Metabolic surgery for type 2 diabetes: efficacy and risks

The Complications of Bariatric Surgery Patients with Type 2 Diabetes in the World: A Systematic Review and Meta-Analysis

BACKGROUND

In this Meta-analysis, we aimed to quantify the incidence of complications of different methods of bariatric surgery on diabetic patients.

INTRODUCTION

Type 2 Diabetes Mellitus (T2DM) is increasing worldwide specifically in obese cases. Additionally, obesity worsens T2DM. Complications of each bariatric surgery method were assessed separately; but, a meta-analysis of these complications and comparison between procedures in T2DM patients have not been investigated previously. The result of this study will help surgeons to choose the most appropriate surgical technique, considering individual conditions for a diabetic patient.

METHODS

We searched PubMed, Scopus, and ISI for original papers including bariatric surgical procedures for diabetic population and the reported consequences. Data analyses were done using Stata software.

RESULTS

Mortality percentage between diabetic and non-diabetic patients was statistically nonsignificant (P = 0.987). Early and late complications were higher in diabetic group in comparison with non-diabetic (6.0% vs. 1.8%, P = 0.024 and 0.6% vs. 0.3%, P = 0.04, respectively). Most prevalent findings in malabsorptive (7.8%, P < 0.001) and restrictive procedures (80%, P < 0.001) were major complications and hypoglycemic episodes, respectively.

CONCLUSION

As our study showed, most of the complications are not necessarily higher in diabetic population but dependent on the method of surgery.

The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management

The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions.

Impact of Bariatric Surgery on Patients With Rheumatoid Arthritis

OBJECTIVE

To investigate the effect of weight loss after bariatric surgery among patients with rheumatoid arthritis (RA).

METHODS

We conducted a retrospective cohort study of RA patients who underwent bariatric surgery (Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or sleeve gastrectomy) at 2 medical centers. We obtained information on anthropometrics, laboratory values, RA disease activity, and medication use at baseline (prior to surgery), at 6 and 12 months following surgery, and at the most recent followup visits. RA disease activity was determined by clinical or validated measures. At each postsurgical visit, characteristics were compared to baseline.

RESULTS

We identified 53 RA patients who underwent bariatric surgery. At baseline prior to surgery, mean ± SD body mass index was 47.8 ± 7.7 kg/m(2), mean ± SD weight was 128.2 ± 24.1 kg, and 57% had moderate to high RA disease activity. Twelve months following surgery, subjects lost a mean ± SD weight of 41.0 ± 17.3 kg, mean ± SD 70% ± 24% excess weight (P < 0.001). RA disease activity significantly improved at postsurgical visits (P < 0.001). At 12 months following surgery, 6% had moderate to high disease activity, compared to 57% at baseline (P < 0.001). At the most recent followup (mean ± SD 5.8 ± 3.2 years after surgery), 74% were in remission, compared to 26% at baseline (P < 0.001). Subjects had significantly lower erythrocyte sedimentation rate, C-reactive protein level, and RA-related medication use at followup visits compared to baseline (P < 0.05).

CONCLUSION

After substantial weight loss from bariatric surgery, RA patients had lower disease activity, decreased serum inflammatory markers, and less RA-related medication use. Weight loss may be an important nonpharmacologic strategy to reduce RA disease activity. However, other factors, such as improved efficacy of medications, improved physical activity, and metabolic changes, may also have contributed to these postsurgical improvements.

MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery

Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality.

Identification of a proliferator-activated receptor-γ antagonist for the treatment of type 2 diabetes mellitus

In the present study, a novel antagonist of the peroxisome proliferator-activated receptor-γ (PPARγ) was screened and identified, and a cell-based evaluation of the biological activity of this PPARγ antagonist was conducted. The aim of the study was to produce results that may provide a foundation for the development of a novel compound in the treatment of type 2 diabetes mellitus. Since obesity is the main cause of insulin resistance and type 2 diabetes, identifying a new reagent that is able to inhibit adipocyte differentiation and lipid accumulation is a feasible method of developing novel anti-diabetes drugs. The PPARγ antagonist was screened using a mammalian one-hybrid system and transcriptional activation. The effects of the compound on adipocyte differentiation were investigated by staining the preadipocytes with Oil Red O. In addition, the effects of the compound on the expression levels of genes associated with lipid metabolism were detected using quantitative polymerase chain reaction on differentiated mature 3T3-L1 adipocytes. As a PPARγ antagonist, N-((1H-benzo[d]imidazol-2-yl)methyl) aniline (Compound Q) was shown to depress the transcriptional activity and coactivator recruitment of PPARγ, as well as preadipocyte differentiation, in a concentration-dependent manner. The compound was also shown to decrease the expression levels of genes associated with PPARγ-regulated lipid metabolism. In conclusion, the compound screening platform was demonstrated to be valid, and the present study identified a novel PPARγ antagonist that was shown to effectively reduce the rate of adipocyte differentiation and the expression of genes associated with lipid metabolism.

Laparoscopy for primary and secondary bariatric procedures

Recently obesity has been defined as a disease and has turned bariatric surgery into a part of a chronic illness management. Obesity induces several comorbidities leading to cardiovascular disease and mortality. The effects of bariatric surgery on these comorbidities used to be classified as weight-loss induced. However bariatric surgery has recently been termed metabolic surgery because of the suspected direct, weight loss independent effect of bariatric procedures on the physiopathological mechanisms causing excess fat storage and insulin resistance. This review describes the standard procedures commonly performed and their specific outcomes on metabolic diseases in order to work towards more patient tailored treatment of obesity and to reduce side effects. Furthermore this review focuses on gaps in understanding the pathogenesis of obesity and its treatment with bariatric surgery. Surgery failures as well as new techniques are discussed and evaluated.

Simple steatosis is a more relevant source of serum inflammatory markers than omental adipose tissue

BACKGROUND AND AIMS

Serum inflammatory biomarkers are closely associated with the risk of cardiovascular disease. However, the major source of these biomarkers is not yet determined. Therefore, we aimed to assess whether simple steatosis or visceral adiposity was a more relevant predictor for serum inflammatory biomarkers.

METHODS

A double approach was used: i) clinical: 50 patients with biopsy-proven simple steatosis, 50 non-simple steatosis overweight patients, and 50 controls were explored for their serum biomarkers (high-sensitivity C-reactive protein, plasminogen activator inhibitor-1 activity, tumor necrosis factor α, and fibrinogen levels) and for visceral adiposity (measured by computed tomography); ii) experimental: using a rat simple steatosis model the effect of omentectomy on inflammatory biomarkers was investigated.

RESULTS

Serum inflammatory biomarkers were significantly higher in the simple steatosis group than in the overweight group. Using multivariate analysis, simple steatosis, visceral adiposity index and visceral adiposity were independently associated with inflammatory biomarkers. In particular, serum inflammatory biomarkers increased with the severity of liver histology (p<0.05), but no with visceral adipose tissue increase. In rats with simple steatosis, the omentectomy treatment was not associated with a decrease of serum inflammatory biomarkers in rats with simple steatosis.

CONCLUSIONS

Clinical and experimental data both indicate that simple steatosis may be more associated with inflammatory biomarkers than omental adipose tissue.