 ratio to undergo one of the two planned treatments and will be followed for at least 6 years after randomization. The main objective of the ESINODOP trial is to investigate the efficacy of LSG compared with CMT alone in inducing and maintaining a remission of T2DM (defined as HbA1c levels ≤6.0 %, without active pharmacologic therapy after 1 year). The remission of T2DM will also be evaluated with the criteria provided by the American Diabetes Association (ADA), and the additional parameters such as adverse event rates, micro- and macrovascular complications, weight loss, gastrointestinal hormones, and quality of life will be compared. The study started on September 2015 and the planned recruitment period is 3 years. Patient recruitment and follow-up take place in the two diabetology and nutrition centers participating in the study, which are performed on a national basis. The ESINODOP trial is designed with the intent of comparing the efficacy of CMT alone to that of CMT in conjunction with LSG performed at the time of diabetes diagnosis in mildly obese diabetic patients. Currently, patients with these characteristics are not eligible for bariatric/metabolic surgery.
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Affiliation(s)
- Stefano Trastulli
- Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy.
| | - Jacopo Desiderio
- Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ilenia Grandone
- Department of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Lucia Fontana
- Department of Diabetology and Clinical Nutrition, Sandro Pertini Hospital, Rome, Italy
| | - Luisa Paolini
- Department of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Maria Altomare
- Department of Diabetology and Clinical Nutrition, Sandro Pertini Hospital, Rome, Italy
| | - Paola D'Angelo
- Department of Diabetology and Clinical Nutrition, Sandro Pertini Hospital, Rome, Italy
| | - Mariangela Palazzi
- Department of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Sergio Leotta
- Department of Diabetology and Clinical Nutrition, Sandro Pertini Hospital, Rome, Italy
| | - Giuseppe Fatati
- Department of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
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Reis LDDO, Nassif PAN, Tabushi FI, Milléo FQ, Favero GM, Ariede BL, Reis CFDD, Dalabona BF. PRELIMINARY ANALYSIS OF INTERLEUKIN-6 CHANGES IN PRE- AND POSTOPERATIVE IN DIABETIC PATIENTS WITH BMI<35 SUBMITTED TO PARTIAL DUODENAL SWITCH. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:252-256. [PMID: 28076480 PMCID: PMC5225865 DOI: 10.1590/0102-6720201600040009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/02/2016] [Indexed: 02/26/2023]
Abstract
Background: Studies related to obesity have shown association with metabolic syndrome. Data showing that obesity is capable to cause low grade chronic inflammation, without its classic signs and symptoms, call attention to researches to study different cells types and the mechanism of the inflammatory process. Aim: To evaluate the variation of glycated hemoglobin (HbA1c) and the pro-inflammatory cytokine interleukin-6 (IL6) in diabetic patients with BMI <35 kg/m2 in the pre and postoperative of partial duodenal switch. Method: Nine patients were studied before and one year after the operation and the variation of the serum IL6 was measured by Elisa. The changes of HbA1c were also registered. Results: The pre-operative IL6 levels reached 65,50436±2,911993 pg/ml and one year after de operation 39,47739±3,410057 and the HbA1c average of 10,67 and 5.8 in the same period. Conclusion: The partial duodenal switch was efficient to control one year after the procedure the chronic inflammatory process caused by the diabetes mellitus type 2 with BMI <35 by dropping the IL6 levels and bringing the HbA1c to normal.
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Affiliation(s)
- Luciano Dias de Oliveira Reis
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Fernando Issamu Tabushi
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Fábio Quirillo Milléo
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Giovani Marino Favero
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Bruno Luiz Ariede
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Cassiana Franco Dias Dos Reis
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Bruno Franco Dalabona
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
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Juodeikis Ž, Brimas G. Long-term results after sleeve gastrectomy: A systematic review. Surg Obes Relat Dis 2016; 13:693-699. [PMID: 27876332 DOI: 10.1016/j.soard.2016.10.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Abstract
Sleeve gastrectomy (SG) has become one of the most commonly used bariatric procedures worldwide. However, data regarding long-term results remain insufficient. The aim of this study was to review the long-term results after SG. We conducted a comprehensive literature search of Medline and the Cochrane Library for articles published until May 2016 on the long-term results (>5 yr) after SG. Studies representing outcomes of SG were included if they reported≥5-year results that contained at least one outcome of interest-weight loss, co-morbidities, long-term complications, or quality of life-and SG was performed as a primary procedure. Of the 297 initially identified articles, 277 studies met the exclusion criteria, and 20 met the inclusion criteria. SG was performed on 2713 patients and 1626 patients reached the≥5-year follow-up point. Among the patients, 71.3% were women and 28.7% were men. The mean preoperative body mass index was 46.9 kg/m2. The duration of follow-up ranged 5 to 11 years. The mean 5-year follow-up rate was 66% (range, 57%-100%). The mean percentage excess weight loss was 58.4%, 59.5%, 56.6%, 56.4%, and 62.5% at 5, 6, 7, 8, and 11 years, respectively. Five years after SG, the resolution or improvement of type 2 diabetes was observed in 77.8% of patients, and arterial hypertension, dyslipidemia, obstructive sleep apnea, gastroesophageal reflux disease, and degenerative joint diseases had improved or resolved in 68.0%, 65.9%, 75.8%, 30.6%, and 55.7% of patients, respectively. This systematic review suggests that SG can lead to substantial and lasting excess weight loss and significant improvement in obesity-related co-morbidities. However, the lack of randomized clinical trials, low follow-up rates, and poorly reported data regarding co-morbidities and quality of life in many of the studies indicate that these findings should be interpreted with caution.
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Affiliation(s)
- Žygimantas Juodeikis
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania.
| | - Gintautas Brimas
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
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Abstract
Lifestyle modification is the cornerstone treatment of type 2 diabetes in the obese patient, and is highly effective at promoting glucose regulation. However, many individuals struggle over time to maintain optimal glycemic control and/or body weight with lifestyle modification. Therefore, additional therapeutic approaches are needed. Pharmacologic interventions have shown promising results for obesity-related diabetes complications. Not surprisingly though lifestyle modification and pharmacology may become ineffective for treating diabetes over time. Bariatric surgery is considered by some, but not all, to be the most effective and durable treatment for combating obesity. In fact many patients with type 2 diabetes have normalized glucose concentrations within days postoperation. Taken together, treatment of obesity in the patient with type 2 diabetes requires a multi-faceted approach.
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Affiliation(s)
- Steven K Malin
- Division of Endocrinology & Metabolism, Department of Kinesiology, Curry School of Education, School of Medicine, University of Virginia, 203 Memorial Gymnasium, Charlottesville, VA 22904, USA
| | - Sangeeta R Kashyap
- Division of Endocrinology, School of Medicine, Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, 9500 Euclid Avenue, NE40, Cleveland, OH 44195, USA.
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Du X, Zhou HX, Zhang SQ, Tian HM, Zhou ZG, Cheng Z. A comparative study of the metabolic effects of LSG and LRYGB in Chinese diabetes patients with BMI<35 kg/m 2. Surg Obes Relat Dis 2016; 13:189-197. [PMID: 27720418 DOI: 10.1016/j.soard.2016.08.499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The metabolic effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in type 2 diabetes (T2D) patients who do not meet National Institutes of Health indications has not been well studied. OBJECTIVES To compare the effectiveness of LSG and LRYGB in Chinese T2D patients with body mass index (BMI)<35 kg/m2. SETTING University hospital, China. METHODS A nonrandomized cohort of patients who underwent LRYGB (n = 64) and LSG (n = 19) were followed up for 3 years and the outcomes (weight loss and remission of diabetes and other metabolic parameters) were compared. Univariate and multivariate analyses were applied to find associated parameters of T2D remission. RESULTS In total, 5 patients (6%) were lost to follow-up. No significant differences in mean percentage of excess weight loss and BMI were observed between the 2 groups at 2 years. At 3-year follow-up, the LRYGB group had significantly higher percentage of excess weight loss and lower BMI. The total (complete and partial) remission rate achieved with both bariatric procedures was 75.9% at 1 year and 56.4% at 3 years. Surgical safety, diabetes remission, and remission of other obesity-related co-morbidities were comparable between the 2 groups. Patients who achieved complete or partial remission had lower fasting plasma glucose, lower plasma glucose at 2 hours, lower glycated hemoglobin, and higher fasting C peptide than the other patients at baseline. High recurrence rates of hypertension and hyperuricemia were observed at 3 years postoperation. CONCLUSIONS Both LSG and LRYGB are safe and effective bariatric procedures for T2D in this Chinese population with diabetes and BMI<35 kg/m2.
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Affiliation(s)
- Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hong-Xu Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Si-Qin Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hao-Ming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Palmisano S, Silvestri M, Giuricin M, Baldini E, Albertario S, Capelli P, Marzano B, Fanti G, Zompicchiatti A, Millo P, Fabozzi M, Brachet Contul R, Ponte E, Allieta R, de Manzini N. Preoperative Predictive Factors of Successful Weight Loss and Glycaemic Control 1 Year After Gastric Bypass for Morbid Obesity. Obes Surg 2016; 25:2040-6. [PMID: 25845353 DOI: 10.1007/s11695-015-1662-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastric bypass (GBP) is one of the most effective surgical procedures to treat morbid obesity and the related comorbidities. This study aimed at identifying preoperative predictors of successful weight loss and type 2 diabetes mellitus (T2DM) remission 1 year after GBP. METHODS Prospective longitudinal study of 771 patients who underwent GBP was performed at four Italian centres between November 2011 and May 2013 with 1-year follow-up. Preoperative anthropometric, metabolic and social parameters, the surgical technique and the previous failed bariatric procedures were analyzed. Weight, the body mass index (BMI), the percentage of excess weight lost (% EWL), the percentage of excess BMI lost (% BMIL) and glycated haemoglobin (HbA1c) were recorded at follow-up. RESULTS Univariate and multivariate analysis showed that BMI <50 kg/m(2) (p = 0.006) and dyslipidaemia (p = 0.05) were predictive factors of successful weight loss. Multivariate analysis of surgical technique showed significant weight loss in patients with a small gastric pouch (p < 0.001); the lengths of alimentary and biliary loops showed no statistical significance. All diabetic patients had a significant reduction of HbA1c (p < 0.001) after surgery. BMI ≥ 50 kg/m(2) (p = 0.02) and low level of preoperative HbA1c (p < 0.01) were independent risk factors of T2DM remission after surgery. CONCLUSIONS This study provides a useful tool for making more accurate predictions of best results in terms of weight loss and metabolic improvement.
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Affiliation(s)
- Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Marta Silvestri
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Michela Giuricin
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Edoardo Baldini
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Simone Albertario
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Patrizio Capelli
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Bernardo Marzano
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Giovanni Fanti
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Aron Zompicchiatti
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Paolo Millo
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Massimiliano Fabozzi
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Riccardo Brachet Contul
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Elisa Ponte
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Rosaldo Allieta
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
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Kirwan JP, Aminian A, Kashyap SR, Burguera B, Brethauer SA, Schauer PR. Bariatric Surgery in Obese Patients With Type 1 Diabetes. Diabetes Care 2016; 39:941-8. [PMID: 27222552 PMCID: PMC8310563 DOI: 10.2337/dc15-2732] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/23/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is a paucity of data on the impact of bariatric surgery in type 1 diabetes (T1D). The aim of this review was to quantify the overall effects of bariatric surgery in obese patients with T1D. METHODS We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar from their inception to December 2015 to identify all relevant studies of bariatric surgery in adult obese patients with T1D. RESULTS The review included 17 studies with 107 individuals, including 10 case series and 7 case reports. Overall, the dominant procedure was gastric bypass (n = 70; 65%). All studies reported a significant reduction in excess weight. A significant reduction in weight-adjusted daily insulin requirements was shown in all case series except one. Pooled mean ± SD of pre- and postoperative glycated hemoglobin (HbA1c) for the entire cohort with available data (n = 96) was 8.4 ± 1.3% and 7.9 ± 1.1%, respectively (P = 0.01). In addition to common postoperative complications, profound glycemic changes (diabetic ketoacidosis and hypoglycemia) and gastrointestinal dysmotility symptoms (prolonged ileus and acute gastric remnant dilation) have been reported. No surgical mortality was reported. CONCLUSIONS Bariatric surgery leads to significant weight loss in severely obese patients with T1D and results in a significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of and cardiovascular risk reduction in T1D in the setting of severe obesity. Diabetic ketoacidosis and hypoglycemia are potentially serious complications. Short-term results of bariatric surgery in patients with T1D are encouraging, but larger and longer-term studies are needed.
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Affiliation(s)
- John P Kirwan
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
| | | | - Bartolome Burguera
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
| | | | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
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Park JY, Kim YJ. Efficacy of Laparoscopic Sleeve Gastrectomy in Mildly Obese Patients with Body Mass Index of 30-35 kg/m(2). Obes Surg 2016; 25:1351-7. [PMID: 25656261 DOI: 10.1007/s11695-015-1575-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has recently gained rapidly increasing popularity as a stand-alone procedure for the treatment of morbid obesity. This study aimed to evaluate the efficacy of LSG in mildly obese patients with a body mass index (BMI) of 30-35 kg/m(2). METHODS One hundred ninety-two patients who consecutively underwent LSG between April 2009 and December 2012 were retrospectively reviewed. The patients were classified into a lower BMI (30-35 kg/m(2)) and higher BMI group (>35 kg/m(2)). Demographics and surgical outcomes were compared between the groups. RESULTS Forty-nine patients (25.5 %) belonged to the lower BMI group, while the other 143 (74.5 %) to the higher BMI group. The preoperative BMI of each group was 32.7 ± 1.6 and 42.6 ± 6.6 kg/m(2), respectively. Severe complications requiring invasive intervention developed only in the higher BMI group (4/143, 2.8 %). The percent of excess weight loss (%EWL) in the lower BMI group was 86.1 % at mean follow-up of 24 months, which was significantly greater than in the higher BMI group (61.9 %, p<0.001). Serial follow-up showed that %EWL was significantly greater in the lower BMI group until 2 years postoperatively, and the difference became statistically insignificant thereafter. The resolution of comorbidities was observed in more than 80 % of the patients both in lower and higher BMI groups. CONCLUSION LSG achieved excellent outcomes without severe complications for mildly obese patients. LSG could serve as a safe and effective stand-alone procedure to achieve sustained weight loss and comorbidity resolution in patients with a lower BMI.
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Affiliation(s)
- Ji Yeon Park
- Department of Surgery, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea
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Yu H, Chen J, Lu J, Bao Y, Tu Y, Zhang L, Zhang P, Jia W. Decreased visceral fat area correlates with improved arterial stiffness after Roux-en-Y gastric bypass in Chinese obese patients with type 2 diabetes mellitus: a 12-month follow-up. Surg Obes Relat Dis 2016; 12:550-555. [DOI: 10.1016/j.soard.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/03/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022]
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Mahawar KK, Aggarwal S, Carr WRJ, Jennings N, Balupuri S, Small PK. Consensus statements and bariatric surgery. Obes Surg 2015; 25:1063-5. [PMID: 25680578 DOI: 10.1007/s11695-015-1606-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK,
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Ardestani A, Rhoads D, Tavakkoli A. Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes Care 2015; 38:659-64. [PMID: 25573879 DOI: 10.2337/dc14-1751] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The impact of bariatric surgeries on insulin-treated type 2 diabetes (I-T2D) in the general population is largely undocumented. We assessed changes in insulin treatment after bariatric surgery in a large cohort of I-T2D patients, comparing Roux-en-Y gastric bypass surgery (RYGB) with laparoscopic adjustable gastric banding (LAGB), controlling for differences in weight loss between procedures. RESEARCH DESIGN AND METHODS Of 113,638 adult surgical patients in the Bariatric Outcomes Longitudinal Database (BOLD), 10% had I-T2D. Analysis was restricted to 5,225 patients with I-T2D and at least 1 year of postoperative follow-up. Regression models were used to identify factors that predict cessation of insulin therapy. To control for differences in weight loss patterns between RYGB and LAGB, a case-matched analysis was also performed. RESULTS Of I-T2D patients who underwent RYGB (n = 3,318), 62% were off insulin at 12 months compared with 34% (n = 1,907) after LAGB (P < 0.001). Regression analysis indicated that RYGB strongly predicted insulin cessation at both 1 and 12 months postoperatively. In the case-matched analysis at 3 months, the proportion of insulin cessation was significantly higher in the RYGB group than in the LAGB group (P = 0.03), and the diabetes remission rate was higher at all time points after this surgery. RYGB was a weight-independent predictor of insulin therapy cessation early after surgery, whereas insulin cessation after LAGB was linked to weight loss. CONCLUSIONS I-T2D patients have a greater probability of stopping insulin after RYGB than after LAGB (62% vs. 34%, respectively, at 1 year), with weight-independent effects in the early months after surgery. These findings support RYGB as the procedure of choice for reversing I-T2D.
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Affiliation(s)
- Ali Ardestani
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Rhoads
- Pediatric Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Center for Weight Management and Metabolic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Mala T, Søvik TT, Kristinsson JA. [More could benefit from bariatric surgery]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:521-2. [PMID: 25806755 DOI: 10.4045/tidsskr.15.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Malin SK, Bena J, Abood B, Pothier CE, Bhatt DL, Nissen S, Brethauer SA, Schauer PR, Kirwan JP, Kashyap SR. Attenuated improvements in adiponectin and fat loss characterize type 2 diabetes non-remission status after bariatric surgery. Diabetes Obes Metab 2014; 16:1230-8. [PMID: 25132119 PMCID: PMC4227926 DOI: 10.1111/dom.12376] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/02/2014] [Accepted: 08/04/2014] [Indexed: 12/15/2022]
Abstract
AIM To identify the metabolic determinants of type 2 diabetes non-remission status after bariatric surgery at 12 and 24 months. METHODS A total of 40 adults [mean ± sd body mass index 36 ± 3 kg/m(2) , age 48 ± 9 years, glycated haemoglobin (HbA1c) 9.7 ± 2%) undergoing bariatric surgery [Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)] were enrolled in the present study, the Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial. Type 2 diabetes remission was defined as HbA1c <6.5% and fasting glucose <126 mg/dl (i.e. <7 mmol/l) without antidiabetic medication. Indices of insulin secretion and sensitivity were calculated from plasma glucose, insulin and C-peptide values during a 120-min mixed-meal tolerance test. Body fat, incretins (glucagon-like polypeptide-1, gastric inhibitory peptide, ghrelin) and adipokines [adiponectin, leptin, tumour necrosis factor-α, high-sensitivity C-reactive protein (hs-CRP)] were also assessed. RESULTS At 24 months, 37 patients had available follow-up data (RYGB, n = 18; SG, n = 19). Bariatric surgery induced type 2 diabetes remission rates of 40 and 27% at 12 and 24 months, respectively. Total fat/abdominal fat loss, insulin secretion, insulin sensitivity and β-cell function (C-peptide0-120 /glucose0-120 × Matsuda index) improved more in those with remission at 12 and 24 months than in those without remission. Incretin levels were unrelated to type 2 diabetes remission, but, compared with those without remission, hs-CRP decreased and adiponectin increased more in those with remission. Only baseline adiponectin level predicted lower HbA1c levels at 12 and 24 months, and elevated adiponectin correlated with enhanced β-cell function, lower triglyceride levels and fat loss. CONCLUSIONS Smaller rises in adiponectin level, a mediator of insulin action and adipose mass, characterize type 2 diabetes non-remission up to 2 years after bariatric surgery. Adjunctive strategies promoting greater fat loss and/or raising adiponectin may be key to achieving higher type 2 diabetes remission rates after bariatric surgery.
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Affiliation(s)
- Steven K. Malin
- Dept of Pathobiology, Cleveland Clinic, Cleveland OH, USA
- Dept of Nutrition, Case Western Reserve University Cleveland Clinic, Cleveland OH, USA
| | - James Bena
- Dept of Quantitative Health Sciences, Cleveland Clinic, Cleveland OH, USA
| | - Beth Abood
- Dept of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland OH, USA
| | - Claire E. Pothier
- Dept of Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
| | - Deepak L Bhatt
- Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Nissen
- Dept of Heart and Vascular, Cleveland Clinic, Cleveland OH, USA
| | - Stacy A. Brethauer
- Dept of Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
| | - Philip R. Schauer
- Dept of Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
| | - John P. Kirwan
- Dept of Pathobiology, Cleveland Clinic, Cleveland OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
- Dept of Nutrition, Case Western Reserve University Cleveland Clinic, Cleveland OH, USA
| | - Sangeeta R. Kashyap
- Dept of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
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A Retrospective Review of the Medical Management of Hypertension and Diabetes Mellitus Following Sleeve Gastrectomy. Obes Surg 2014; 25:642-7. [DOI: 10.1007/s11695-014-1375-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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