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Pedersen SS, Ingerslev LR, Olsen M, Prause M, Billestrup N. Butyrate functions as a histone deacetylase inhibitor to protect pancreatic beta cells from IL-1β-induced dysfunction. FEBS J 2024; 291:566-583. [PMID: 37985375 DOI: 10.1111/febs.17005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/06/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
Butyrate, a gut microbial metabolite, has beneficial effects on glucose homeostasis and has become an attractive drug candidate for type 2 diabetes (T2D). Recently, we showed that butyrate protects pancreatic beta cells against cytokine-induced dysfunction. In this study, we explored the underlying mechanisms of butyrate action. Pancreatic mouse islets were exposed to a non-cytotoxic concentration of interleukin-1β (IL-1β) for 10 days to mimic low-grade inflammation in T2D. Similar to the effect of butyrate, an isoform-selective histone deacetylase 3 (HDAC3) inhibitor normalized IL-1β-reduced glucose-stimulated insulin secretion and insulin content. In contrast, free fatty acid receptor 2 and 3 (FFAR2/3) agonists failed to normalize IL-1β-induced beta cell dysfunction. Furthermore, butyrate inhibited HDAC activity and increased the acetylation of histone H3 and H4 by 3- and 10-fold, respectively. Genome-wide analysis of histone H3 lysine 27 acetylation (H3K27ac) revealed that butyrate mainly increased H3K27ac at promoter regions (74%), while H3K27ac peaks regulated by IL-1β were more equally distributed at promoters (38%), introns (23%) and intergenic regions (23%). Gene ontology analysis showed that butyrate increased IL-1β-reduced H3K27ac levels near several genes related to hormone secretion and reduced IL-1β-increased H3K27ac levels near genes associated with inflammatory responses. Butyrate alone increased H3K27ac near many genes related to MAPK signaling, hormone secretion, and differentiation, and decreased H3K27ac at genes involved in cell replication. Together, these results suggest that butyrate prevents IL-1β-induced pancreatic islet dysfunction by inhibition of HDACs resulting in changes in H3K27ac levels at genes relevant for beta cell function and inflammatory responses.
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Affiliation(s)
- Signe Schultz Pedersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lars Roed Ingerslev
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Mathias Olsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Michala Prause
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nils Billestrup
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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2
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Sayyed Kassem L, Rajpal A, Barreiro MV, Ismail‐Beigi F. Beta-cell function in type 2 diabetes (T2DM): Can it be preserved or enhanced? J Diabetes 2023; 15:817-837. [PMID: 37522521 PMCID: PMC10590683 DOI: 10.1111/1753-0407.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 08/01/2023] Open
Abstract
Type 2 diabetes (T2DM) is a complex metabolic disorder manifested by hyperglycemia, insulin resistance, and deteriorating beta-cell function. A way to prevent progression of the disease might be to enhance beta-cell function and insulin secretion. However, most previous studies examined beta-cell function while patients were using glycemia-lowering agents without an adequate period off medications (washout). In the present review we focus on studies with a washout period. We performed a literature search (2010 to June 2021) using beta-cell function and enhancement. The evidence shows that beta-cell function can be enhanced. Bariatric surgery and very low calorie diets show improvement in beta-cell function in many individuals. In addition, use of glucagon-like peptide-1 receptor agonists for prolonged periods (3 years or more) can also lead to improvement of beta-cell function. Further research is needed to understand the mechanisms leading to improved beta-cell function and identify agents that could enhance beta-cell function in patients with T2DM.
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Affiliation(s)
- Laure Sayyed Kassem
- Case Western Reserve UniversityClevelandOhioUSA
- Cleveland VA Medical CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Aman Rajpal
- Case Western Reserve UniversityClevelandOhioUSA
- Cleveland VA Medical CenterCase Western Reserve UniversityClevelandOhioUSA
| | | | - Faramarz Ismail‐Beigi
- Case Western Reserve UniversityClevelandOhioUSA
- Cleveland VA Medical CenterCase Western Reserve UniversityClevelandOhioUSA
- University Hospitals of ClevelandClevelandOhioUSA
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3
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Rendell MS. Obesity and diabetes: the final frontier. Expert Rev Endocrinol Metab 2023; 18:81-94. [PMID: 36710450 DOI: 10.1080/17446651.2023.2168643] [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: 06/28/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Obesity is a key target in the treatment and prevention of diabetes and independently to reduce the burden of cardiovascular disease. We reviewed the options now available and anticipated to deal with obesity. AREAS COVERED We considered the epidemiology, genetics, and causation of obesity and the relationship to diabetes, and the dietary, pharmaceutical, and surgical management of the condition. The literature search covered both popular media via Google Search and the academic literature as indexed on PubMed with search terms including obesity, childhood obesity, adipocytes, insulin resistance, mechanisms of satiety, bariatric surgery, GLP-1 receptor agonists, and SGLT2 inhibitors. EXPERT OPINION Although bariatric surgery has been the primary approach to treating obese individuals, the emergence of agents impacting the brain satiety centers now promises effective, non-invasive treatment of obesity for individuals with and without diabetes. The GLP-1 receptor agonists have assumed the primary role in treating obesity with significant weight loss. Long-term results with semaglutide and tirzepatide are now approaching the success seen with bariatric surgery. Future agents combining the benefits of satiety control and thermogenesis to dissipate caloric excess are under investigation.
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Affiliation(s)
- Marc S Rendell
- The Association of Diabetes Investigators, Newport Coast, CA, USA
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4
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Cincione RI, Losavio F, Cibelli G, Messina G, Polito R, Casula E, Cincione PP, Amatruda M, Limone P. Revised Protein Sparing Diet in Obesity and Type 2 Diabetes Mellitus. Nutrients 2022; 14:nu14245325. [PMID: 36558484 PMCID: PMC9788379 DOI: 10.3390/nu14245325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/24/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Effective nutrition therapy is a pressing issue in obesity and type 2 diabetes mellitus (T2DM) management. As such, this research aimed to determine the performance of a revised dietary strategy built on the protein-sparing diet in obesity and type 2 diabetes mellitus with regard to obtaining a rapid and stable improvement in glucometabolic control, body weight, body composition, and energy metabolism when applying the strategy in just twenty-one days. The revised protein-sparing diet differs from the traditional protein-sparing modified fast (PSMF) because it does not include foods. The daily calorie intake of this diet is exclusively derived from Isolate whey protein in addition to a formulation of Isolate whey protein enriched with essential amino acids in free form, with the addition of lipids such as extra virgin olive oil and coconut oil as a source of medium chain fatty acids, where the latter is taken for only the first four days of the diet, together with the use, for the same duration, of extended-release metformin, as the only antihyperglycemic allowed. Anthropometric measurements, bioimpedance analysis, indirect calorimetry, and blood chemistry assessments were conducted at the beginning of the study, time 0 (T0), and at the end, time 1 (T1), i.e., on the 21st day. The main outcomes of the revised protein-sparing diet after only twenty-one days were a reduction in body weight with the predominant loss of visceral atherogenic abdominal fat and, therefore, a possible contextual reduction in ectopic fat deposits together with a simultaneous reduction in insulin resistance and normalization of insulin levels, maintenance of free fat mass and basal metabolism, restoration of metabolic flexibility, and improvement of the glucometabolic and lipidic parameters. These results demonstrate the promising potential of the revised protein-sparing diet as an "etiologic tool" in the integrated nutritional treatment of metabolic diseases such as obesity and type 2 diabetes mellitus.
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Affiliation(s)
- Raffaele Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
- Correspondence:
| | - Francesca Losavio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | | | | | - Marco Amatruda
- Faculty of Medicine, University of Foggia, 71122 Foggia, Italy
| | - Pierpaolo Limone
- Department of Humanities, University of Foggia, 71122 Foggia, Italy
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5
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Mollah S, Biswas S. Optimal control for the complication of Type 2 diabetes: the role of awareness programs by media and treatment. INTERNATIONAL JOURNAL OF DYNAMICS AND CONTROL 2022; 11:877-891. [PMID: 35975278 PMCID: PMC9371968 DOI: 10.1007/s40435-022-01013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Abstract
T2 diabetes is a silent killer and serious public health issue across the world, though awareness of diabetes allows understanding of the causes and prevention of the disease. With this inspiration, we formulate a deterministic model by incorporating awareness and saturated treatment function of the T2 diabetes model to study the dynamics of the disease. We have carried out thoroughly analysis of the model system, including positivity of solutions, boundedness, equilibrium, and stability analysis. Again, we consider the deterministic model system as an optimal control problem by taking awareness (M) and treatment (u) as time-depended control parameters. The sufficient conditions for optimal control for T2 diabetes are obtained utilizing the Pontryagin’s maximum principle in time-dependent controls to find optimal strategies for disease control. We intended to assess the efficacy and costs of several strategies to determine which is the best cost-effective strategy with the limited resources for treatment. The parameters incident rate (\documentclass[12pt]{minimal}
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\begin{document}$$\beta $$\end{document}β), awareness coefficient (p), media (M), and treatment (u) highly influence the dynamics of T2 diabetes. Numerical simulations suggest that both awareness and treatment controls have a significant impact on the optimal system and are economically feasible to reduce the prevalence of T2 diabetes.
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Affiliation(s)
- Saddam Mollah
- Department of Mathematics, Centre for Mathematical Biology and Ecology, Jadavpur University, 188, Raja S. C. Mallik Road, Kolkata, 700032 India
| | - Santosh Biswas
- Department of Mathematics, Centre for Mathematical Biology and Ecology, Jadavpur University, 188, Raja S. C. Mallik Road, Kolkata, 700032 India
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Shibib L, Al-Qaisi M, Ahmed A, Miras AD, Nott D, Pelling M, Greenwald SE, Guess N. Reversal and Remission of T2DM - An Update for Practitioners. Vasc Health Risk Manag 2022; 18:417-443. [PMID: 35726218 PMCID: PMC9206440 DOI: 10.2147/vhrm.s345810] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/10/2022] [Indexed: 01/04/2023] Open
Abstract
Over the past 50 years, many countries around the world have faced an unchecked pandemic of obesity and type 2 diabetes (T2DM). As best practice treatment of T2DM has done very little to check its growth, the pandemic of diabesity now threatens to make health-care systems economically more difficult for governments and individuals to manage within their budgets. The conventional view has been that T2DM is irreversible and progressive. However, in 2016, the World Health Organization (WHO) global report on diabetes added for the first time a section on diabetes reversal and acknowledged that it could be achieved through a number of therapeutic approaches. Many studies indicate that diabetes reversal, and possibly even long-term remission, is achievable, belying the conventional view. However, T2DM reversal is not yet a standardized area of practice and some questions remain about long-term outcomes. Diabetes reversal through diet is not articulated or discussed as a first-line target (or even goal) of treatment by any internationally recognized guidelines, which are mostly silent on the topic beyond encouraging lifestyle interventions in general. This review paper examines all the sustainable, practical, and scalable approaches to T2DM reversal, highlighting the evidence base, and serves as an interim update for practitioners looking to fill the practical knowledge gap on this topic in conventional diabetes guidelines.
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Affiliation(s)
- Lina Shibib
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mo Al-Qaisi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ahmed Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - David Nott
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Marc Pelling
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen E Greenwald
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Nicola Guess
- School of Life Sciences, Westminster University, London, UK
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7
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Rosenfeld RM, Kelly JH, Agarwal M, Aspry K, Barnett T, Davis BC, Fields D, Gaillard T, Gulati M, Guthrie GE, Moore DJ, Panigrahi G, Rothberg A, Sannidhi DV, Weatherspoon L, Pauly K, Karlsen MC. Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine. Am J Lifestyle Med 2022; 16:342-362. [PMID: 35706589 PMCID: PMC9189586 DOI: 10.1177/15598276221087624] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Objective The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA (RMR)
| | - John H Kelly
- Loma Linda University School of Medicine, Loma Linda, CA, USA (JHK)
| | - Monica Agarwal
- Department of Medicine Division of Endocrinology, Diabetes, & Metabolism, Birmingham, University of Alabama at Birmingham, AL, USA (MA)
| | - Karen Aspry
- Lipid and Prevention Program, Lifespan Cardiovascular Institute, East Greenwich, RI, USA (KA)
| | - Ted Barnett
- Rochester Lifestyle Medicine Institute, Rochester, NY, USA (TB)
| | - Brenda C Davis
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
| | | | - Trudy Gaillard
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA (TG)
| | - Mahima Gulati
- Middlesex Health Multispecialty Group, Middletown, CT, USA (MG)
| | | | | | | | - Amy Rothberg
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, USA (AR)
| | - Deepa V Sannidhi
- University of California San Diego Department of Family Medicine and Public Health, La Jolla, CA, USA (DVS)
| | | | - Kaitlyn Pauly
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
| | - Micaela C Karlsen
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
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8
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Roncero-Ramos I, Gutierrez-Mariscal FM, Gomez-Delgado F, Villasanta-Gonzalez A, Torres-Peña JD, Cruz-Ares SDL, Rangel-Zuñiga OA, Luque RM, Ordovas JM, Delgado-Lista J, Perez-Martinez P, Camargo A, Alcalá-Diaz JF, Lopez-Miranda J. Beta cell functionality and hepatic insulin resistance are major contributors to type 2 diabetes remission and starting pharmacological therapy: from CORDIOPREV randomized controlled trial. Transl Res 2021; 238:12-24. [PMID: 34298148 DOI: 10.1016/j.trsl.2021.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/17/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022]
Abstract
In order to assess whether previous hepatic IR (Hepatic-IRfasting) and beta-cell functionality could modulate type 2 diabetes remission and the need for starting glucose-lowering treatment, newly-diagnosed type 2 diabetes participants who had never received glucose-lowering treatment (190 out of 1002) from the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (a prospective, randomized and controlled clinical trial), were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was defined according to the American Diabetes Association recommendation for levels of HbA1c, fasting plasma glucose and 2h plasma glucose after oral glucose tolerance test, and having maintained them for at least 2 consecutive years. Patients were classified according to the median of Hepatic-IRfasting and beta-cell functionality, measured as the disposition index (DI) at baseline. Cox proportional hazards regression determined the potential for Hepatic-IRfasting and DI indexes as predictors of diabetes remission and the probability of starting pharmacological treatment after a 5-year follow-up. Low-Hepatic-IRfasting or high-DI patients had a higher probability of diabetes remission than high-Hepatic-IRfasting or low-DI subjects (HR:1.79; 95% CI 1.06-3.05; and HR:2.66; 95% CI 1.60-4.43, respectively) after a dietary intervention with no pharmacological treatment and no weight loss. The combination of low-Hepatic-IRfasting and high-DI presented the highest probability of remission (HR:4.63; 95% CI 2.00-10.70). Among patients maintaining diabetes, those with high- Hepatic-IRfasting and low-DI showed the highest risk of starting glucose-lowering therapy (HR:3.24;95% CI 1.50-7.02). Newly-diagnosed type 2 diabetes patients with better beta-cell functionality and lower Hepatic-IRfasting had a higher probability of type 2 diabetes remission in a dietary intervention without pharmacological treatment or weight loss, whereas among patients not achieving remission, those with worse beta-cell functionality and higher Hepatic-IRfasting index had the highest risk of starting glucose-lowering treatment after 5 years of follow-up.
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Affiliation(s)
- Irene Roncero-Ramos
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Francisco M Gutierrez-Mariscal
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Francisco Gomez-Delgado
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Alejandro Villasanta-Gonzalez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Jose D Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Silvia De La Cruz-Ares
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Oriol A Rangel-Zuñiga
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Raul M Luque
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain; Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain; Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Cordoba, Spain
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, J.M.-US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts; IMDEA Alimentacion, CNIC, Madrid, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Antonio Camargo
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Juan F Alcalá-Diaz
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Jose Lopez-Miranda
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain.
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9
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Borer KT. Why We Eat Too Much, Have an Easier Time Gaining Than Losing Weight, and Expend Too Little Energy: Suggestions for Counteracting or Mitigating These Problems. Nutrients 2021; 13:3812. [PMID: 34836068 PMCID: PMC8618649 DOI: 10.3390/nu13113812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
The intent of this review is to survey physiological, psychological, and societal obstacles to the control of eating and body weight maintenance and offer some evidence-based solutions. Physiological obstacles are genetic and therefore not amenable to direct abatement. They include an absence of feedback control against gaining weight; a non-homeostatic relationship between motivations to be physically active and weight gain; dependence of hunger and satiation on the volume of food ingested by mouth and processed by the gastrointestinal tract and not on circulating metabolites and putative hunger or satiation hormones. Further, stomach size increases from overeating and binging, and there is difficulty in maintaining weight reductions due to a decline in resting metabolism, increased hunger, and enhanced efficiency of energy storage. Finally, we bear the evolutionary burden of extraordinary human capacity to store body fat. Of the psychological barriers, human craving for palatable food, tendency to overeat in company of others, and gullibility to overeat when offered large portions, can be overcome consciously. The tendency to eat an unnecessary number of meals during the wakeful period can be mitigated by time-restricted feeding to a 6-10 hour period. Social barriers of replacing individual physical work by labor-saving appliances, designing built environments more suitable for car than active transportation; government food macronutrient advice that increases insulin resistance; overabundance of inexpensive food; and profit-driven efforts by the food industry to market energy-dense and nutritionally compromised food are best overcome by informed individual macronutrient choices and appropriate timing of exercise with respect to meals, both of which can decrease insulin resistance. The best defense against overeating, weight gain, and inactivity is the understanding of factors eliciting them and of strategies that can avoid and mitigate them.
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Affiliation(s)
- Katarina T Borer
- School of Kinesiology, The University of Michigan, Ann Arbor, MI 48104, USA
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10
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Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes-the Sunderland (UK) Experience. Obes Surg 2021; 32:42-47. [PMID: 34632532 DOI: 10.1007/s11695-021-05741-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE UK guidelines recommend an HbA1c < 8.5% prior to elective surgery. Optimisation of pre-operative glycaemic control can be often difficult. Aim to correlate the effect of pre-operative HbA1c on the peri-operative complication rates and whether elective bariatric surgery should be delayed in poorly controlled diabetics. MATERIAL AND METHODS Retrospective data of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass, one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy during January 2014 and April 2018. Patients were categorised into group 1, non-diabetics with an HbA1c < 6.5%; group 2, well-controlled diabetics with HbA1c between 6.5 and 8.4%; and group 3, poorly controlled diabetics with HbA1c ≥ 8.5%. Primary outcome was peri-operative complication rates. RESULTS Group 1 (n = 978), 81.8% female, median (i.q.r.) age 44.0 (34-52) years, median (i.q.r.) BMI 42.0 (38.7-46.7); group 2 (n = 350), 66.3% female, age 51.0 (45-59) years, BMI 41.8 (37.5-46.5); and group 3 (n = 90), 60% female, age 52.0 (45-56) years and BMI 41.4(36.9-44.8). Early complication rates in each group were low, 1.0% vs 1.7% vs 1.1% (p = 0.592). Mean length of stay was 2 days across the groups (p > 0.05). There was no difference in 30-day re-admission rates between groups 2.8%, 2.9% and 3.3% (p = 0.983). At 6 months and 1 year, there was sustained and equal reduction in HbA1c in all groups (p < 0.05). CONCLUSION Patients undergoing metabolic surgery for poorly controlled diabetes achieve non-inferior peri-operative outcomes. Hence, delaying metabolic surgery in an attempt to optimise diabetic control is not justifiable.
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11
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Chandru S, Pramodkumar TA, Pradeepa R, Muthukumar S, Balasubramanyam M, Bhuvaneshwari R, Anjana RM, Mohan V. Outcomes of metabolic surgery in obese patients with type 2 diabetes with respect to impact on beta cell function, insulin sensitivity and diabetes remission - A study from south India. Diabetes Metab Syndr 2020; 14:1829-1835. [PMID: 32961515 DOI: 10.1016/j.dsx.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Metabolic surgery is gaining popularity as a procedure for the treatment of morbid obesity among patients with type 2 diabetes (T2DM). The aim of the study was to evaluate the effects of metabolic surgery on beta cell function, insulin sensitivity and glycemic status in obese Asian Indian patients. METHODS This is a prospective study of 26 patients with T2DM who underwent metabolic surgery. Complete diabetes remission was defined as FPG<100 mg/dl and HbA1c < 6%, without antidiabetic medications one-year post surgery. Anthropometry, HOMA-IR (insulin resistance), HOMA-insulin sensitivity, beta cell function and antidiabetic drug usage were measured at baseline, 6 months and 12 months post-surgery. RESULTS The overall duration of diabetes was 10.3 ± 5.4 years. At one year, 7 (27%) of 26 T2DM patients, achieved diabetes remission while the other 19 had improvement in diabetes status. ROC curves showed that those who had diabetes duration <8.5 years achieved remission. There was a significant decrease in HOMA-IR [3.7 ± 1.8 vs 1.4 ± 0.9 vs1.2 ± 0.6, p < 0.001] and improvement in HOMA-Insulin sensitivity [34 ± 17 vs 93 ± 50 vs 112 ± 62, p < 0.001] from baseline to 6 and 12 months post-surgery respectively. There was a significant (p < 0.001) reduction in the usage of anti-diabetes medications post-surgery. The limitations of this study are small sample size and limited follow up period of 1 year. CONCLUSIONS Among T2DM patients, metabolic surgery resulted in significant improvement in beta cell function and insulin sensitivity along with reduction in anti-diabetes medication. Diabetes remission was mainly seen in those who had duration of diabetes <8.5 years.
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Affiliation(s)
- Sundaramoorthy Chandru
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India; University of Madras, Chennai, India.
| | | | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | | | - Raghavan Bhuvaneshwari
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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12
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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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13
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Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2020; 16:1701-1712. [PMID: 32800734 DOI: 10.1016/j.soard.2020.06.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/10/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) confers the highest rate of type 2 diabetes (T2D) remission compared with other bariatric procedures. Previous studies suggest that type of antidiabetic therapy used before surgery and duration of disease influence postsurgical glycemic outcomes. Short-term, progressive improvement in insulin sensitivity and beta-cell function after metabolic surgery in patients with noninsulin-treated T2D has been demonstrated. Whether patients with more advanced disease can achieve sustained remission remains unclear. OBJECTIVE The aim of this study was to assess long-term glycemic outcomes in insulin-treated patients with T2D after BPD-DS and identify predictors of sustained diabetes remission or relapse. SETTING University-affiliated tertiary care center. METHODS Data from 141 patients with insulin-treated T2D who underwent BPD-DS between 1994 and 2006 with 10 years of follow-up data were collected from a prospective electronic database. RESULTS Follow-up was available in 132 patients (91%). At 10 years after metabolic surgery, 90 patients (68.1%) had a complete remission of diabetes, 3 (2.3%) had a partial remission, 21 (15.9%) had an improvement, and 3 (2.3%) were unchanged in their diabetes status. Fourteen patients died during the 10-year follow-up period. Relapse after an initial period of remission occurred in 15 (11.4%) patients. Insulin discontinuation was achieved in 97%. Duration of diabetes was an independent predictor of nonremission at 10 years. CONCLUSIONS The BPD-DS maintains remission at 10 years postoperatively in patients with more advanced diabetes. Long-term benefits of the BPD-DS on weight loss and glycemic control should be considered when offering metabolic surgery to patients with insulin-treated T2D.
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14
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Gutierrez-Mariscal FM, Cardelo MP, de la Cruz S, Alcala-Diaz JF, Roncero-Ramos I, Guler I, Vals-Delgado C, López-Moreno A, Luque RM, Delgado-Lista J, Perez-Martinez P, Yubero-Serrano EM, Lopez-Miranda J. Reduction in Circulating Advanced Glycation End Products by Mediterranean Diet Is Associated with Increased Likelihood of Type 2 Diabetes Remission in Patients with Coronary Heart Disease: From the Cordioprev Study. Mol Nutr Food Res 2020; 65:e1901290. [PMID: 32529753 DOI: 10.1002/mnfr.201901290] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/01/2020] [Indexed: 01/26/2023]
Abstract
SCOPE It is hypothesized that decreased advanced glycation end products (AGEs) levels could affect type 2 diabetes mellitus (T2DM) remission in newly diagnosed patients through the consumption of two healthy diets. METHODS AND RESULTS Patients from CORDIOPREV study, all with previous cardiovascular events, with T2DM at the beginning of the study are included. Patients are randomized to a Mediterranean or a low-fat diet for five years. No different diabetes remission rates are found among diets. Serum methylglioxal (MG) and carboximethyllysine (CML), levels dietary AGE, as well as gene expression of AGER1 and RAGE are measured. Serum MG decreases only after the consumption of the Mediterranean diet. Moreover, a COX regression analysis shows that each SD decrease in the MG, occurring after the Mediterranean diet, increases the probability of T2DM remission with HR:2.56(1.02-6.25) and p = 0.046 and each SD increase in disposition index at baseline increases the probability of remission with HR:1.94(1.32-2.87) and p = 0.001. CONCLUSIONS It is demonstrated that the reduction of serum AGEs levels and the modulation of its metabolism, occurring after the consumption of a Mediterranean diet, might be involved in the molecular mechanism underlying the T2DM remission of newly diagnosed patients with coronary heart disease.
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Affiliation(s)
- Francisco M Gutierrez-Mariscal
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Magdalena P Cardelo
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Silvia de la Cruz
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Juan F Alcala-Diaz
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Irene Roncero-Ramos
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Ipek Guler
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,Department of Innovation and Methodology, IMIBIC, Córdoba, 14004, Spain
| | - Cristina Vals-Delgado
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Alejandro López-Moreno
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Raul M Luque
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Department of Cell Biology, Physiology, and Immunology, University of Cordoba, Córdoba, 14071, Spain
| | - Javier Delgado-Lista
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Pablo Perez-Martinez
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Elena M Yubero-Serrano
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
| | - Jose Lopez-Miranda
- Maimonines Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, 14004, Spain.,Hospital Universitario Reina Sofia (HURS), Córdoba, 14004, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, 28029, Spain.,Lipids and Atherosclerosis Unit, Reina Sofia University Hospital, University of Córdoba, Córdoba, 14004, Spain
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15
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Brinks R, Tönnies T, Hoyer A. Assessing two methods for estimating excess mortality of chronic diseases from aggregated data. BMC Res Notes 2020; 13:216. [PMID: 32299486 PMCID: PMC7161167 DOI: 10.1186/s13104-020-05046-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/28/2020] [Indexed: 03/04/2023] Open
Abstract
Objective To assess the numerical properties of two recently published estimation techniques for excess mortality based on aggregated data about diabetes in Germany. Results Application of the new methods to the claims data yields implausible findings for the excess mortality of type 2 diabetes in ages below 50 years of age.
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Affiliation(s)
- Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany. .,Department and Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Thaddäus Tönnies
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
| | - Annika Hoyer
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
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16
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de La Harpe R, Rüeger S, Kutalik Z, Ballabeni P, Suter M, Vionnet N, Laferrère B, Pralong F. Weight Loss Directly Influences Intermediate-Term Remission of Diabetes Mellitus After Bariatric Surgery: A Retrospective Case-Control Study. Obes Surg 2020; 30:1332-1338. [PMID: 31754925 PMCID: PMC10015445 DOI: 10.1007/s11695-019-04283-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Roux en Y gastric bypass surgery (RYGB) is an effective therapy for patients with severe obesity. It induces both significant weight loss and rapid improvements of metabolic complications. This study was undertaken to better define the direct role of weight loss in the metabolic improvements. METHODS A retrospective, case-control study of a cohort of 649 patients with obesity who underwent RYGB, comparing higher and lower responders at 2 years after surgery (n = 100 pairs). Pairs of patients were matched for age, gender, and initial BMI. The rates of remission of diabetes, hypertension, dyslipidemia, and hyperuricemia were compared using a mixed effects logistic regression analysis. RESULTS Diabetes before surgery was present in 12/100 lower responders and 17/100 higher responders. Remission at 2 years was observed in 4/12 (33%) of lower responders, compared to 15/17 (88%) of higher responders. Thus, the odds of diabetes remission was significantly smaller in lower responders (OR = 0.067, 95% CI 0.01-0.447). A mixed model regression analysis of all the parameters for each patient showed that the odds of achieving remission of any comorbidity was significantly lower in lower responders (OR = 0.62, 95% CI = 0.39-0.97). CONCLUSION We could demonstrate that weight loss is a significant determinant of the remission of diabetes 2 years after RYGB. These data underline the importance of weight loss in the benefits of this procedure.
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Affiliation(s)
- R de La Harpe
- Service of Internal Medicine, Morges, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - S Rüeger
- School of Life Sciences, EPFL, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Z Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne (UNIL), Lausanne, Switzerland
| | - P Ballabeni
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne (UNIL), Lausanne, Switzerland.,Clinical Research Center (CRC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - M Suter
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland
| | - N Vionnet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - B Laferrère
- New York Obesity Nutrition Research Center, Divison of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - F Pralong
- Center for Endocrinology, Diabetology and Obesity, La Tour Private Hospital, Meyrin, Switzerland
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17
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Stanford FC, Mushannen T, Cortez P, Campoverde Reyes KJ, Lee H, Gee DW, Pratt JS, Boepple PA, Bredella MA, Misra M, Singhal V. Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults. Front Endocrinol (Lausanne) 2020; 11:157. [PMID: 32265846 PMCID: PMC7105703 DOI: 10.3389/fendo.2020.00157] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/06/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: We sought to compare the short and long-term outcomes of MBS in adolescents vs. adults who have undergone a Roux-en-Y gastric bypass (RYGB) or Sleeve gastrectomy (SG). Design: Retrospective cohort study. Setting: Single tertiary care academic referral center. Participants: One hundred fifty adolescent (≤ 21-years) and adult (>21-years) subjects with severe obesity between 15 and 70 years of age who underwent RYGB or SG. Outcomes: Metabolic parameters, weight and height measures were obtained pre-and post-surgery (at 3 and 6 months, and then annually for 4 years). Results: Median pre-surgical body mass index (BMI) was higher in adolescents (n = 76) vs. adults (n = 74): 50 (45-57) vs. 44 (40-51) kg/m2 (p < 0.0001). However, obesity related complications were greater in adults vs. adolescents: 66 vs. 21% had hypertension, 68 vs. 28% had dyslipidemia, and 42 vs. 21% had type 2 diabetes mellitus (all p < 0.010). % BMI reduction and % weight loss (WL) were greater in adolescents vs. adults at all time points (p < 0.050). %WL was higher in adolescents who underwent SG at each time point (p < 0.050), and trended higher among adolescents who underwent RYGB (p = 0.060), compared to adults with the respective procedure. Follow-up data showed greater resolution of type 2 diabetes and hypertension in adolescents than adults (87.5 vs. 54.8%; p = 0.04, and 68.7 vs. 35.4%; p = 0.040). Conclusion: Adolescents compared to adults had greater reductions in BMI and weight, even at 4 years, and greater resolution of type 2 diabetes and hypertension. Earlier intervention in the treatment of severe obesity with MBS may lead to better outcomes.
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Affiliation(s)
- Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
| | - Tasnim Mushannen
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Weill Cornell Medicine, Education City, Al Rayyan, Qatar
| | - Priscilla Cortez
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Biology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hang Lee
- Departments of Biostatistics and Harvard Medical School, Boston, MA, United States
| | - Denise W. Gee
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
| | - Janey S. Pratt
- Department of Surgery and Pediatric Surgery and Stanford University School of Medicine, Stanford, CA, United States
| | - Paul A. Boepple
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
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18
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Taylor R, Al-Mrabeh A, Sattar N. Understanding the mechanisms of reversal of type 2 diabetes. Lancet Diabetes Endocrinol 2019; 7:726-736. [PMID: 31097391 DOI: 10.1016/s2213-8587(19)30076-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 12/13/2022]
Abstract
Clinical and pathophysiological studies have shown type 2 diabetes to be a condition mainly caused by excess, yet reversible, fat accumulation in the liver and pancreas. Within the liver, excess fat worsens hepatic responsiveness to insulin, leading to increased glucose production. Within the pancreas, the β cell seems to enter a survival mode and fails to function because of the fat-induced metabolic stress. Removal of excess fat from these organs via substantial weight loss can normalise hepatic insulin responsiveness and, in the early years post-diagnosis, is associated with β-cell recovery of acute insulin secretion in many individuals, possibly by redifferentiation. Collectively, these changes can normalise blood glucose levels. Importantly, the primary care-based Diabetes Remission Clinical Trial (DiRECT) showed that 46% of people with type 2 diabetes could achieve remission at 12 months, and 36% at 24 months, mediated by weight loss. This major change in our understanding of the underlying mechanisms of disease permits a reassessment of advice for people with type 2 diabetes.
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Affiliation(s)
- Roy Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - Ahmad Al-Mrabeh
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Romano L, Marchetti M, Gualtieri P, Di Renzo L, Belcastro M, De Santis GL, Perrone MA, De Lorenzo A. Effects of a Personalized VLCKD on Body Composition and Resting Energy Expenditure in the Reversal of Diabetes to Prevent Complications. Nutrients 2019; 11:nu11071526. [PMID: 31277506 PMCID: PMC6683248 DOI: 10.3390/nu11071526] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
The reversion of diabetes and the treatment of long-term obesity are difficult challenges. The failure mechanisms of rapid weight loss are mainly related to the wasting of lean mass. This single-arm study aims to evaluate the effects of a very low-calorie ketogenic diet (VLCKD) on body composition and resting energy expenditure in the short term reversal of diabetes mellitus Type 2. For eight weeks, subjects were administered a personalized VLCKD with protein intake based on lean mass and synthetic amino acidic protein supplementation. Each subject was assessed by anthropometry, Dual-energy X-ray Absorptiometry(DXA), bioimpedentiometric analysis (BIA), indirect calorimetry, and biochemical analysis. The main findings were the saving of lean mass, the reduction of abdominal fat mass, restored metabolic flexibility, the maintenance of resting energy expenditure, and the reversion of diabetes. These results highlight how the application of preventive, predictive, personalized, and participative medicine to nutrition may be promising for the prevention of diabetes and enhancement of obesity treatment.
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Affiliation(s)
- Lorenzo Romano
- School of Specialization in Food Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Marchetti
- School of Specialization in Food Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | | | - Gemma Lou De Santis
- School of Specialization in Food Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | | | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Sadel, Casa di cura San Giuseppe, 88836 Cotronei (KR), Italy
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20
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Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C, Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, Rodrigues AM, Rehackova L, Adamson AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Welsh P, Kean S, Ford I, McConnachie A, Messow CM, Sattar N, Taylor R. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019; 7:344-355. [PMID: 30852132 DOI: 10.1016/s2213-8587(19)30068-3] [Citation(s) in RCA: 453] [Impact Index Per Article: 90.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The DiRECT trial assessed remission of type 2 diabetes during a primary care-led weight-management programme. At 1 year, 68 (46%) of 149 intervention participants were in remission and 36 (24%) had achieved at least 15 kg weight loss. The aim of this 2-year analysis is to assess the durability of the intervention effect. METHODS DiRECT is an open-label, cluster-randomised, controlled trial done at primary care practices in the UK. Practices were randomly assigned (1:1) via a computer-generated list to provide an integrated structured weight-management programme (intervention) or best-practice care in accordance with guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (>5700 or ≤5700 people). Allocation was concealed from the study statisticians; participants, carers, and study research assistants were aware of allocation. We recruited individuals aged 20-65 years, with less than 6 years' duration of type 2 diabetes, BMI 27-45 kg/m2, and not receiving insulin between July 25, 2014, and Aug 5, 2016. The intervention consisted of withdrawal of antidiabetes and antihypertensive drugs, total diet replacement (825-853 kcal per day formula diet for 12-20 weeks), stepped food reintroduction (2-8 weeks), and then structured support for weight-loss maintenance. The coprimary outcomes, analysed hierarchically in the intention-to-treat population at 24 months, were weight loss of at least 15 kg, and remission of diabetes, defined as HbA1c less than 6·5% (48 mmol/mol) after withdrawal of antidiabetes drugs at baseline (remission was determined independently at 12 and 24 months). The trial is registered with the ISRCTN registry, number 03267836, and follow-up is ongoing. FINDINGS The intention-to-treat population consisted of 149 participants per group. At 24 months, 17 (11%) intervention participants and three (2%) control participants had weight loss of at least 15 kg (adjusted odds ratio [aOR] 7·49, 95% CI 2·05 to 27·32; p=0·0023) and 53 (36%) intervention participants and five (3%) control participants had remission of diabetes (aOR 25·82, 8·25 to 80·84; p<0·0001). The adjusted mean difference between the control and intervention groups in change in bodyweight was -5·4 kg (95% CI -6·9 to -4·0; p<0·0001) and in HbA1c was -4·8 mmol/mol (-8·3 to -1·4 [-0·44% (-0·76 to -0·13)]; p=0·0063), despite only 51 (40%) of 129 patients in the intervention group using anti-diabetes medication compared with 120 (84%) of 143 in the control group. In a post-hoc analysis of the whole study population, of those participants who maintained at least 10 kg weight loss (45 of 272 with data), 29 (64%) achieved remission; 36 (24%) of 149 participants in the intervention group maintained at least 10 kg weight loss. Serious adverse events were similar to those reported at 12 months, but were fewer in the intervention group than in the control group in the second year of the study (nine vs 22). INTERPRETATION The DiRECT programme sustained remissions at 24 months for more than a third of people with type 2 diabetes. Sustained remission was linked to the extent of sustained weight loss. FUNDING Diabetes UK.
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Affiliation(s)
- Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison C Barnes
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carl Peters
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Ahmad Al-Mrabeh
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Angela M Rodrigues
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lucia Rehackova
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | | | - Yvonne McIlvenna
- College of Medical, Veterinary & Life Sciences, and General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Science, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia-Martina Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients 2019; 11:E766. [PMID: 30939855 PMCID: PMC6520897 DOI: 10.3390/nu11040766] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) has long been identified as an incurable chronic disease based on traditional means of treatment. Research now exists that suggests reversal is possible through other means that have only recently been embraced in the guidelines. This narrative review examines the evidence for T2D reversal using each of the three methods, including advantages and limitations for each. METHODS A literature search was performed, and a total of 99 original articles containing information pertaining to diabetes reversal or remission were included. RESULTS Evidence exists that T2D reversal is achievable using bariatric surgery, low-calorie diets (LCD), or carbohydrate restriction (LC). Bariatric surgery has been recommended for the treatment of T2D since 2016 by an international diabetes consensus group. Both the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) now recommend a LC eating pattern and support the short-term use of LCD for weight loss. However, only T2D treatment, not reversal, is discussed in their guidelines. CONCLUSION Given the state of evidence for T2D reversal, healthcare providers need to be educated on reversal options so they can actively engage in counseling patients who may desire this approach to their disease.
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Affiliation(s)
- Sarah J Hallberg
- Virta Health, 535 Mission Street, San Francisco, CA 94105, USA.
- Indiana University Health Arnett, Lafayette, IN 47904, USA.
- Indiana University School of Medicine, Indianapolis, 46202 IN, USA.
| | - Victoria M Gershuni
- Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Tamara L Hazbun
- Indiana University Health Arnett, Lafayette, IN 47904, USA.
- Indiana University School of Medicine, Indianapolis, 46202 IN, USA.
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22
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Taylor R, Valabhji J, Aveyard P, Paul D. Prevention and reversal of Type 2 diabetes: highlights from a symposium at the 2019 Diabetes UK Annual Professional Conference. Diabet Med 2019; 36:359-365. [PMID: 30597609 DOI: 10.1111/dme.13892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 11/26/2022]
Abstract
AIM This symposium covers the gamut of Type 2 diabetes prevention, reversing established Type 2 diabetes, population-level delivery of weight loss programmes and personal insights into achieving and retaining substantial weight loss. RESULTS The NHS Diabetes Prevention Programme was launched in 2016 and rates of referral and attendance have both exceeded expectations. By March 2018, mean weight loss for completers (those attending more than 60% of sessions) was 3.2 kg reflecting considerable health benefits. Established Type 2 diabetes is now known to be a reversible condition in the early years, and the underlying mechanism is the removal of the excess fat from within liver and pancreas in these susceptible individuals. The Diabetes Remission Clinical Trial has shown that around half of a primary care population of people with Type 2 diabetes of less than 6 years' duration can be returned to non-diabetic blood glucose control which lasts at least 12 months. This raises the question of population-level intervention to achieve weight loss. The success of some mass weight loss programmes requires to be recognized. Reframing mass provision of weight loss support should be a vital part of our clinical strategy to prevent and treat Type 2 diabetes. However, the current obesogenic environment is a reality in which individuals must live. A personal account of achieving substantial and maintaining substantial weight loss provides an invaluable insight into practical problems encountered. All health professionals dealing with weight control should assimilate and reflect upon this understanding. CONCLUSIONS Effective prevention and long term reversal of Type 2 diabetes is feasible. The impact upon the individual must be considered during delivery of advice and support.
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Affiliation(s)
- R Taylor
- Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, UK
| | - J Valabhji
- Imperial College Healthcare NHS Trust and NHS England, Skipton House, London, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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23
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Taylor R, Barnes AC. Can type 2 diabetes be reversed and how can this best be achieved? James Lind Alliance research priority number one. Diabet Med 2019; 36:308-315. [PMID: 30378706 DOI: 10.1111/dme.13851] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
The James Lind Alliance, in association with Diabetes UK, conducted a survey of people with Type 2 diabetes to establish their priorities for research. The number one research priority was found to be 'Can Type 2 diabetes be cured or reversed, what is the best way to achieve this, and is there a point beyond which the condition cannot be reversed?'. The present review summarizes the current understanding of weight loss-induced reversal of Type 2 diabetes. It considers the diagnostic criteria for remission and describes the clinical features of post-diabetes. It is of great importance to recognize these, as post-diabetes differs considerably from the high cardiovascular risk state of prediabetes. Current data demonstrate long-term stable β-cell function, providing weight regain is prevented. If an individual, having previously demonstrated susceptibility to Type 2 diabetes, returns to their previous weight then recurrence of the condition is certain. Appropriate use of the terms 'reversal' and 'remission' is discussed, with emphasis that the word 'cure' is inappropriate. Evidence-based means of achieving and maintaining remission of Type 2 diabetes are described, together with a summary of the information on the steadily diminishing chance of achieving reversal with increasing duration of Type 2 diabetes.
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Affiliation(s)
- R Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine and Human Nutrition Research Centre, University of Newcastle upon Tyne, UK
| | - A C Barnes
- Institute of Health and Society, University of Newcastle upon Tyne, UK
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Azagury D, Papasavas P, Hamdallah I, Gagner M, Kim J. ASMBS Position Statement on medium- and long-term durability of weight loss and diabetic outcomes after conventional stapled bariatric procedures. Surg Obes Relat Dis 2018; 14:1425-1441. [PMID: 30242000 DOI: 10.1016/j.soard.2018.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Dan Azagury
- Bariatric & Minimally Invasive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Isam Hamdallah
- Bariatric Surgery Center, Saint Agnes Hospital, Baltimore, Maryland
| | - Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Hôpital du Sacre Coeur, Montreal, Canada
| | - Julie Kim
- Weight Management Center, Mount Auburn Hospital, Cambridge, Massachusetts
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25
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Pucci A, Tymoszuk U, Cheung WH, Makaronidis JM, Scholes S, Tharakan G, Elkalaawy M, Guimaraes M, Nora M, Hashemi M, Jenkinson A, Adamo M, Monteiro MP, Finer N, Batterham RL. Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores. Diabet Med 2018; 35:360-367. [PMID: 29055156 PMCID: PMC5836992 DOI: 10.1111/dme.13532] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/22/2022]
Abstract
AIMS The comparative efficacy of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA1c , age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2-year post-surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission. METHODS A retrospective single-centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression. RESULTS The proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817-0.916); DiaRem: 0.865 (95%CI: 0.814-0.915), P=0.856]. Two-year % weight loss was higher post RYGB [26.6 (95%CI: 24.8-28.4)] vs post-sleeve gastrectomy [20.6 (95%CI: 18.3-22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12-5.60), P=0.025]. This association became non-significant when adjusted for % weight loss. CONCLUSION DiaBetter and DiaRem scores predict diabetes remission following both procedures. Two-year % weight loss plays a key role in determining diabetes remission.
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Affiliation(s)
- A. Pucci
- Centre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - U. Tymoszuk
- Department of Epidemiology & Public HealthLondonUK
| | - W. H. Cheung
- Centre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - J. M. Makaronidis
- Centre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - S. Scholes
- Department of Epidemiology & Public HealthLondonUK
- Health and Social Surveys Research GroupResearch Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - G. Tharakan
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - M. Elkalaawy
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
- Clinical and Experimental Surgery DepartmentMedical Research InstituteUniversity of AlexandriaAlexandriaEgypt
| | - M. Guimaraes
- Department of General SurgeryCentro Hospitalar de Entre o Douro e VougaSanta Maria da FeiraPortugal
| | - M. Nora
- Department of General SurgeryCentro Hospitalar de Entre o Douro e VougaSanta Maria da FeiraPortugal
| | - M. Hashemi
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - A. Jenkinson
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - M. Adamo
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - M. P. Monteiro
- Clinical and Experimental EndocrinologyDepartment of AnatomyMultidisciplinary Unit for Biomedical Research (UMIB)Instituto de Ciências Biomédicas Abel SalazarUniversity of PortoPortoPortugal
- Endocrine UnitCentro Hospitalar de Entre o Douro e VougaSanta Maria da FeiraPortugal
| | - N. Finer
- Centre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
| | - R. L. Batterham
- Centre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- University College London Hospital BariatricCentre for Weight Management and Metabolic SurgeryLondonUK
- National Institute of Health ResearchUniversity College London Hospital Biomedical Research CentreLondonUK
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26
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Taylor R, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Sattar N, Welsh P, Peters C, Zhyzhneuskaya S, Hollingsworth KG, Al-Mrabeh A, Rodrigues AM, Rehackova L, Adamson AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Kean S, Ford I, McConnachie A, Lean MEJ. Clinical and metabolic features of the randomised controlled Diabetes Remission Clinical Trial (DiRECT) cohort. Diabetologia 2018; 61:589-598. [PMID: 29188339 PMCID: PMC6448967 DOI: 10.1007/s00125-017-4503-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/25/2017] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Substantial weight loss in type 2 diabetes can achieve a return to non-diabetic biochemical status, without the need for medication. The Diabetes Remission Clinical Trial (DiRECT), a cluster-randomised controlled trial, is testing a structured intervention designed to achieve and sustain this over 2 years in a primary care setting to determine practicability for routine clinical practice. This paper reports the characteristics of the baseline cohort. METHODS People with type 2 diabetes for <6 years with a BMI of 27-45 kg/m2 were recruited in 49 UK primary care practices, randomised to either best-practice diabetes care alone or with an additional evidence-based weight management programme (Counterweight-Plus). The co-primary outcomes, at 12 months, are weight loss ≥15 kg and diabetes remission (HbA1c <48 mmol/mol [6.5%]) without glucose-lowering therapy for at least 2 months. Outcome assessors are blinded to group assignment. RESULTS Of 1510 people invited, 423 (28%) accepted; of whom, 306 (72%) were eligible at screening and gave informed consent. Seven participants were later found to have been randomised in error and one withdrew consent, leaving 298 (176 men, 122 women) who will form the intention to treat (ITT) population for analysis. Mean (SD) age was 54.4 (7.6) years, duration of diabetes 3.0 (1.7) years, BMI 34.6 (4.4) kg/m2 for all participants (34.2 (4.2) kg/m2 in men and 35.3 (4.6) kg/m2 in women) and baseline HbA1c (on treatment) 59.3 (12.7) mmol/mol (7.6% [1.2%]). The recruitment rate in the intervention and control groups, and comparisons between the subgroups recruited in Scotland and England, showed few differences. CONCLUSIONS/INTERPRETATION DiRECT has recruited a cohort of people with type 2 diabetes with characteristics similar to those seen in routine practice, indicating potential widespread applicability. Over 25% of the eligible population wished to participate in the study, including a high proportion of men, in line with the prevalence distribution of type 2 diabetes. TRIAL REGISTRATION www.controlled-trials.com/ISRCTN03267836 ; date of registration 20 December 2013.
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Affiliation(s)
- Roy Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing - GRI Campus, College of Medical, Veterinary and Life Sciences, University of Glasgow, 2nd Floor, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - Alison C Barnes
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing - GRI Campus, College of Medical, Veterinary and Life Sciences, University of Glasgow, 2nd Floor, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK
- Counterweight Ltd, Corby, Northants, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing - GRI Campus, College of Medical, Veterinary and Life Sciences, University of Glasgow, 2nd Floor, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing - GRI Campus, College of Medical, Veterinary and Life Sciences, University of Glasgow, 2nd Floor, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Carl Peters
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Ahmad Al-Mrabeh
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Angela M Rodrigues
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lucia Rehackova
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | | | - Yvonne McIlvenna
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing - GRI Campus, College of Medical, Veterinary and Life Sciences, University of Glasgow, 2nd Floor, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK.
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Abstract
The ageing trajectory is plastic and can be slowed down by lifestyle factors, including good nutrition, adequate physical activity and avoidance of smoking. In humans, plant-based diets such as the Mediterranean dietary pattern are associated with healthier ageing and lower risk of age-related disease, whereas obesity accelerates ageing and increases the likelihood of most common complex diseases including CVD, T2D, dementia, musculoskeletal diseases and several cancers. As yet, there is only weak evidence in humans about the molecular mechanisms through which dietary factors modulate ageing but evidence from cell systems and animal models suggest that it is probable that better dietary choices influence all 9 hallmarks of ageing. It seems likely that better eating patterns retard ageing in at least two ways including (i) by reducing pervasive damaging processes such as inflammation, oxidative stress/redox changes and metabolic stress and (ii) by enhancing cellular capacities for damage management and repair. From a societal perspective, there is an urgent imperative to discover, and to implement, cost-effective lifestyle (especially dietary) interventions which enable each of us to age well, i.e. to remain physically and socially active and independent and to minimise the period towards the end of life when individuals suffer from frailty and multi-morbidity.
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Affiliation(s)
- Fiona C Malcomson
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Does bariatric surgery prevent progression of diabetic retinopathy? Eye (Lond) 2017; 31:1131-1139. [PMID: 28731054 DOI: 10.1038/eye.2017.119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 04/02/2017] [Indexed: 12/16/2022] Open
Abstract
PurposeTo assess the changes in diabetic retinopathy (DR) in type 2 diabetes (T2DM) patients post bariatric surgery and report on the risk factors that may be associated with it.Patients and methodsRetrospective observational study of T2DM patients who underwent bariatric surgery in a UK specialist bariatric unit between 2009 and 2015. Preoperative and postoperative weight, HbA1c, and annual DR screening results were collected from medical records. Patients with preoperative retinal screening and at least one postoperative retinal screening were eligible for analysis. Multivariate analysis was used to explore significant clinical predictors on postoperative worsening in DR.ResultsA total of 102 patients were eligible for analysis and were followed up for 4 years. Preoperatively, 68% of patients had no DR compared to 30% with background retinopathy, 1% pre-proliferative retinopathy, and 1% proliferative retinopathy. In the first postoperative visit, 19% of patients developed new DR compared to 70% stable and 11% improved. These proportions remained similar for each postoperative visit over time. Young age, male gender, high preoperative HbA1c, and presence of preoperative retinopathy were the significant predictors of worsening postoperatively.ConclusionBariatric surgery does not prevent progression of DR. Young male patients with pre-existing DR and poor preoperative glycaemic control are most at risk of progression. All diabetic patients should attend regular DR screening post bariatric surgery to allow early detection of potentially sight-threatening changes, particularly among those with identifiable risk factors. Future prospective studies with prolonged follow-up are required to clarify the duration of risk.
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Abstract
415 million people live with diabetes worldwide, and an estimated 193 million people have undiagnosed diabetes. Type 2 diabetes accounts for more than 90% of patients with diabetes and leads to microvascular and macrovascular complications that cause profound psychological and physical distress to both patients and carers and put a huge burden on health-care systems. Despite increasing knowledge regarding risk factors for type 2 diabetes and evidence for successful prevention programmes, the incidence and prevalence of the disease continues to rise globally. Early detection through screening programmes and the availability of safe and effective therapies reduces morbidity and mortality by preventing or delaying complications. Increased understanding of specific diabetes phenotypes and genotypes might result in more specific and tailored management of patients with type 2 diabetes, as has been shown in patients with maturity onset diabetes of the young. In this Seminar, we describe recent developments in the diagnosis and management of type 2 diabetes, existing controversies, and future directions of care.
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Affiliation(s)
- Sudesna Chatterjee
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK; Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK; Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK; Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.
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Abstract
Premature atherosclerosis in diabetes accounts for much of the decreased life span. New treatments have reduced this risk considerably. This review explores the relationship among the disturbances in glucose, lipid, and bile salt metabolic pathways that occur in diabetes. In particular, excess nutrient intake and starvation have major metabolic effects, which have allowed us new insights into the disturbance that occurs in diabetes. Metabolic regulators such as the forkhead transcription factors, the farnesyl X transcription factors, and the fibroblast growth factors have become important players in our understanding of the dysregulation of metabolism in diabetes and overnutrition. The disturbed regulation of lipoprotein metabolism in both the intestine and the liver has been more clearly defined over the past few years, and the atherogenicity of the triglyceride-rich lipoproteins, and - in tandem - low levels of high-density lipoproteins, is seen now as very important. New information on the apolipoproteins that control lipoprotein lipase activity has been obtained. This is an exciting time in the battle to defeat diabetic atherosclerosis.
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Affiliation(s)
- GH Tomkin
- Diabetes Institute of Ireland, Beacon Hospital
- Trinity College, University of Dublin, Dublin, Ireland
- Correspondence: GH Tomkin, Diabetes Institute of Ireland, Beacon Hospital, Clontra, Quinns Road, Shankill, Dublin 18, Ireland, Email
| | - D Owens
- Diabetes Institute of Ireland, Beacon Hospital
- Trinity College, University of Dublin, Dublin, Ireland
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Jahn U, Schubert T, Schlepp S, Deuber HJ. [Metabolic surgery or conservative measures as therapy of obese type 2 diabetics?]. Wien Med Wochenschr 2016; 167:234-244. [PMID: 27921198 DOI: 10.1007/s10354-016-0532-4] [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: 05/13/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Abstract
After bariatric surgery there are some favourable effects on comorbidities of obesity as glucose and lipid metabolism besides weight loss. Therefore surgical measures targeting at improvement of such metabolic disorders especially diabetes type 2 has been called "metabolic surgery". The complexity of its underlying metabolic mechanisms is not yet clear, but restriction of energy and weight loss (maintenance) seem to be the cornerstones.Risks of these procedures which are drawn of the established methods of bariatric surgery are reported to be relatively low in qualified centers. Being an elective operation special focus has to be set on mortality and morbidity, numbers of therapeutic failure and redo-surgery. Multiple irreversible and not seldom severe, potentially life-threatening consequences of bariatric surgery require consequent interdisciplinary postsurgery care and therapy throughout the whole life, especially substitution therapy of deficiencies due to post-operative malassimilation, if necessary. Little is known about long term consequences of modified anatomy and function of digestive system caused by surgery, and there may be a delay of (many) years until manifestation of clinical problems.Obese diabetics (BMI ≥ 35 kg/m2) should primarily be treated conservatively in an "individualized" way. Metabolic surgery should not be considered earlier than failure of the conservative approach has to be stated (in this case as an "ultima ratio" in well defined trials). A broader use of metabolic surgery beyond this narrow frame is not yet supported by long-term evidence-based data showing its value and safety.
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Lin PJ, Borer KT. Third Exposure to a Reduced Carbohydrate Meal Lowers Evening Postprandial Insulin and GIP Responses and HOMA-IR Estimate of Insulin Resistance. PLoS One 2016; 11:e0165378. [PMID: 27798656 PMCID: PMC5087910 DOI: 10.1371/journal.pone.0165378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/06/2016] [Indexed: 12/28/2022] Open
Abstract
Background Postprandial hyperinsulinemia, hyperglycemia, and insulin resistance increase the risk of type 2 diabetes (T2D) and cardiovascular disease mortality. Postprandial hyperinsulinemia and hyperglycemia also occur in metabolically healthy subjects consuming high-carbohydrate diets particularly after evening meals and when carbohydrate loads follow acute exercise. We hypothesized the involvement of dietary carbohydrate load, especially when timed after exercise, and mediation by the glucose-dependent insulinotropic peptide (GIP) in this phenomenon, as this incretin promotes insulin secretion after carbohydrate intake in insulin-sensitive, but not in insulin-resistant states. Methods Four groups of eight metabolically healthy weight-matched postmenopausal women were provided with three isocaloric meals (a pre-trial meal and two meals during the trial day) containing either 30% or 60% carbohydrate, with and without two-hours of moderate-intensity exercise before the last two meals. Plasma glucose, insulin, glucagon, GIP, glucagon-like peptide 1 (GLP-1), free fatty acids (FFAs), and D-3-hydroxybutyrate concentrations were measured during 4-h postprandial periods and 3-h exercise periods, and their areas under the curve (AUCs) were analyzed by mixed-model ANOVA, and insulin resistance during fasting and meal tolerance tests within each diet was estimated using homeostasis-model assessment (HOMA-IR). Results The third low-carbohydrate meal, but not the high-carbohydrate meal, reduced: (1) evening insulin AUC by 39% without exercise and by 31% after exercise; (2) GIP AUC by 48% without exercise and by 45% after exercise, and (3) evening insulin resistance by 37% without exercise and by 24% after exercise. Pre-meal exercise did not alter insulin-, GIP- and HOMA-IR- lowering effects of low-carbohydrate diet, but exacerbated evening hyperglycemia. Conclusions Evening postprandial insulin and GIP responses and insulin resistance declined by over 30% after three meals that limited daily carbohydrate intake to 30% compared to no such changes after three 60%-carbohydrate meals, an effect that was independent of pre-meal exercise. The parallel timing and magnitude of postprandial insulin and GIP changes suggest their dependence on a delayed intestinal adaptation to a low-carbohydrate diet. Pre-meal exercise exacerbated glucose intolerance with both diets most likely due to impairment of insulin signaling by pre-meal elevation of FFAs.
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Affiliation(s)
- Po-Ju Lin
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Katarina T. Borer
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
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Abstract
Type 2 diabetes causes major global health problems and has been believed to be a lifelong condition with inevitable worsening. Steadily increasing numbers of drugs appeared to be required to achieve even modest control. Early type 2 diabetes has now been shown to be reversed by substantial weight loss and this has allowed temporal tracking of the underlying pathophysiological changes. Areas covered: In early type 2 diabetes, negative calorie balance decreases liver fat within days, and allows return of normal control of hepatic glucose production. Over 8 weeks, the negative calorie balance allows the raised levels of intra-pancreatic fat and simultaneously first phase insulin secretion to normalise. These findings are consistent with the 2008 Twin Cycle Hypothesis of the etiology and pathogenesis of type 2 diabetes. Individuals develop type 2 diabetes when they exceed their personal fat threshold for safe storage of fat and there is no difference in pathophysiology between those with BMI above or below 30 kg/m2. Expert commentary: Type 2 diabetes can now be understood as a state of excess fat in liver and pancreas, and remains reversible for at least 10 years in most individuals.
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Affiliation(s)
- Roy Taylor
- a Magnetic Resonance Centre, Institute for Cellular Medicine , Newcastle University , Newcastle upon Tyne , UK
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Otero-Losada M, González J, Müller A, Ottaviano G, Cao G, Azzato F, Ambrosio G, Milei J. Exercise Ameliorates Endocrine Pancreas Damage Induced by Chronic Cola Drinking in Rats. PLoS One 2016; 11:e0155630. [PMID: 27192084 PMCID: PMC4871573 DOI: 10.1371/journal.pone.0155630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/01/2016] [Indexed: 12/23/2022] Open
Abstract
Purpose This study evaluates whether the daily practice of an exercise routine might protect from endocrine pancreas damage in cola drinking rats. Methods Forty-eight Wistar rats were randomly assigned to 4 groups depending on a) beverage consumption ad libitum, water (W) or cola beverage (C), and b) physical activity, sedentary (S) or treadmill running (R). Accordingly, 4 groups were studied: WS (water sedentary), WR (water runner), CS (cola sedentary) and CR (cola runner). Body weight, nutritional data, plasma levels of glucose, creatinine, total cholesterol and cholesterol fractions, and triglycerides (enzymocolorimetry), and systolic blood pressure (plethysmography) were measured. After 6 months, euthanasia was performed (overdose sodium thiopental). Pancreatic tissue was immediately excised and conventionally processed for morphometrical and immunohistochemical determinations. Results The effects of running and chronic cola drinking on pancreas morphology showed interaction (p<0.001) rather than simple summation. Cola drinking (CS vs WS) reduced median pancreatic islet area (-30%, 1.8 104 μm2 vs 2.58 104 μm2, p<0.0001) and median β-cell mass (-43%, 3.81 mg vs 6.73 mg, p<0.0001), and increased median α/β ratio (+49%, 0.64 vs 0.43, p< 0.001). In water drinking rats (WR vs WS), running reduced median α-cell mass (-48%, 1.48 mg vs 2.82 mg, p<0.001) and α/β ratio (-56%, 0.19 vs 0.43, p<0.0001). Differently, in cola drinking rats (CR vs CS), running partially restored median islet area (+15%, 2.06 104 μm2 vs 1.79 104 μm2, p<0.05), increased median β-cell mass (+47%, 5.59 mg vs 3.81 mg, p <0.0001) and reduced median α/β ratio (-6%, 0.60 vs 0.64, p<0.05). Conclusion This study is likely the first reporting experimental evidence of the beneficial effect of exercise on pancreatic morphology in cola-drinking rats. Presently, the increase of nearly 50% in β cells mass by running in cola drinking rats is by far the most relevant finding. Moderate running, advisably indicated in cola consumers and patients at risk of diabetes, finds here experimental support.
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Affiliation(s)
- Matilde Otero-Losada
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
- * E-mail:
| | - Julián González
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Angélica Müller
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Graciela Ottaviano
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Gabriel Cao
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Francisco Azzato
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Giuseppe Ambrosio
- Università di Perugia, Cardiologia e Fisiopatologia Cardiovascolare, Perugia, Italy
| | - José Milei
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
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Sjöholm K, Sjöström E, Carlsson LMS, Peltonen M. Weight Change-Adjusted Effects of Gastric Bypass Surgery on Glucose Metabolism: 2- and 10-Year Results From the Swedish Obese Subjects (SOS) Study. Diabetes Care 2016; 39:625-31. [PMID: 26681719 DOI: 10.2337/dc15-1407] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/25/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It has been suggested that weight change-independent effects on fasting insulin and glucose levels are present after gastric bypass (GBP) but not after banding and vertical banded gastroplasty (VBG). We therefore evaluated weight change-adjusted effects of GBP, compared with restrictive surgical procedures, on long-term changes in fasting levels of glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) in the Swedish Obese Subjects (SOS) study. RESEARCH DESIGN AND METHODS Participants who completed the 2-year (n = 1,762) and/or the 10-year (n = 1,216) follow-up were divided into three weight change classes (weight loss >30%, 20-30%, or ≤20%), and by surgical method (banding, VBG, or GBP). Glucose, insulin, and HOMA-IR changes were analyzed in relation to weight change over 2 and 10 years. Analyses were performed in the full cohort and also in subgroups based on baseline glucose status. RESULTS Within weight change classes, reductions in glucose, insulin, and HOMA-IR were similar in the three surgery groups both at 2 and at 10 years. Reductions in glucose, insulin, and HOMA-IR increased with increasing weight loss, and changes were typically related to weight change within each surgery group. Moreover, the association between weight change and change in glucose, insulin, or HOMA-IR did not differ between the surgery groups at 2 and 10 years. When patients were subdivided also by baseline glucose status, similar relationships between weight changes and changes in glucose, insulin, and HOMA-IR were observed. CONCLUSIONS Even though weight loss-independent effects are important for short-term diabetes remission, our results suggest that degree of weight loss is more important for long-term reductions in fasting insulin and glucose than choice of bariatric surgery procedure.
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Affiliation(s)
- Kajsa Sjöholm
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Sjöström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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Associations between weight change and biomarkers of cardiometabolic risk in South Asians: secondary analyses of the PODOSA trial. Int J Obes (Lond) 2016; 40:1005-11. [PMID: 26927315 PMCID: PMC4892347 DOI: 10.1038/ijo.2016.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES The association of weight changes with cardiometabolic biomarkers in South Asians has been sparsely studied. SUBJECTS/METHODS We measured cardiometabolic biomarkers at baseline and after 3 years in the Prevention of Diabetes and Obesity in South Asians Trial. We investigated the effect of a lifestyle intervention on biomarkers in the randomized groups. In addition, treating the population as a single cohort, we estimated the association between change in weight and change in biomarkers. RESULTS Complete data were available at baseline and after 3 years in 151 participants. At 3 years, there was an adjusted mean reduction of 1·44 kg (95% confidence interval (95% CI): 0.18-2.71) in weight and 1.59 cm (95% CI: 0.08-3.09) in waist circumference in the intervention arm as compared with the control arm. There was no clear evidence of difference between the intervention and control arms in change of mean value of any biomarker. As a single cohort, every 1 kg weight reduction during follow-up was associated with a reduction in triglycerides (-1.3%, P=0.048), alanine aminotransferase (-2.5%, P=0.032), gamma-glutamyl transferase (-2.2%, P=0.040), leptin (-6.5%, P<0.0001), insulin (-3.7%, P=0.0005), fasting glucose (-0.8%, P=0.0071), 2-h glucose (-2.3%, P=0.0002) and Homeostatic Model Assessment of insulin resistance (HOMA-IR: -4.5%, P=0.0002). There was no evidence of associations with other lipid measures, tissue plasminogen activator, markers of inflammation or blood pressure. CONCLUSIONS We demonstrate that modest weight decrease in SAs is associated with improvements in markers of total and ectopic fat as well as insulin resistance and glycaemia in South Asians at risk of diabetes. Future trials with more intensive weight change are needed to extend these findings.
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Leslie WS, Ford I, Sattar N, Hollingsworth KG, Adamson A, Sniehotta FF, McCombie L, Brosnahan N, Ross H, Mathers JC, Peters C, Thom G, Barnes A, Kean S, McIlvenna Y, Rodrigues A, Rehackova L, Zhyzhneuskaya S, Taylor R, Lean MEJ. The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial. BMC FAMILY PRACTICE 2016; 17:20. [PMID: 26879684 PMCID: PMC4754868 DOI: 10.1186/s12875-016-0406-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/21/2016] [Indexed: 12/14/2022]
Abstract
Background Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death. Biochemical remission of T2DM has been demonstrated with weight loss around 15kg following bariatric surgery and in several small studies of non-surgical energy-restriction treatments. The non-surgical Counterweight-Plus programme, running in Primary Care where obesity and T2DM are routinely managed, produces >15 kg weight loss in 33 % of all enrolled patients. The Diabetes UK-funded Counterpoint study suggested that this should be sufficient to reverse T2DM by removing ectopic fat in liver and pancreas, restoring first-phase insulin secretion. The Diabetes Remission Clinical Trial (DiRECT) was designed to determine whether a structured, intensive, weight management programme, delivered in a routine Primary Care setting, is a viable treatment for achieving durable normoglycaemia. Other aims are to understand the mechanistic basis of remission and to identify psychological predictors of response. Methods/Design Cluster-randomised design with GP practice as the unit of randomisation: 280 participants from around 30 practices in Scotland and England will be allocated either to continue usual guideline-based care or to add the Counterweight-Plus weight management programme, which includes primary care nurse or dietitian delivery of 12-20weeks low calorie diet replacement, food reintroduction, and long-term weight loss maintenance. Main inclusion criteria: men and women aged 20-65years, all ethnicities, T2DM 0-6years duration, BMI 27-45 kg/m2. Tyneside participants will undergo Magnetic Resonance (MR) studies of pancreatic and hepatic fat, and metabolic studies to determine mechanisms underlying T2DM remission. Co-primary endpoints: weight reduction ≥ 15 kg and HbA1c <48 mmol/mol at one year. Further follow-up at 2 years. Discussion This study will establish whether a structured weight management programme, delivered in Primary Care by practice nurses or dietitians, is a viable treatment to achieve T2DM remission. Results, available from 2018 onwards, will inform future service strategy. Trial registration Current Controlled Trials ISRCTN03267836. Date of Registration 20/12/2013 Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0406-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wilma S Leslie
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Ian Ford
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Naveed Sattar
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | | | - Ashley Adamson
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Falko F Sniehotta
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | | | - Naomi Brosnahan
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | | | - John C Mathers
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Carl Peters
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - George Thom
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Alison Barnes
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Sharon Kean
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | | | - Angela Rodrigues
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Lucia Rehackova
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | | | - Roy Taylor
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Mike E J Lean
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
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KUNEŠOVÁ M, SEDLÁČKOVÁ B, BRADNOVÁ O, TVRZICKÁ E, STAŇKOVÁ B, ŠRÁMKOVÁ P, DOLEŽALOVÁ K, KALOUSKOVÁ P, HLAVATÝ P, HILL M, BENDLOVÁ B, FRIED M, HAINER V, VRBÍKOVÁ J. Fatty Acid Composition of Adipose Tissue Triglycerides in Obese Diabetic Women After Bariatric Surgery: a 2-Year Follow up. Physiol Res 2015; 64:S155-66. [DOI: 10.33549/physiolres.933132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Bariatric surgery is the most effective method in the treatment of obesity and type 2 diabetes (T2DM). The aim of this study was to evaluate the effects of different types of bariatric procedures on remission of T2DM and on the fatty acid composition in subcutaneous adipose tissue. Patients included obese diabetic women who underwent bariatric surgery: biliopancreatic diversion (BPD), n=8, laparoscopic gastric banding (LAGB), n=9 or laparoscopic greater curvature plication (LGCP), n=12. Anthropometric characteristics and fatty acid composition of adipose tissue (FA AT) were analyzed before surgery, then 6 months and 2 years after surgery. FA AT was analyzed by gas chromatography. Diabetes remission was estimated. BPD was most efficient in inducing a remission of diabetes (p=0.004). Significantly higher increases in lauric (12:0), myristoleic (14:1n-5) and palmitoleic (16:1n-7) acids and delta-9 desaturase were found two years after BPD, suggesting higher lipogenesis in adipose tissue. Docosatetraenoic acid (22:4n-6) increased significantly after BPD, while docosapentaenoic acid (22:5n-3) decreased 6 months after BPD and increased after 2 years. No changes were found after LAGB and LGCP after 2 years. Bariatric surgery led to significant changes in the fatty acid composition of subcutaneous adipose tissue in severely obese diabetic women after six months and two years, and was partly influenced by the type of surgery used.
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Affiliation(s)
- M. KUNEŠOVÁ
- Institute of Endocrinology Obesity Management Centre, Prague, Czech Republic
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The long-term impact of biliopancreatic diversion on glycemic control in the severely obese with type 2 diabetes mellitus in relation to preoperative duration of diabetes. Surg Obes Relat Dis 2015; 12:345-9. [PMID: 26381876 DOI: 10.1016/j.soard.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to be effective in severely obese patients with type 2 diabetes mellitus (T2DM). OBJECTIVE Evaluate the long-term efficacy of biliopancreatic diversion (BPD) for the treatment of T2DM depending on the preoperative duration of T2DM. SETTING University Hospital. METHODS Retrospective analysis investigating 2 subsets of severely obese patients who had undergone BPD from 1984 to 1995. The first included 52 patients with a preoperative T2DM duration of ~1 year (SD group - 49 on oral agents and 3 on insulin), and the second included 68 patients who had been diabetic for>5 years before BPD (LD group - 52 on oral agents and 16 on insulin). Postoperatively, T2DM was regarded as in remission when fasting serum glucose (FSG) was lower than 100 mg/dL on regular diet and without antidiabetic therapy. RESULTS In the SD patients, the number of individuals without T2DM remission were lower both at 5-10 (0/31, 0% of patients, versus 8/54, 15% of patients, p<.04) and at>15 years (1/28, 3% of patients, versus 10/41, 24% of patients, p<.0012). Furthermore, after BPD, the number of patients with dyslipidemia strongly reduced (p<.001) in both groups, values at 5-10 years remaining very similar to those observed at>15 years. CONCLUSION These results indicate that severely obese patients with longer T2DM duration have a worse metabolic outcome maintained at long and very long term following BPD.
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