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Yang W, Sun L, Hao L, Zhang X, Lv Q, Xu X, Wang Y, Li Y, Zhou L, Zhao Y, Zang X, Wang Y. Effects of the family customised online FOCUS programme on patients with heart failure and their informal caregivers: a multicentre, single-blind, randomised clinical trial. EClinicalMedicine 2024; 69:102481. [PMID: 38370538 PMCID: PMC10874718 DOI: 10.1016/j.eclinm.2024.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background Living with heart failure can severely affect the physical and mental health of patients with heart failure and their caregivers. Available dyadic self-care interventions for heart failure are scarce, especially in China. We aimed to develop and test the family FOCUS programme. Methods This single-blind, randomised, controlled study was conducted at four hospitals in Tianjin, China. Patients with heart failure (aged at least 18 years) and their caregiver (dyads) were randomly assigned to either the intervention (n = 71) or control (n = 71) group in a 1:1 ratio. The primary outcomes of this study were patient self-care, with three specific dimensions (self-care maintenance, symptom perception, and self-care management), and caregiver contribution to self-care, mirroring these three dimensions. The outcomes were assessed at baseline (T0) and 4 (T1), 12 (T2), and 24 (T3) weeks post-discharge, respectively. This work is registered on ChiCTR, ChiCTR2100053168. Findings Between May 20, 2022, and September 30, 2022, 142 dyads with heart failure were enrolled. The intervention group exhibited dropout rates of 6%, 8.5%, and 18.3% at 4, 12, and 24 weeks after discharge, while the control group showed 9.9%, 12.3%, and 25.4%. Compared with the control group, patients in the intervention group reported improved self-care maintenance (β: 8.5, 95% CI: 0.7, 16.4) and management (β: 7.2, 95% CI: 0.1, 14.3) at T1, as well as improved symptom perception at both T1 (β: 9.7, 95% CI: 1.5, 17.9) and T2 (β: 9.6, 95% CI: 0.6, 18.6). Furthermore, caregiver contributions to self-care maintenance, self-care management, and symptom perception (excluding T3) exhibited significant improvements at all timepoints. Interpretation Although the significant improvements in patients' self-care were not long-lasting, this study suggested that the family FOCUS programme consistently enhanced caregivers' contributions to self-care. Future work could explore the effect of the family FOCUS programme on families with multiple chronic conditions. Funding The National Natural Science Foundation of China.
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Affiliation(s)
- Weiling Yang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lili Hao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xueying Xu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaqi Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanting Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Thaker VV, Kwee LC, Chen H, Bahnson J, Ilkayeva O, Muehlbauer MJ, Wolfe B, Purnell JQ, Pi-Sunyer X, Newgard CB, Shah SH, Laferrère B. Metabolite signature of diabetes remission in individuals with obesity undergoing weight loss interventions. Obesity (Silver Spring) 2024; 32:304-314. [PMID: 37962326 DOI: 10.1002/oby.23943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE This observational study investigated metabolomic changes in individuals with type 2 diabetes (T2D) after weight loss. We hypothesized that metabolite changes associated with T2D-relevant phenotypes are signatures of improved health. METHODS Fasting plasma samples from individuals undergoing bariatric surgery (n = 71 Roux-en-Y gastric bypass [RYGB], n = 22 gastric banding), lifestyle intervention (n = 66), or usual care (n = 14) were profiled for 139 metabolites before and 2 years after weight loss. Principal component analysis grouped correlated metabolites into factors. Association of preintervention metabolites was tested with preintervention clinical features and changes in T2D markers. Association between change in metabolites/metabolite factors and change in T2D remission markers, homeostasis model assessment of β-cell function, homeostasis model assessment of insulin resistance, and glycated hemoglobin (HbA1c) was assessed. RESULTS Branched-chain amino acids (BCAAs) were associated with preintervention adiposity. Changes in BCAAs (valine, leucine/isoleucine) and branched-chain ketoacids were positively associated with change in HbA1c (false discovery rate q value ≤ 0.001) that persisted after adjustment for percentage weight change and RYGB (p ≤ 0.02). In analyses stratified by RYGB or other weight loss method, some metabolites showed association with non-RYGB weight loss. CONCLUSIONS This study confirmed known metabolite associations with obesity/T2D and showed an association of BCAAs with HbA1c change after weight loss, independent of the method or magnitude of weight loss.
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Affiliation(s)
- Vidhu V Thaker
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Judy Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute, Durham, North Carolina, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Durham, North Carolina, USA
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, Durham, North Carolina, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Durham, North Carolina, USA
| | - Bruce Wolfe
- Departments of Surgery and Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Q Purnell
- Departments of Surgery and Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Xavier Pi-Sunyer
- New York Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher B Newgard
- Duke Molecular Physiology Institute, Durham, North Carolina, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Durham, North Carolina, USA
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Svati H Shah
- Duke Molecular Physiology Institute, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Blandine Laferrère
- New York Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Li Y, Yang W, Qu Y, Zhang X, Lin M, Fu L, Wang C, Qiu P, Zang X. Effects of an autonomy-supportive intervention programme (ASIP) on self-care, quality of life, and mental health in heart failure patients: a randomized controlled trial. Qual Life Res 2023; 32:3039-3052. [PMID: 37418228 DOI: 10.1007/s11136-023-03467-1] [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] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Patients with heart failure (HF) possess low self-care activation and motivation, leading to a deprived quality of life and adverse mental health conditions. To this end, self-determination theory emphasizes that autonomy-supportive interventions (ASI) can stimulate intrinsic motivation and improve behaviors and quality of life. Nevertheless, studies that focused on ASI for HF are inadequate. This study aims to evaluate the effects of an HF-ASIP on self-care, quality of life and mental health in HF patients. METHODS In a two-arm randomized controlled trial, the participants are randomly allocated to the intervention (n = 41) or control (n = 41) groups. The intervention group received routine care and participated in an 8-week HF-ASIP, including individual education and consultation sessions. In contrast, the control group received only routine care. The primary outcome includes self-care management, while the secondary outcomes include self-care maintenance, quality of life, mental health, and motivation. After measuring the outcomes at baseline (T0), 4-week (T1), 8-week (T2), and 12-week (T3) follow-up, the intervention effects are assessed using the generalized equation models. RESULTS The outcomes indicated that self-care management (T2: P = 0.001; T3: P = 0.016), self-care maintenance (T2: P = 0.003; T3: P = 0.001), depression (T2: P = 0.007; T3: P = 0.012), anxiety (T2: P = 0.001; T3: P = 0.012), MLHFQ total score (T1: P = 0.004; T2: P < 0.001; T3: P = 0.001), autonomous motivation (T2: P = .0.006; T3: P = 0.002) showed statistically difference between the groups. CONCLUSION In summary, the 8-week HF-ASIP significantly improved the attributes of self-care, quality of life, mental health, and motivation in HF patients, suggesting the potential for practical intervention effect. TRIAL REGISTRATION ChiCTR2100053970.
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Affiliation(s)
- Yanting Li
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Weiling Yang
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Yuanyuan Qu
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Mei Lin
- Tianjin Medical University General Hospital, Tianjin, China
| | - Li Fu
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Cuicui Wang
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Pingping Qiu
- School of Nursing, Fujian Medical University, Fujian, China.
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China.
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Pelligra A, Mrugala J, Griess K, Kirschner P, Nortmann O, Bartosinska B, Köster A, Krupenko NI, Gebel D, Westhoff P, Steckel B, Eberhard D, Herebian D, Belgardt BF, Schrader J, Weber APM, Krupenko SA, Lammert E. Pancreatic islet protection at the expense of secretory function involves serine-linked mitochondrial one-carbon metabolism. Cell Rep 2023; 42:112615. [PMID: 37294632 PMCID: PMC10592470 DOI: 10.1016/j.celrep.2023.112615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/11/2023] Open
Abstract
Type 2 diabetes is characterized by insulin hypersecretion followed by reduced glucose-stimulated insulin secretion (GSIS). Here we show that acute stimulation of pancreatic islets with the insulin secretagogue dextrorphan (DXO) or glibenclamide enhances GSIS, whereas chronic treatment with high concentrations of these drugs reduce GSIS but protect islets from cell death. Bulk RNA sequencing of islets shows increased expression of genes for serine-linked mitochondrial one-carbon metabolism (OCM) after chronic, but not acute, stimulation. In chronically stimulated islets, more glucose is metabolized to serine than to citrate, and the mitochondrial ATP/ADP ratio decreases, whereas the NADPH/NADP+ ratio increases. Activating transcription factor-4 (Atf4) is required and sufficient to activate serine-linked mitochondrial OCM genes in islets, with gain- and loss-of-function experiments showing that Atf4 reduces GSIS and is required, but not sufficient, for full DXO-mediated islet protection. In sum, we identify a reversible metabolic pathway that provides islet protection at the expense of secretory function.
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Affiliation(s)
- Angela Pelligra
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Jessica Mrugala
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany; Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Kerstin Griess
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Philip Kirschner
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Oliver Nortmann
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Barbara Bartosinska
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Andrea Köster
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Natalia I Krupenko
- University of North Carolina (UNC) Nutrition Research Institute, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Dominik Gebel
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Philipp Westhoff
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany; Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Bodo Steckel
- Department of Molecular Cardiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Daniel Eberhard
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany; Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Diran Herebian
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Bengt-Frederik Belgardt
- Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jürgen Schrader
- Department of Molecular Cardiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Andreas P M Weber
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany; Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Sergey A Krupenko
- University of North Carolina (UNC) Nutrition Research Institute, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Eckhard Lammert
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany; Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764 Neuherberg, Germany.
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Ghusn W, Ikemiya K, Al Annan K, Acosta A, Dayyeh BKA, Lee E, Spaniolas K, Kendrick M, Higa K, Ma P, Ghanem OM. Diabetes Mellitus Remission in Patients with BMI > 50 kg/m 2 after Bariatric Surgeries: A Real-World Multi-Centered Study. Obes Surg 2023:10.1007/s11695-023-06622-2. [PMID: 37118640 DOI: 10.1007/s11695-023-06622-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a common comorbidity associated with obesity, particularly in patients with body mass index (BMI) ≥ 50 kg/m2. We aim to study real-world T2DM long-term remission in patients with BMI ≥ 50 kg/m2 following Roux-En-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). METHODS This was a retrospective study of the electronic medical records of all patients with BMI ≥ 50 kg/m2, T2DM, and have undergone RYGB or SG at three tertiary referral centers in the United States. We assessed the change in T2DM outcomes after bariatric surgery using a matched paired t-test for continuous variables and Bowker and Pearson test for categorical variables. We performed a multivariate logistic regression to determine predictors of remission. RESULTS A total of 279 patients with T2DM (65% females, mean age 51.0 ± 11.7 years, 89% white, BMI 56.6 ± 5.9 kg/m2) were analyzed. Long-term T2DM remission (≥ 5 years) was demonstrated in 47% of patients. The duration of T2DM (p < 0.0001), number of T2DM medications (p = 0.003) and weight loss (p = 0.048) were the only independent factors for long-term T2DM remission. CONCLUSIONS In this cohort of patients with BMI ≥ 50 kg/m2, RYGB and SG demonstrated significant and similar long-term T2DM remission rates and weight loss outcomes.
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Affiliation(s)
- Wissam Ghusn
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kayla Ikemiya
- Fresno Heart and Surgical Hospital, UCSF Fresno, Fresno, CA, USA
| | - Karim Al Annan
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Edmund Lee
- Division of Bariatric, Foregut and Advanced GI Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Kostantinos Spaniolas
- Division of Bariatric, Foregut and Advanced GI Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Michael Kendrick
- Department of Surgery, Endocrine and Metabolic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kelvin Higa
- Fresno Heart and Surgical Hospital, UCSF Fresno, Fresno, CA, USA
| | - Pearl Ma
- Fresno Heart and Surgical Hospital, UCSF Fresno, Fresno, CA, USA
| | - Omar M Ghanem
- Department of Surgery, Endocrine and Metabolic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Shah H, Kramer A, Mullins CA, Mattern M, Gannaban RB, Townsend RL, Campagna SR, Morrison CD, Berthoud HR, Shin AC. Reduction of Plasma BCAAs following Roux-en-Y Gastric Bypass Surgery Is Primarily Mediated by FGF21. Nutrients 2023; 15:1713. [PMID: 37049555 PMCID: PMC10096671 DOI: 10.3390/nu15071713] [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: 02/24/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Type 2 diabetes (T2D) is a challenging health concern worldwide. A lifestyle intervention to treat T2D is difficult to adhere, and the effectiveness of approved medications such as metformin, thiazolidinediones (TZDs), and sulfonylureas are suboptimal. On the other hand, bariatric procedures such as Roux-en-Y gastric bypass (RYGB) are being recognized for their remarkable ability to achieve diabetes remission, although the underlying mechanism is not clear. Recent evidence points to branched-chain amino acids (BCAAs) as a potential contributor to glucose impairment and insulin resistance. RYGB has been shown to effectively lower plasma BCAAs in insulin-resistant or T2D patients that may help improve glycemic control, but the underlying mechanism for BCAA reduction is not understood. Hence, we attempted to explore the mechanism by which RYGB reduces BCAAs. To this end, we randomized diet-induced obese (DIO) mice into three groups that underwent either sham or RYGB surgery or food restriction to match the weight of RYGB mice. We also included regular chow-diet-fed healthy mice as an additional control group. Here, we show that compared to sham surgery, RYGB in DIO mice markedly lowered serum BCAAs most likely by rescuing BCAA breakdown in both liver and white adipose tissues. Importantly, the restored BCAA metabolism following RYGB was independent of caloric intake. Fasting insulin and HOMA-IR were decreased as expected, and serum valine was strongly associated with insulin resistance. While gut hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) are postulated to mediate various surgery-induced metabolic benefits, mice lacking these hormonal signals (GLP-1R/Y2R double KO) were still able to effectively lower plasma BCAAs and improve glucose tolerance, similar to mice with intact GLP-1 and PYY signaling. On the other hand, mice deficient in fibroblast growth factor 21 (FGF21), another candidate hormone implicated in enhanced glucoregulatory action following RYGB, failed to decrease plasma BCAAs and normalize hepatic BCAA degradation following surgery. This is the first study using an animal model to successfully recapitulate the RYGB-led reduction of circulating BCAAs observed in humans. Our findings unmasked a critical role of FGF21 in mediating the rescue of BCAA metabolism following surgery. It would be interesting to explore the possibility of whether RYGB-induced improvement in glucose homeostasis is partly through decreased BCAAs.
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Affiliation(s)
- Harsh Shah
- Neurobiology of Nutrition Laboratory, Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Alyssa Kramer
- Neurobiology of Nutrition Laboratory, Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Caitlyn A. Mullins
- Neurobiology of Nutrition Laboratory, Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Marie Mattern
- Neurobiology of Nutrition Laboratory, Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Ritchel B. Gannaban
- Neurobiology of Nutrition Laboratory, Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - R. Leigh Townsend
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA
| | - Shawn R. Campagna
- Department of Chemistry, University of Tennessee, Knoxville, TN 37996, USA
| | - Christopher D. Morrison
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA
| | - Hans-Rudolf Berthoud
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA
| | - Andrew C. Shin
- Neurobiology of Nutrition Laboratory, Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Mirghani H, Altedlawi Albalawi I. Metabolic surgery versus usual care effects on diabetes remission: a systematic review and meta-analysis. Diabetol Metab Syndr 2023; 15:31. [PMID: 36829204 PMCID: PMC9951503 DOI: 10.1186/s13098-023-01001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Bariatric surgery is superior to usual care for diabetes remission. Previous meta-analyses were limited by pooling observational and randomized trials, using various definitions of diabetes remission, and not controlling for various diabetes medications. The current meta-analysis aimed to compare bariatric surgery and usual care regarding the same. METHODS We searched PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Library for relevant articles from the date of the first inception up to February 2023. The keywords diabetes remission, Bariatric surgery, metabolic surgery, lifestyles, usual care, GLIP-1 agonists, insulin use, gastric banding, biliopancreatic diversion, sleeve gastrectomy, and Roux-en-Y gastric bypass, were used. A datasheet was used to extract the relevant data. RESULTS Diabetes remission (complete and prolonged) was higher among bariatric surgeries compared to usual care, odd ratio, 0.06, 95 CI, 0.02-0.25 and 0.12, 95 CI, 0.02-0.72, respectively. bariatric surgery patients were younger, had higher HbA1c, odd ratio, - 3.13, 95 CI, - 3.71 to 2.54, and 0.25, 95 CI, 0.02-0.48, respectively, insulin use was higher, and glucagon-like peptide agonists use was lower among bariatric surgery patients, odd ratio, 0.49, 95% CI, 0.24-0.97, and 3.06, 95% CI, 1.44-6.53, respectively. CONCLUSION Bariatric surgery was better than usual care in diabetes remission. Bariatric surgery patients were younger, had higher HbA1c, and received more insulin and lower GLP-1 agonists. No differences were evident regarding body mass index and the duration of diabetes. Further trials comparing the new anti-diabetic medications and different forms of bariatric surgery and controlling for the level of exercise and diet are recommended.
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Affiliation(s)
- Hyder Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, PO Box 3378, Tabuk, 51941, Saudi Arabia.
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Kumar A, Margekar S, Kumar R. Diabetes remission: Myth or reality? INDIAN JOURNAL OF MEDICAL SPECIALITIES 2023. [DOI: 10.4103/injms.injms_123_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Zhao J, Jiang Y, Qian J, Qian Z, Yang H, Shi W, Gong Y, Jiao Y, Tang L. A nomogram model based on the combination of the systemic immune-inflammation index and prognostic nutritional index predicts weight regain after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2023; 19:50-58. [PMID: 36008279 DOI: 10.1016/j.soard.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The high rate of weight regain after laparoscopic sleeve gastrectomy is a great challenge. The systemic immune-inflammation index (SII; calculated by neutrophils, lymphocytes, and platelets) and prognostic nutritional index (PNI; calculated by albumin and lymphocytes) are widely used as prognostic factors in various diseases. OBJECTIVES The objective of this study was to investigate independent the independent risk factors associated with weight regain in patients after laparoscopic sleeve gastrectomy. SETTING A single-center retrospective study. METHODS Weight regain was defined as the percentage of increase in body weight ≥10% in comparison with the nadir weight postoperatively. Eligible patients admitted to the bariatric center of our hospital were consecutively enrolled and grouped according to the occurrence of weight regain within 5 postoperative years. Univariate and multivariate logistic regression analyses were performed to assess potential risk factors. A nomogram model containing the risk factors was then constructed and evaluated by R. RESULTS A total of 217 patients were enrolled, and 87 (40.1%) patients experienced weight regain. Univariate and logistic regression analyses indicated that depression (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.20-5.22, P = .015), psychological counseling (OR: 2.27, 95% CI: 1.20-4.33, P = .017), preoperative C-reactive protein (OR: 2.20, 95% CI: 1.18-4.13, P = .012), and combination of SII-PNI scores (OR: .45, 95% CI: .31-.67, P < .001) were 4 independent risk factors for postoperative weight regain in laparoscopic sleeve gastrectomy patients. The area under the curve of the constructed nomogram model for predicting weight regain was .706. CONCLUSIONS This study concluded that the combination of the SII-PNI was an independent risk factor for weight regain and that the nomogram model based on the combination of the SII-PNI had a good predictive value.
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Affiliation(s)
- Jie Zhao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Yicheng Jiang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Jun Qian
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Zhifen Qian
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Haojun Yang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Weihai Shi
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Yu Gong
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Yuwen Jiao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China.
| | - Liming Tang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China.
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10
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Ricci M, Mancebo-Sevilla JJ, Cobos Palacios L, Sanz-Cánovas J, López-Sampalo A, Hernández-Negrin H, Pérez-Velasco MA, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R. Remission of type 2 diabetes: A critical appraisal. Front Endocrinol (Lausanne) 2023; 14:1125961. [PMID: 37077356 PMCID: PMC10107406 DOI: 10.3389/fendo.2023.1125961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Michele Ricci
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- *Correspondence: Michele Ricci, ; Maria Rosa Bernal-López,
| | - Juan José Mancebo-Sevilla
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Lidia Cobos Palacios
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Jaime Sanz-Cánovas
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Almudena López-Sampalo
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Halbert Hernández-Negrin
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Miguel Angel Pérez-Velasco
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
| | - Luis M. Pérez-Belmonte
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- Servicio de Medicina Interna, Hospital Helicópteros Sanitarios, Marbella, Spain
| | - Maria Rosa Bernal-López
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Michele Ricci, ; Maria Rosa Bernal-López,
| | - Ricardo Gómez-Huelgas
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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11
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Thiem H, Rychlik RP, Weimann A. Kosten-Effektivitäts-Analyse des Optifast 52 Programms bei
Patienten mit Adipositas Grad III und Diabetes mellitus Typ 2. AKTUELLE ERNÄHRUNGSMEDIZIN 2022. [DOI: 10.1055/a-1955-0935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Zusammenfassung
Hintergrund Adipositas stellt für eine Vielzahl weiterer
Erkrankungen einen wesentlichen Risikofaktor dar, darunter insbesondere Diabetes
mellitus Typ 2 (DMT2). DMT2 als Adipositas-assoziierte Folgeerkrankung bedeutet
sowohl aus medizinischer als auch ökonomischer Sicht eine hohe Belastung
für das deutsche Gesundheitssystem. Ziel therapeutischer
Maßnahmen zur Gewichtsreduktion bei Patienten mit DMT2 ist somit immer
auch die Verbesserung der diabetischen Stoffwechsellage. Bei Patienten mit
Adipositas Grad III (BMI≥40 kg/m2) kann
alternativ zu einer metabolischen bariatrischen Operation auch ein
strukturiertes, multimodales Therapieprogramm (Optifast 52 Programm) angeboten
werden.
Methodik In einer Kosten-Effektivitäts-Analyse sollen die
gesundheitsökonomischen Auswirkungen des Optifast 52 Programms im
Vergleich zur metabolischen Operation bei adipösen Patienten (BMI
40–50 kg/m2) mit DMT2 als
Adipositasassoziierter Begleiterkrankung ermittelt werden. Ziel beider
Therapieoptionen ist die Remission des DMT2 aufgrund von Gewichtsreduktion.
Mithilfe eines Entscheidungsbaum-Modells wird die Therapie des DMT2 für
einen Zeitraum von drei Jahren modelliert. Berücksichtigt werden die
direkten medizinischen Kosten aus Perspektive der gesetzlichen
Krankenversicherung in Deutschland.
Ergebnisse Die kumulierten Behandlungskosten des DMT2 liegen unter
Anwendung des Optifast 52 Programms bei durchschnittlich 9.425,01 Euro
für den Gesamtzeitraum von drei Jahren im Vergleich zu 13.727,94 Euro
für Patienten mit metabolischer Operation. Unter
Berücksichtigung der Effektivität der beiden Therapieoptionen
zeigt sich, dass das Optifast 52 Programm mit 11.536,33 Euro im Vergleich zu
14.908,56 Euro für eine metabolische Operation kosteneffektiv ist.
Schlussfolgerung Die Reduktion des Körpergewichts ist bei
Patienten mit Adipositas wesentlich für eine erfolgreiche Therapie des
DMT2. Die metabolische Operation kann dabei zu deutlichen Gewichtsverlusten
führen, ist jedoch aufgrund der vergleichsweise höheren
Komplikationsraten und der hohen finanziellen Belastung für das deutsche
Gesundheitssystem kritisch zu sehen. Aus gesundheitsökonomischer Sicht
stellt das Optifast 52 Programm deswegen eine kosteneffektive Alternative zur
metabolischen Operation dar.
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Affiliation(s)
- Helena Thiem
- Institut für Empirische Gesundheitsökonomie,
Burscheid
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12
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Simonson DC, Hu B, Arterburn DE, Schauer PR, Kashyap SR, Courcoulas AP, Cummings DE, Patti ME, Gourash WF, Vernon AH, Jakicic JM, Kirwan JP. Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D): Study rationale, design, and methods. Diabetes Obes Metab 2022; 24:1206-1215. [PMID: 35233923 PMCID: PMC9177689 DOI: 10.1111/dom.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
AIMS Long-term data from randomized clinical trials comparing metabolic (bariatric) surgery versus a medical/lifestyle intervention for treatment of patients with obesity/overweight and type 2 diabetes (T2D) are lacking. The Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is a consortium of four randomized trials designed to compare long-term efficacy and safety of surgery versus medical/lifestyle therapy on diabetes control and clinical outcomes. MATERIALS AND METHODS Patients with T2D and body mass index (BMI) of 27-45 kg/m2 who were previously randomized to metabolic surgery (Roux-en-Y gastric bypass, adjustable gastric band, or sleeve gastrectomy) versus medical/lifestyle intervention in the STAMPEDE, SLIMM-T2D, TRIABETES, or CROSSROADS trials have been enrolled in ARMMS-T2D for observational follow-up. The primary outcome is change in glycated haemoglobin after a minimum 7 years of follow-up, with additional analyses to determine rates of diabetes remission and relapse, as well as cardiovascular and renal endpoints. RESULTS In total, 302 patients (192 surgical, 110 medical/lifestyle) previously randomized in the four parent studies were eligible for participation in the ARMMS-T2D observational study. Participant demographics were 71% white, 27% African-American and 68% female. At baseline: age, 50 ± 8 years; BMI, 36.5 ± 3.5 kg/m2 ; duration of diabetes, 8.8 ± 5.6 years; glycated haemoglobin, 8.6% ± 1.6%; and fasting glucose, 168 ± 64 mg/dl. More than 35% of patients had a BMI <35 kg/m2 . CONCLUSIONS ARMMS-T2D will provide the largest body of long-term, level 1 evidence to inform clinical decision-making regarding the comparative durability, efficacy and safety of metabolic surgery relative to a medical/lifestyle intervention among patients with T2D, including those with milder class I obesity or mere overweight.
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Affiliation(s)
- Donald C. Simonson
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Bo Hu
- Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | | | | | - Ashley H. Vernon
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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13
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Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. Int J Nurs Stud 2022; 134:104314. [DOI: 10.1016/j.ijnurstu.2022.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
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14
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Kim J, Kwon HS. Not Control but Conquest: Strategies for the Remission of Type 2 Diabetes Mellitus. Diabetes Metab J 2022; 46:165-180. [PMID: 35385632 PMCID: PMC8987695 DOI: 10.4093/dmj.2021.0377] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
A durable normoglycemic state was observed in several studies that treated type 2 diabetes mellitus (T2DM) patients through metabolic surgery, intensive therapeutic intervention, or significant lifestyle modification, and it was confirmed that the functional β-cell mass was also restored to a normal level. Therefore, expert consensus introduced the concept of remission as a common term to express this phenomenon in 2009. Throughout this article, we introduce the recently updated consensus statement on the remission of T2DM in 2021 and share our perspective on the remission of diabetes. There is a need for more research on remission in Korea as well as in Western countries. Remission appears to be prompted by proactive treatment for hyperglycemia and significant weight loss prior to irreversible β-cell changes. T2DM is not a diagnosis for vulnerable individuals to helplessly accept. We attempt to explain how remission of T2DM can be achieved through a personalized approach. It may be necessary to change the concept of T2DM towards that of an urgent condition that requires rapid intervention rather than a chronic, progressive disease. We must grasp this paradigm shift in our understanding of T2DM for the benefit of our patients as endocrine experts.
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Affiliation(s)
- Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Hyuk-Sang Kwon https://orcid.org/0000-0003-4026-4572 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63(yuksam)-ro, Yeongdeungpo-gu, Seoul 07345, Korea E-mail:
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15
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Kalra S, Bantwal G, Kapoor N, Sahay R, Bhattacharya S, Anne B, Gopal RA, Kota S, Kumar A, Joshi A, Sanyal D, Tiwaskar M, Das AK. Quantifying Remission Probability in Type 2 Diabetes Mellitus. Clin Pract 2021; 11:850-859. [PMID: 34842637 PMCID: PMC8628725 DOI: 10.3390/clinpract11040100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College & Hospital, Bengaluru 560034, India;
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India;
- Non Communicable Disease Unit, The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad 500095, India;
| | | | - Beatrice Anne
- Department of Endocrinology, Nizams Institute of Medical Sciences, Hyderabad 500082, India;
| | - Raju A Gopal
- Department of Endocrinology, Endodiab Clinic, Kozhikode 673016, India;
| | - Sunil Kota
- Department of Endocrinology, Diabetes and Endocare Clinic, Berhampur 760004, India;
| | - Ashok Kumar
- Department of Endocrinology, CEDAR Diabetes Thyroid & Hormone Clinic Panipat, Panipat 132103, India;
| | - Ameya Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai 401107, India;
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata 700032, India;
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai 400068, India;
| | - Ashok Kumar Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry 605014, India;
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16
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Kumar RB, Srivastava G, Reid TJ, Aronne LJ. Understanding the pathophysiologic pathways that underlie obesity and options for treatment. Expert Rev Endocrinol Metab 2021; 16:321-338. [PMID: 34904501 DOI: 10.1080/17446651.2021.1991310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity is a chronic, multifactorial condition with devastating health consequences. It was thought that obesity could be controlled with discipline and lifestyle changes, but we now know that the underlying pathophysiology is a dysregulation of the body's energy balance system, controlled by a complex interplay of neural, hormonal, and metabolic pathways. Recognizing obesity as a chronic disease places a greater responsibility on all health care professionals to screen and identify patients at risk and develop long-term tailored treatment plans. AREAS COVERED This narrative review describes the central and peripheral pathways regulating obesity, the factors contributing to its development and how to effectively manage this disease. EXPERT OPINION Obesity is a disease with pathophysiologic mechanisms and should be treated accordingly to reduce the significant risk of morbidity and mortality. Lifestyle interventions remain the cornerstones of treatment; however, these measures alone are rarely enough for long-term maintenance of weight loss. Additional interventions, such as pharmacotherapy or bariatric surgery, are indicated for many patients and should be recommended. Treatment considerations should include assessment of comorbidities or risk factors, as many anti-obesity agents and bariatric surgeries also have beneficial effects on other weight-associated comorbidities.Plain language summary: This plain language summary highlights information from a recent scientific article about obesity. Obesity is a disease that leads to excess accumulation of body fat that may negatively affect health. People can check if they have obesity by measuring their body mass index (BMI for short). The BMI is a screening tool to see if you are at risk of obesity. Obesity is defined as a BMI of 30 kg/m2 or higher with lower cut-offs in Asian populations. Obesity is a chronic health condition that leads to a shorter life span. People with obesity have a higher chance of having other health conditions, such as type 2 diabetes, fatty liver disease, heart disease, kidney problems, osteoarthritis, and some types of cancer. It can be hard for people with obesity to lose weight for various reasons. The aim of this article is to help doctors who treat people with obesity understand more about the causes for obesity, as well as the available treatment options, which include lifestyle changes, medicines, and for some people, weight loss surgery.[Figure: see text][Figure: see text][Figure: see text][Figure: see text].
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Affiliation(s)
- Rekha B Kumar
- Weill Cornell Medical College, New York, United States
| | | | - Tirissa J Reid
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States
| | - Louis J Aronne
- Weill Cornell Medical College, New York, United States
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States
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17
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Iqbal Z, Fachim HA, Gibson JM, Baricevic-Jones I, Campbell AE, Geary B, Donn RP, Hamarashid D, Syed A, Whetton AD, Soran H, Heald AH. Changes in the Proteome Profile of People Achieving Remission of Type 2 Diabetes after Bariatric Surgery. J Clin Med 2021; 10:3659. [PMID: 34441954 PMCID: PMC8396849 DOI: 10.3390/jcm10163659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) results in metabolic pathway recalibration. We have identified potential biomarkers in plasma of people achieving type 2 diabetes mellitus (T2DM) remission after BS. Longitudinal analysis was performed on plasma from 10 individuals following Roux-en-Y gastric bypass (n = 7) or sleeve gastrectomy (n = 3). Sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) was done on samples taken at 4 months before (baseline) and 6 and 12 months after BS. Four hundred sixty-seven proteins were quantified by SWATH-MS. Principal component analysis resolved samples from distinct time points after selection of key discriminatory proteins: 25 proteins were differentially expressed between baseline and 6 months post-surgery; 39 proteins between baseline and 12 months. Eight proteins (SHBG, TF, PRG4, APOA4, LRG1, HSPA4, EPHX2 and PGLYRP) were significantly different to baseline at both 6 and 12 months post-surgery. The panel of proteins identified as consistently different included peptides related to insulin sensitivity (SHBG increase), systemic inflammation (TF and HSPA4-both decreased) and lipid metabolism (APOA4 decreased). We found significant changes in the proteome for eight proteins at 6- and 12-months post-BS, and several of these are key components in metabolic and inflammatory pathways. These may represent potential biomarkers of remission of T2DM.
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Affiliation(s)
- Zohaib Iqbal
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK; (Z.I.); (J.M.G.); (R.P.D.); (H.S.)
- Department of Endocrinology, Diabetes and Metabolism, Salford Royal Foundation Trust, Salford M6 8HD, UK; (D.H.); (A.S.)
| | - Helene A. Fachim
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK; (Z.I.); (J.M.G.); (R.P.D.); (H.S.)
- Department of Endocrinology, Diabetes and Metabolism, Salford Royal Foundation Trust, Salford M6 8HD, UK; (D.H.); (A.S.)
| | - J. Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK; (Z.I.); (J.M.G.); (R.P.D.); (H.S.)
- Department of Endocrinology, Diabetes and Metabolism, Salford Royal Foundation Trust, Salford M6 8HD, UK; (D.H.); (A.S.)
| | - Ivona Baricevic-Jones
- Stoller Biomarker Discovery Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (I.B.-J.); (A.E.C.); (B.G.); (A.D.W.)
| | - Amy E. Campbell
- Stoller Biomarker Discovery Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (I.B.-J.); (A.E.C.); (B.G.); (A.D.W.)
| | - Bethany Geary
- Stoller Biomarker Discovery Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (I.B.-J.); (A.E.C.); (B.G.); (A.D.W.)
| | - Rachelle P. Donn
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK; (Z.I.); (J.M.G.); (R.P.D.); (H.S.)
| | - Dashne Hamarashid
- Department of Endocrinology, Diabetes and Metabolism, Salford Royal Foundation Trust, Salford M6 8HD, UK; (D.H.); (A.S.)
| | - Akheel Syed
- Department of Endocrinology, Diabetes and Metabolism, Salford Royal Foundation Trust, Salford M6 8HD, UK; (D.H.); (A.S.)
| | - Anthony D. Whetton
- Stoller Biomarker Discovery Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (I.B.-J.); (A.E.C.); (B.G.); (A.D.W.)
- Manchester National Institute for Health Research Biomedical Research Centre, Manchester M13 9WL, UK
| | - Handrean Soran
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK; (Z.I.); (J.M.G.); (R.P.D.); (H.S.)
| | - Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK; (Z.I.); (J.M.G.); (R.P.D.); (H.S.)
- Department of Endocrinology, Diabetes and Metabolism, Salford Royal Foundation Trust, Salford M6 8HD, UK; (D.H.); (A.S.)
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Akkus G, Tetiker T. Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies? World J Diabetes 2021; 12:1312-1324. [PMID: 34512896 PMCID: PMC8394232 DOI: 10.4239/wjd.v12.i8.1312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus (T2DM). Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM. There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM, but remission rates of T2DM after metabolic surgery can display great variability.
AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy, adjustable gastric banding, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.
METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures.
RESULTS In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patient with T2DM, but further studies are needed to clarify better the rate of diabetes remission.
CONCLUSION In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patients with T2DM, but further studies are needed to clarify better the rate of diabetes remission.
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Affiliation(s)
- Gamze Akkus
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
| | - Tamer Tetiker
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
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19
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Brown A, McArdle P, Taplin J, Unwin D, Unwin J, Deakin T, Wheatley S, Murdoch C, Malhotra A, Mellor D. Dietary strategies for remission of type 2 diabetes: A narrative review. J Hum Nutr Diet 2021; 35:165-178. [PMID: 34323335 DOI: 10.1111/jhn.12938] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
Type 2 diabetes (T2DM) is a growing health issue globally, which until recently has been considered to be one that is both chronic and progressive. Treatments, although having lifestyle and dietary change as core components, have been focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies which have set out to achieve remission; remission of T2DM has emerged as treatment goal. A group of specialist dietitians, medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM, and undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss, and although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, but may rather constitute a 'state of mitigation' of T2DM. This technical point may not be considered important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches which can help to achieve it. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Adrian Brown
- Centre for Obesity Research, University College London, London, UK.,National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Paul McArdle
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | - Campbell Murdoch
- Private GP, Farmborough, Bath, UK.,Diabetes Digital Media, Coventry, UK
| | - Aseem Malhotra
- Visiting Professor of Evidence Based Medicine, Bahiana School of Medicine and Public Heath, Salvador, Brazil
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, UK
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20
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DI Giuseppe G, Ciccarelli G, Cefalo CM, Cinti F, Moffa S, Improta F, Capece U, Pontecorvi A, Giaccari A, Mezza T. Prediabetes: how pathophysiology drives potential intervention on a subclinical disease with feared clinical consequences. Minerva Endocrinol (Torino) 2021; 46:272-292. [PMID: 34218657 DOI: 10.23736/s2724-6507.21.03405-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder whose rising incidence suggests the epidemic proportions of the disease. Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) - alone or combined - represent two intermediate metabolic condition between Normal Glucose Tolerance (NGT) and overt T2DM. Several studies have demonstrated that insulin resistance and beta-cell impairment can be identified even in normoglycemic prediabetic individuals. Worsening of these two conditions may lead to progression of IGT and/or IFG status to overt diabetes. Starting from these assumptions, it seems logical to suppose that interventions aimed at improving metabolic conditions, even in prediabetes, could represent an effective target to halt transition from IGT/IFG to manifest T2DM. Starting from pathophysiological knowledge, in this review we evaluate two possible interventions (lifestyle modifications and pharmacological agents) eligible as prediabetes therapy since they have been demonstrated to improve insulin resistance and beta-cell impairment. Detecting high-risk people and treating them could represent an effective strategy to slow down progression to overt diabetes, normalize glucose tolerance, and even prevent micro- and macrovascular complications.
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Affiliation(s)
- Gianfranco DI Giuseppe
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gea Ciccarelli
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara M Cefalo
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Cinti
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Moffa
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Improta
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Capece
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Giaccari
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa Mezza
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy - .,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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21
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Mateo-Gavira I, Sánchez-Toscano E, Mayo-Ossorio MÁ, Pacheco-García JM, Prada-Oliveira JA, Vílchez-López FJ. Evaluation of Clinical Factors Predictive of Diabetes Remission Following Bariatric Surgery. J Clin Med 2021; 10:jcm10091945. [PMID: 34062745 PMCID: PMC8124312 DOI: 10.3390/jcm10091945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Bariatric surgery is an effective treatment for achieving significant weight loss and improving metabolic comorbidities such as type 2 diabetes mellitus (T2DM). The aim of our study was to investigate clinical factors related to T2DM remission in obese patients who had undergone bariatric surgery. METHODS A cohort of patients with T2DM and a minimum of class II obesity undergoing bariatric surgery had their clinical and anthropometric variables assessed. The statistical evaluation included multivariate analyses of clinical factors predicting a T2DM remission two years post-surgery. RESULTS 83 patients were included (mean age 44.13 ± 10.38 years). Two years post-surgery, the percentage of excess weight lost was 63.43 ± 18.59%, and T2DM was resolved in 79.5% of the patients. T2DM remission was directly related to a high body mass index (BMI) (OR: 1.886; p = 0.022) and the absence of macro-vascular complications (OR: 34.667; p = 0.002), while it was inversely associated with T2DM with a duration longer than 5 years (OR: 0.022; p = 0.040) and baseline insulin treatment (OR: 0.001; p = 0.009). 15.6% of the patients presented early complications and 20.5% developed late complications. CONCLUSION In our study sample, bariatric surgery proved to be an effective and safe technique for sustained medium-term weight loss and the resolution of T2DM. A higher baseline BMI, a shorter T2DM duration, non-insulin treatment, and the absence of macro-vascular complications are factors predictive of T2DM remission.
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Affiliation(s)
- Isabel Mateo-Gavira
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (I.M.-G.); (E.S.-T.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
| | - Esteban Sánchez-Toscano
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (I.M.-G.); (E.S.-T.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
| | - Mª Ángeles Mayo-Ossorio
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- General Surgery Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - José Manuel Pacheco-García
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- General Surgery Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - Jose Arturo Prada-Oliveira
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- School of Medicine, Cadiz University (UCA), 11003 Cádiz, Spain
| | - Francisco Javier Vílchez-López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (I.M.-G.); (E.S.-T.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain; (M.Á.M.-O.); (J.M.P.-G.); (J.A.P.-O.)
- Correspondence: ; Tel.: +34-956-003-095
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22
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Hritcu L, Borcea D, Anton E, Morosan S, Pasca S, Trinca C, Spataru M, Petrariu F, Burtan L, Ciobica A, Curpan A, Timofte D. EXPERIMENTAL INDUCTION OF TYPE 2 DIABETES MELLITUS AND THE EFFICIENCY OF BARIATRIC SURGERY IN ITS REVERSAL IN RATS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:149-156. [PMID: 34925562 PMCID: PMC8665240 DOI: 10.4183/aeb.2021.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Following recent years, there is an increased body of literature on the connections that might exist between type 2 diabetes mellitus and the efficiency of bariatric surgery in its reversal compared to other medical approaches such as dieting. AIM To induce experimentally type 2 diabetes mellitus in rats in order to observe the effects of bariatric surgery in the recovery as well as the reestablishment of normal insulin levels in order to extend the findings in house animals. MATERIALS AND METHODS This study was conducted in three stages: the first consisted in inducing type 2 diabetes mellitus (T2DM) in 40 young Wistar male rats, by initially feeding them human food high in vegetal fats, oleaginous seeds, simple and complex carbohydrates, sugars, lipids, fats, proteins and fructose for a period of 8 weeks followed by a single low dose of streptozotocin (STZ), administered through intraperitoneal injection. The second stage of the study started when the rats became obese and therefore qualified for the bariatric procedure and the third stage consisted of post-operation supervision and care. The surgical procedure, performed on 10 obese rats, consisted in reducing the size of the stomach by partial gastrectomy of a 1.5 - 2.0 cm wide and 6.5 - 7.5 cm long area on the large curvature. RESULTS Showed rapid improvements in body weight and blood sugar control after 9 days. CONCLUSION After putting the rats on a diet high in carbohydrates, sugars, lipids and fats and administering them STZ, the induction of type 2 diabetes was successful and the partial gastrectomy led to a better blood sugar control. The bariatric procedure provides a faster therapeutic response than conventional diets.
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Affiliation(s)
- L.D. Hritcu
- “Ion Ionescu de la Brad” University of Agricultural Science and Veterinary Medicine, Iasi, Romania
| | - D. Borcea
- “Ion Ionescu de la Brad” University of Agricultural Science and Veterinary Medicine, Iasi, Romania
| | - E. Anton
- “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - S. Morosan
- INSERM Sorbonne University, Paris, France
| | - S. Pasca
- “Ion Ionescu de la Brad” University of Agricultural Science and Veterinary Medicine, Iasi, Romania
| | - C. Trinca
- “Ion Ionescu de la Brad” University of Agricultural Science and Veterinary Medicine, Iasi, Romania
| | - M.C. Spataru
- “Ion Ionescu de la Brad” University of Agricultural Science and Veterinary Medicine, Iasi, Romania
| | - F.D. Petrariu
- “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - L.C. Burtan
- “Ion Ionescu de la Brad” University of Agricultural Science and Veterinary Medicine, Iasi, Romania
| | - A. Ciobica
- “Alexandru Ioan Cuza” University of Iasi, Faculty of Biology - Department of Research, Iasi, Romania
| | - A. Curpan
- “Alexandru Ioan Cuza” University of Iasi, Faculty of Biology - Department of Biology, Iasi, Romania
| | - D. Timofte
- “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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23
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Purnell JQ, Dewey EN, Laferrère B, Selzer F, Flum DR, Mitchell JE, Pomp A, Pories WJ, Inge T, Courcoulas A, Wolfe BM. Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study. J Clin Endocrinol Metab 2021; 106:774-788. [PMID: 33270130 PMCID: PMC7947785 DOI: 10.1210/clinem/dgaa849] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. OBJECTIVE To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). DESIGN An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. SETTING Ten US hospitals. PARTICIPANTS A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. INTERVENTIONS Roux-en-Y gastric bypass or LAGB. MAIN OUTCOME MEASURES Diabetes rates and associations of patient characteristics with remission status. RESULTS Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB. CONCLUSIONS Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB.Trial Registration clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Jonathan Q Purnell
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Correspondence and Reprint Requests: Jonathan Q Purnell, MD, Knight Cardiovascular Institute, HRC5N, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. E-mail:
| | - Elizabeth N Dewey
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Blandine Laferrère
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Faith Selzer
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - James E Mitchell
- Department of Clinical Neuroscience, University of North Dakota, Fargo, ND, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Thomas Inge
- Department of Surgery, University of Colorado, Denver, CO, USA
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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24
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Treatment Effect of Type 2 Diabetes Patients in Outpatient Department Based on Blockchain Electronic Mobile Medical App. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6693810. [PMID: 33728034 PMCID: PMC7939747 DOI: 10.1155/2021/6693810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/21/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
As the pace of people's lives accelerates, there are more and more diabetic patients. This research mainly explores the treatment effect of type 2 diabetic patients based on blockchain electronic mobile medical app. Considering that it is more realistic to adopt an off-chain storage solution, the blockchain-based medical data sharing platform in this study adopts an off-chain storage solution. Only key information is stored in the blockchain network, and all medical data will be in the cloud space. For storage, cloud storage uses Aliyun's OSS storage service, which can be expanded infinitely. The cloud operation module is responsible for all operations that interact with cloud storage. The chain code can call the cloud operation module to upload the user's encrypted medical data and user ID to Alibaba Cloud's OSS. The chain code will return the storage address of the medical data and the authorized access address is sent to the blockchain network for consensus on the chain. The message processing module provides information processing functions such as chat information processing, APP use reminders, and health tips. The indicator recording module includes indicator recording functions including 6 indicators of blood sugar, medication, diet, weight, exercise, and sleep. The main function of the indicator analysis module is to display the curve trends of the 6 indicators recorded by the patient in three days, one week, and one month. Comparing the change range of the mean value of glycosylated hemoglobin at the beginning and end of the two groups of patients, it can be found that the change range of glycosylated hemoglobin in the intervention group is −6.04%, while the change range of the control group is only −3.26%. The impact of the mobile medical app designed in this study will indeed be reflected in the patient's blood sugar control and help patients to better control blood sugar.
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25
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Kwee LC, Ilkayeva O, Muehlbauer MJ, Bihlmeyer N, Wolfe B, Purnell JQ, Xavier Pi-Sunyer F, Chen H, Bahnson J, Newgard CB, Shah SH, Laferrère B. Metabolites and diabetes remission after weight loss. Nutr Diabetes 2021; 11:10. [PMID: 33627633 PMCID: PMC7904757 DOI: 10.1038/s41387-021-00151-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
There is marked heterogeneity in the response to weight loss interventions with regards to weight loss amount and metabolic improvement. We sought to identify biomarkers predictive of type 2 diabetes remission and amount of weight loss in individuals with severe obesity enrolled in the Longitudinal Assessment of Bariatric Surgery (LABS) and the Look AHEAD (Action for Health in Diabetes) studies. Targeted mass spectrometry-based profiling of 135 metabolites was performed in pre-intervention blood samples using a nested design for diabetes remission over five years (n = 93 LABS, n = 80 Look AHEAD; n = 87 remitters), and for extremes of weight loss at five years (n = 151 LABS; n = 75 with high weight loss). Principal components analysis (PCA) was used for dimensionality reduction, with PCA-derived metabolite factors tested for association with both diabetes remission and weight loss. Metabolic markers were tested for incremental improvement to clinical models, including the DiaRem score. Two metabolite factors were associated with diabetes remission: one primarily composed of branched chain amino acids (BCAA) and tyrosine (odds ratio (95% confidence interval) [OR (95% CI)] = 1.4 [1.0–1.9], p = 0.045), and one with betaine and choline (OR [95% CI] = 0.7 [0.5–0.9], p = 0.02).These results were not significant after adjustment for multiple tests. Inclusion of these two factors in clinical models yielded modest improvements in model fit and performance: in a constructed clinical model, the C-statistic improved from 0.87 to 0.90 (p = 0.02), while the net reclassification index showed improvement in prediction compared to the DiaRem score (NRI = 0.26, p = 0.0013). No metabolite factors associated with weight loss at five years. Baseline levels of metabolites in the BCAA and trimethylamine-N-oxide (TMAO)-microbiome-related pathways are independently and incrementally associated with sustained diabetes remission after weight loss interventions in individuals with severe obesity. These metabolites could serve as clinically useful biomarkers to identify individuals who will benefit the most from weight loss interventions.
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Affiliation(s)
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute, Durham, NC, USA.,Sarah W. Stedman Nutrition and Metabolism Center, Durham, NC, USA
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, Durham, NC, USA.,Sarah W. Stedman Nutrition and Metabolism Center, Durham, NC, USA
| | | | - Bruce Wolfe
- Departments of Surgery and Medicine, Oregon Health & Science University,, Portland, OR, USA
| | - Jonathan Q Purnell
- Departments of Surgery and Medicine, Oregon Health & Science University,, Portland, OR, USA
| | - F Xavier Pi-Sunyer
- New York Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine Medical Center, Winston-Salem, NC, USA
| | - Judy Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine Medical Center, Winston-Salem, NC, USA
| | - Christopher B Newgard
- Duke Molecular Physiology Institute, Durham, NC, USA.,Sarah W. Stedman Nutrition and Metabolism Center, Durham, NC, USA.,Department of Pharmacology & Cancer Biology and Division of Endocrinology, Department of Medicine, Duke University, Durham, DC, USA
| | - Svati H Shah
- Duke Molecular Physiology Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, DC, USA
| | - Blandine Laferrère
- New York Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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26
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Review, Performance Comparison, and Validation of Models Predicting Type 2 Diabetes Remission After Bariatric Surgery in a Western European Population. Obes Surg 2021; 31:1549-1560. [PMID: 33398626 DOI: 10.1007/s11695-020-05157-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The majority of patients with type 2 diabetes (T2DM) achieve remission after bariatric surgery. Several models are available to preoperatively predict T2DM remission. This study compares the performance of these models in a Western population one year after surgery and explores their predictive value in comparison to a model specifically designed for our study population. MATERIALS AND METHODS Prediction models were retrieved using a literature search. Patients were retrospectively selected from a database of the Antwerp University Hospital. Performance of the models was assessed by determining the area under the receiver operating characteristic curve (AUROC), the accuracy, and the goodness of fit, and by comparing them to a custom-made logistic model. RESULTS The probability of T2DM remission was calculated using 11 predictive scoring models and 8 regression models in a cohort of 250 patients. Complete T2DM remission occurred in 64.0% of patients. The IMS score (AUROC = 0.912; accuracy = 83.6%), DiaBetter score (0.907; 82.0%), and Ad-DiaRem score (0.903; 82.8%) best predicted T2DM remission and closely approached the performance of the custom-constructed model (0.917; 84.0%). The model by Ioffe et al. (0.630; 69.2%), Umemura et al. (0.692; 71.4%), and the ABCD score (0.757; 72.8%) were the least accurate. CONCLUSION Most T2DM remission models reliably predicted one-year T2DM remission, with limited inter-model differences. The accuracy of most models approached that of the custom-constructed model, indicating a high predictive capability and performance in our patient cohort. To date, most models are only validated to estimate T2DM remission one year after surgery and they do not predict long-term remission.
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27
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de Cleva R, Kawamoto F, Borges G, Caproni P, Cassenote AJF, Santo MA. C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass. Clinics (Sao Paulo) 2021; 76:e2906. [PMID: 34378729 PMCID: PMC8311643 DOI: 10.6061/clinics/2021/e2906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.
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Affiliation(s)
- Roberto de Cleva
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Flavio Kawamoto
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Georgia Borges
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Priscila Caproni
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alex Jones Flores Cassenote
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marco Aurelio Santo
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Mazzei M, Edwards MA. Poor glycemic control in bariatric patients: a reason to delay or a reason to proceed? Surg Obes Relat Dis 2020; 17:744-755. [PMID: 33423962 DOI: 10.1016/j.soard.2020.11.022] [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: 06/17/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND More than 90% of patients with type 2 diabetes (T2D) have obesity, and over 85% of diabetic patients who undergo metabolic and bariatric surgery (MBS) will see improvement or resolution of diabetes. However, diabetes is a known risk factor for surgical complications. OBJECTIVES To determine whether poor preoperative glycemic control confers an increased perioperative risk after MBS. SETTING Academic Hospital. METHODS Retrospective review of data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). From the 2017-2018 MBSAQIP databases, we identified patients with diabetes who underwent Roux-en-Y gastric bypass or gastric sleeve surgery. Unmatched and propensity-matched univariate analyses, as well as multivariate logistic regressions, were performed to compare 30-day postoperative outcomes and complication rates between patients with poor (glycated hemoglobin [HbA1C] > 7.0) and good (HbA1C ≤ 7.0) glycemic control. RESULTS Of 40,132 T2D patients, 19,094 (52.42%) had an HbA1C level ≤ 7.0. Patients with poor glycemic control had slightly higher rates of overall morbidity (6.53% versus 5.49%, respectively; relative risk = 1.188; P < .001). However, in a 1:1 matched analysis of 23,930 patients controlling for body mass index, surgery type, approach, and co-morbidities, the findings of poorer outcomes were largely mitigated. In a multivariate analysis, poor glycemic control was not associated with morbidity. CONCLUSIONS In T2D patients, poor glycemic control does not independently increase the risk of 30-day morbidity following MBS. Adverse outcomes in the setting of poor glycemic control appear to be largely mediated by associated co-morbidities. Performing MBS in the setting of suboptimal glycemic control may be justified, with the understanding that delaying or refusing surgery can contribute to worsening of diabetes-related co-morbidities that, in turn, may ultimately have a more deleterious effect on outcomes.
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Affiliation(s)
- Michael Mazzei
- Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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Chen X, Zhang J, Zhou Z. The effects of metabolic surgery on microvascular complications in obese patients with type 2 diabetes: a meta-analysis. Surg Obes Relat Dis 2020; 17:434-443. [PMID: 33144039 DOI: 10.1016/j.soard.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/17/2020] [Accepted: 09/09/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Metabolic surgery is a standard treatment for obesity with type 2 diabetes (T2D), although the effects of metabolic surgery on the incidence rate of microvascular complications remain controversial. OBJECTIVES We aimed to evaluate the effect of metabolic surgery versus nonsurgical treatments on the incidence rate of microvascular complications in obesity with T2D. SETTING A meta-analysis of published studies. METHODS We searched PubMed, Web of Science, and the Cochrane Library to identify clinical studies assessing the effect of metabolic surgery on the incidence rate of microvascular diabetic complications compared with that of nonsurgical treatments. We extracted the primary outcomes, including the incidence rate of microvascular complications after metabolic surgery. RESULTS A total of 32,756 participants from 12 studies were identified. Metabolic surgery reduced the incidence rate of microvascular complications (odds ratios [OR], .34; 95% confidence intervals [CI], .30-.39; P < .001) compared with that of nonsurgical treatments in obesity with T2D. Moreover, metabolic surgery also reduced the incidence of diabetic nephropathy (OR, .39; 95% CI, .30-.50; P < .001), diabetic retinopathy (OR, .52; 95% CI, .42-.65; P < .001) and diabetic neuropathy (OR, .27; 95% CI, .22-.34; P < .001) compared with nonsurgical treatments in obesity with T2D. CONCLUSION Metabolic surgery was superior to nonsurgical treatments in reducing the incidence of microvascular complications in obesity with T2D. Prospective studies, preferably randomized controlled trials, with evaluations of different types of metabolic surgery are warranted to provide guidelines for treatment preferences in obesity with T2D.
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Affiliation(s)
- Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China.
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
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Harrod CS, Elman MR, Vesco KK, Wolfe BM, Mitchell JE, Pories WJ, Pomp A, Boone-Heinonen J, Purnell JQ. Associations of Pregnancy After Bariatric Surgery with Long-Term Weight Trajectories and Birth Weight: LABS-2 Study. Obesity (Silver Spring) 2020; 28:2209-2215. [PMID: 32918404 PMCID: PMC7650043 DOI: 10.1002/oby.22944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether pregnancy following bariatric surgery affects long-term maternal weight change and offspring birth weight. METHODS Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)-2 study, linear regression was used to evaluate percent change in total body weight over a 5-year follow-up period among reproductive-aged women who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. RESULTS Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2 , 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5-year follow-up period (β = 2.02; 95% CI: -1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). CONCLUSIONS Postoperative pregnancy did not diminish long-term weight loss in women in the LABS-2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight-loss expectations and family planning following bariatric surgery.
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Affiliation(s)
| | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bruce M Wolfe
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Alfons Pomp
- Weill Cornell University Medical Center, New York, New York, USA
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[Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years]. NUTR HOSP 2020; 37:750-756. [PMID: 32686438 DOI: 10.20960/nh.02993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.
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Ilyas S, Al-Refai R, Maharjan R, Diaz Bustamante L, Ghattas KN, Khan S. Bariatric Surgery and Type 2 Diabetes Mellitus: Assessing Factors Leading to Remission. A Systematic Review. Cureus 2020; 12:e9973. [PMID: 32983676 PMCID: PMC7510520 DOI: 10.7759/cureus.9973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) is a health problem of paramount proportions and is associated with significant morbidity and mortality. Our study aims to review data published on the effects of different types of bariatric surgeries on T2DM remission, compared to lifestyle and medical intervention (LMI) exclusively, along with a comprehensive finding of numerous preoperative factors that lead to remission. We used PubMed, PubMed Central (PMC), and MEDLINE to search for literature. Our criteria included peer-reviewed, English language articles published in 2010 and onwards, consisting of adults with T2DM and a body mass index (BMI) of >30 kg/m2 as the population of interest. Twenty-four articles with 5,411 patients were selected for this systematic review, which included nine randomized controlled trials (RCTs) and 15 observational studies. The primary endpoint was T2DM remission. Based on the review, bariatric surgery is superior to LMI in inducing remission in T2DM, especially when employing the Roux-en-Y Gastric Bypass (RYGB) technique. Lower age of onset and shorter duration of T2DM, along with a high BMI are some of the factors that can lead to greater remission rates. Further research in RCTs is needed by incorporating double/triple-blind protocols, a standard definition of T2DM remission, long follow-up periods to evaluate for relapses in remission and any side effects, with a focus on inflammatory markers (eg, osteopontin), scoring systems (eg, DiaRem), and benefits of One-Anastomosis Gastric Bypass (OAGB) over other modalities, to advance our understanding of T2DM remission.
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Affiliation(s)
- Shahbakht Ilyas
- Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.,Medicine and Surgery, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Reham Al-Refai
- Pathology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Reeju Maharjan
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Liliana Diaz Bustamante
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Kyrillos N Ghattas
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.,Internal Medicine, Assiut University, Assiut, EGY
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Yoshino M, Kayser BD, Yoshino J, Stein RI, Reeds D, Eagon JC, Eckhouse SR, Watrous JD, Jain M, Knight R, Schechtman K, Patterson BW, Klein S. Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes. N Engl J Med 2020; 383:721-732. [PMID: 32813948 PMCID: PMC7456610 DOI: 10.1056/nejmoa2003697] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss. METHODS We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles. RESULTS Weight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 μmol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 μmol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) μmol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5±15.9 to 61.6±13.0 μmol per kilogram of fat-free mass per minute in the diet group and from 29.4±12.6 to 54.5±10.4 μmol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group. CONCLUSIONS In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02207777.).
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Affiliation(s)
- Mihoko Yoshino
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Brandon D Kayser
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Jun Yoshino
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Richard I Stein
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Dominic Reeds
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - J Christopher Eagon
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Shaina R Eckhouse
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Jeramie D Watrous
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Mohit Jain
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Rob Knight
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Kenneth Schechtman
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Bruce W Patterson
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
| | - Samuel Klein
- From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego
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Lemieux I. Reversing Type 2 Diabetes: The Time for Lifestyle Medicine Has Come! Nutrients 2020; 12:nu12071974. [PMID: 32635141 PMCID: PMC7400171 DOI: 10.3390/nu12071974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Isabelle Lemieux
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC G1V 4G5, Canada
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McTigue KM, Wellman R, Nauman E, Anau J, Coley RY, Odor A, Tice J, Coleman KJ, Courcoulas A, Pardee RE, Toh S, Janning CD, Williams N, Cook A, Sturtevant JL, Horgan C, Arterburn D. Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg 2020; 155:e200087. [PMID: 32129809 PMCID: PMC7057171 DOI: 10.1001/jamasurg.2020.0087] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Question How do type 2 diabetes (T2DM) outcomes compare across the 2 most common bariatric procedures? Findings In this cohort study of 9710 adults with T2DM who underwent bariatric surgery, most patients who had Roux-en-Y gastric bypass or sleeve gastrectomy experienced T2DM remission at some point over 5 years of follow-up. Patients who had Roux-en-Y gastric bypass showed slightly higher T2DM remission rates, better glycemic control, and fewer T2DM relapse events than patients who had sleeve gastrectomy. Meaning Understanding diabetes outcomes of different bariatric procedures will help surgeons and patients with diabetes make informed health care choices. Importance Bariatric surgery can lead to substantial improvements in type 2 diabetes (T2DM), but outcomes vary across procedures and populations. It is unclear which bariatric procedure has the most benefits for patients with T2DM. Objective To evaluate associations of bariatric surgery with T2DM outcomes. Design, Setting, and Participants This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study. Adult patients with T2DM who had bariatric surgery between January 1, 2005, and September 30, 2015, were included. Data analysis was conducted from April 2017 to August 2019. Interventions Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Main Outcome and Measures Type 2 diabetes remission, T2DM relapse, percentage of total weight lost, and change in glycosylated hemoglobin (hemoglobin A1c). Results A total of 9710 patients were included (median [interquartile range] follow-up time, 2.7 [2.9] years; 7051 female patients [72.6%]; mean [SD] age, 49.8 [10.5] years; mean [SD] BMI, 49.0 [8.4]; 6040 white patients [72.2%]). Weight loss was significantly greater with RYGB than SG at 1 year (mean difference, 6.3 [95% CI, 5.8-6.7] percentage points) and 5 years (mean difference, 8.1 [95% CI, 6.6-9.6] percentage points). The T2DM remission rate was approximately 10% higher in patients who had RYGB (hazard ratio, 1.10 [95% CI, 1.04-1.16]) than those who had SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% (95% CI, 57.7%-60.7%) and 55.9% (95% CI, 53.9%-57.9%), respectively, at 1 year and 86.1% (95% CI, 84.7%-87.3%) and 83.5% (95% CI, 81.6%-85.1%) at 5 years postsurgery. Among 6141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG (hazard ratio, 0.75 [95% CI, 0.67-0.84]). Estimated relapse rates for those who had RYGB and SG were 8.4% (95% CI, 7.4%-9.3%) and 11.0% (95% CI, 9.6%-12.4%) at 1 year and 33.1% (95% CI, 29.6%-36.5%) and 41.6% (95% CI, 36.8%-46.1%) at 5 years after surgery. At 5 years, compared with baseline, hemoglobin A1c was reduced 0.45 (95% CI, 0.27-0.63) percentage points more for patients who had RYGB vs patients who had SG. Conclusions and Relevance In this large multicenter study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycemic control compared with those who had SG. These findings can help inform patient-centered surgical decision-making.
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Affiliation(s)
- Kathleen M McTigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Alberto Odor
- Center for Health Technology, University of California, Davis, Davis
| | - Julie Tice
- PaTH Clinical Data Research Network, Pennsylvania State University, Hershey
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roy E Pardee
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Cheri D Janning
- Duke Clinical & Translational Science Institute, Durham, North Carolina
| | - Neely Williams
- Mid-South Clinical Data Research Network, Meharry-Vanderbilt Alliance Community Partner, Nashville, Tennessee.,Now with Community Partners Network Inc, Nashville, Tennessee
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Casie Horgan
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle
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Association between weight loss and serum biomarkers with risk of incident cancer in the Longitudinal Assessment of Bariatric Surgery cohort. Surg Obes Relat Dis 2020; 16:1086-1094. [PMID: 32471725 DOI: 10.1016/j.soard.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/20/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery reduces cancer risk in populations with obesity. It is unclear if weight loss alone or metabolic changes related to bariatric surgery cause this effect. OBJECTIVE We evaluated the relationship between surgical weight loss and serum biomarker changes with incident cancer in a bariatric surgery cohort. SETTING Ten U.S. clinical facilities. METHODS The Longitudinal Assessment of Bariatric Surgery 2 (LABS-2) is a prospective multicenter cohort (n = 2458, 79% female, mean age = 46). We evaluated weight and serum biomarkers, measured preoperatively and 1 year postoperatively, as predictors for incident cancer. Associations were determined using Cox proportional hazards models adjusting for weight loss, age, sex, education, and smoking history. RESULTS Over 8759 person-years of follow-up, 82 patients reported new cancer diagnosis (936 per 100,000 person-years, 95% confidence interval [CI]: 749-1156). Cancer risk was decreased by approximately 50% in participants with 20% to 34.9% total weight loss (TWL) compared with <20% TWL (hazard ratio [HR] = .49, 95%CI: .29-.83). Reduced cancer risk was observed with percent decrease from baseline for glucose (per 10%, HR = .94, 95%CI: .90-.99), proinsulin (per 20%, HR = .95, 95%CI: .93-.98), insulin (per 30%, HR = .97, 95%CI: .96-.99), and leptin (per 20%, HR = .81, 95%CI: .68-.97), and per 15% percent increase in ghrelin (HR = .94, 95%CI: .29-.83). CONCLUSIONS After bariatric surgery, cancer risk is reduced >50% when weight loss exceeds 20% TWL compared with patients with <20% TWL. Weight loss alone may not explain the observed risk reduction, as improvements in diabetes, leptin, and ghrelin were associated with decreased cancer risk.
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Wu T, Wong SKH, Law BTT, Grieve E, Wu O, Tong DKH, Leung DKW, Lam CLK, Wong CKH. Five-year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes: A population-based propensity score-matched cohort study. Diabetes Metab Res Rev 2020; 36:e3236. [PMID: 31912598 DOI: 10.1002/dmrr.3236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
Abstract
AIMS To compare disease remission rates, weight loss, and changes of metabolic parameters of patients after bariatric surgery with nonsurgical patients. METHODS Based on the 2006-2017 Hospital Authority database, a population-based retrospective cohort of obese type 2 diabetes mellitus (T2DM) patients with and without bariatric surgery were identified. Surgical patients were matched with nonsurgical patients on 1-to-5 propensity score. Remission rates of diabetes, hypertension, and dyslipidaemia were reported annually up to 60 months. Changes in weight loss measurements (Body Mass Index [BMI], percentage of total weight loss [%TWL], percentage of excess weight loss [%EWL], and percentage of rebound in excess weight loss [%REWL]) and metabolic parameters (haemoglobin A1c [HbA1c ], systolic blood pressure [SBP], diastolic blood pressure [DBP], and low-density lipoprotein cholesterol [LDL-C]) were measured for both groups. RESULTS Four hundred one surgical patients (310 restrictive surgeries; 91 bypass surgeries) and 1894 nonsurgical patients were included. Surgical patients had higher remission rates in diabetes and dyslipidaemia and better glycaemic control at 12 to 60 months (all Ps < .01). SBP and DBP were significantly lower for surgical group up to 12 months and similar between two groups after 12 months. Surgical patients had significantly lower BMI during follow-up period. %TWL and %EWL were higher in the surgery group (15.7% vs 3.7%; 48.8% vs 12.0%) at 60 months (P < .001); differences in %REWL between two groups were insignificant. The effectiveness of restrictive and bypass surgeries was similar at 60 months, although restrictive surgeries were slightly more effective in T2DM remission. CONCLUSIONS Bariatric surgery was effective in weight loss, remission of diabetes, and dyslipidaemia in 5-year post-surgery.
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Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | | | - Betty Tsz Ting Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Daniel King Hung Tong
- Surgery Centre, Hong Kong Sanatorium & Hospital, University of Glasgow, Hong Kong SAR, China
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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Chung IM, Rajakumar G, Subramanian U, Venkidasamy B, Khanna VG, Thiruvengadam M. Insights on the current status and advancement of diabetes mellitus type 2 and to avert complications: An overview. Biotechnol Appl Biochem 2020; 67:920-928. [PMID: 31736194 DOI: 10.1002/bab.1853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/12/2019] [Indexed: 01/11/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is an endocrine metabolic disorder, occurring worldwide due to aging, advancement in lifestyle by modernization. T2DM is characterized by higher levels of glucose in the blood due to unresponsive secretion of pancreatic insulin and insulin activity or altogether. T2DM is regarded as a powerful genetic susceptible disease that leads to high risk with insulin resistance and β-cell dysfunction. To manage and overcome type 2 diabetes, physical activity, diet strategies, and other therapeutic medications along with usage of antiglycemic agents are developed and attempted appropriately. In the present review, attention has been focused on the understanding of T2DM outcomes, complications with possible management strategies, and pathophysiology of T2DM. Further, a detailed note on antiglycemic agents in use and other possible drugs of choice was discussed in the light of current preventive strategies are presented in this review.
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Affiliation(s)
- Ill-Min Chung
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul, Republic of Korea
| | - Govindasamy Rajakumar
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul, Republic of Korea
| | - Umadevi Subramanian
- Translational Research Platform for Veterinary Biologicals, Central University Laboratory Building, Tamil Nadu Veterinary and Animal Sciences University (TANUVAS), Madhavaram Milk Colony, Chennai, Tamil Nadu, India
| | - Baskar Venkidasamy
- Department of Biotechnology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Venkatesan Gopiesh Khanna
- Department of Biotechnology, Vels Institute of Science, Technology & Advanced Studies (VISTAS), Pallavaram, Chennai, Tamil Nadu, India
| | - Muthu Thiruvengadam
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul, Republic of Korea
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Varela-Rodríguez BM, Juiz-Valiña P, Varela L, Outeiriño-Blanco E, Bravo SB, García-Brao MJ, Mena E, Noguera JF, Valero-Gasalla J, Cordido F, Sangiao-Alvarellos S. Beneficial Effects of Bariatric Surgery-Induced by Weight Loss on the Proteome of Abdominal Subcutaneous Adipose Tissue. J Clin Med 2020; 9:jcm9010213. [PMID: 31941045 PMCID: PMC7019912 DOI: 10.3390/jcm9010213] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022] Open
Abstract
Bariatric surgery (BS) is the most effective treatment for obesity and has a positive impact on cardiometabolic risk and in the remission of type 2 diabetes. Following BS, the majority of fat mass is lost from the subcutaneous adipose tissue depot (SAT). However, the changes in this depot and functions and as well as its relative contribution to the beneficial effects of this surgery are still controversial. With the aim of studying altered proteins and molecular pathways in abdominal SAT (aSAT) after body weight normalization induced by BS, we carried out a proteomic approach sequential window acquisition of all theoretical mass spectra (SWATH-MS) analysis. These results were complemented by Western blot, electron microscopy and RT-qPCR. With all of the working tools mentioned, we confirmed that after BS, up-regulated proteins were associated with metabolism, the citric acid cycle and respiratory electron transport, triglyceride catabolism and metabolism, formation of ATP, pyruvate metabolism, glycolysis/gluconeogenesis and thermogenesis among others. In contrast, proteins with decreased values are part of the biological pathways related to the immune system. We also confirmed that obesity caused a significant decrease in mitochondrial density and coverage, which was corrected by BS. Together, these findings reveal specific molecular mechanisms, genes and proteins that improve adipose tissue function after BS characterized by lower inflammation, increased glucose uptake, higher insulin sensitivity, higher de novo lipogenesis, increased mitochondrial function and decreased adipocyte size.
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Affiliation(s)
- Bárbara María Varela-Rodríguez
- Endocrine, Nutritional and Metabolic Diseases Group, Faculty of Health Sciences, Universidade da Coruña, Campus de Oza, 15006 A Coruña, Spain; (B.M.V.-R.); (P.J.-V.); (F.C.)
- INIBIC (Instituto de Investigación Biomédica de A Coruña), Xubias de Arriba, 84. 15006 A Coruña, Spain
- CICA (Centro de Investigaciones Científicas Avanzadas), As Carballeiras, s/n Campus de, San Vicente de Elviña, 15008 A Coruña, Spain
| | - Paula Juiz-Valiña
- Endocrine, Nutritional and Metabolic Diseases Group, Faculty of Health Sciences, Universidade da Coruña, Campus de Oza, 15006 A Coruña, Spain; (B.M.V.-R.); (P.J.-V.); (F.C.)
- INIBIC (Instituto de Investigación Biomédica de A Coruña), Xubias de Arriba, 84. 15006 A Coruña, Spain
- CICA (Centro de Investigaciones Científicas Avanzadas), As Carballeiras, s/n Campus de, San Vicente de Elviña, 15008 A Coruña, Spain
| | - Luis Varela
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Elena Outeiriño-Blanco
- Department of Endocrinology, Hospital Universitario A Coruña, A Coruña, 15006 A Coruña, Spain;
| | - Susana Belén Bravo
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, 15705 A Coruña, Spain;
| | - María Jesús García-Brao
- Department of Digestive and General Surgery, Hospital Universitario A Coruña, 15006 A Coruña, Spain; (M.J.G.-B.); (E.M.); (J.F.N.)
| | - Enrique Mena
- Department of Digestive and General Surgery, Hospital Universitario A Coruña, 15006 A Coruña, Spain; (M.J.G.-B.); (E.M.); (J.F.N.)
| | - José Francisco Noguera
- Department of Digestive and General Surgery, Hospital Universitario A Coruña, 15006 A Coruña, Spain; (M.J.G.-B.); (E.M.); (J.F.N.)
| | - Javier Valero-Gasalla
- Department of Plastic, Reconstructive & Aesthetic Surgery. Hospital Universitario A Coruña, 15006 A Coruña, Spain;
| | - Fernando Cordido
- Endocrine, Nutritional and Metabolic Diseases Group, Faculty of Health Sciences, Universidade da Coruña, Campus de Oza, 15006 A Coruña, Spain; (B.M.V.-R.); (P.J.-V.); (F.C.)
- INIBIC (Instituto de Investigación Biomédica de A Coruña), Xubias de Arriba, 84. 15006 A Coruña, Spain
- CICA (Centro de Investigaciones Científicas Avanzadas), As Carballeiras, s/n Campus de, San Vicente de Elviña, 15008 A Coruña, Spain
- Department of Endocrinology, Hospital Universitario A Coruña, A Coruña, 15006 A Coruña, Spain;
| | - Susana Sangiao-Alvarellos
- Endocrine, Nutritional and Metabolic Diseases Group, Faculty of Health Sciences, Universidade da Coruña, Campus de Oza, 15006 A Coruña, Spain; (B.M.V.-R.); (P.J.-V.); (F.C.)
- INIBIC (Instituto de Investigación Biomédica de A Coruña), Xubias de Arriba, 84. 15006 A Coruña, Spain
- CICA (Centro de Investigaciones Científicas Avanzadas), As Carballeiras, s/n Campus de, San Vicente de Elviña, 15008 A Coruña, Spain
- Correspondence:
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Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis 2019; 16:175-247. [PMID: 31917200 DOI: 10.1016/j.soard.2019.10.025] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Caroline Apovian
- Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - W Timothy Garvey
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rachel Pessah-Pollack
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | | | - Stephanie Adams
- American Association of Clinical Endocrinologists, Jacksonville, Florida
| | - John B Cleek
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Karen Flanders
- Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Michael V Seger
- Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Zaveri H, Surve A, Cottam D, Cottam A, Medlin W, Richards C, Belnap L, Cottam S, Horsley B. Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center. Obes Surg 2019; 28:3062-3072. [PMID: 29909514 DOI: 10.1007/s11695-018-3358-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. PURPOSE To analyze the outcomes with SADI-S at 4 years. METHODS Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. RESULTS There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. CONCLUSIONS SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.
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Affiliation(s)
- Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Austin Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - LeGrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Benjamin Horsley
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Douros JD, Tong J, D’Alessio DA. The Effects of Bariatric Surgery on Islet Function, Insulin Secretion, and Glucose Control. Endocr Rev 2019; 40:1394-1423. [PMID: 31241742 PMCID: PMC6749890 DOI: 10.1210/er.2018-00183] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
Abstract
Although bariatric surgery was developed primarily to treat morbid obesity, evidence from the earliest clinical observations to the most recent clinical trials consistently demonstrates that these procedures have substantial effects on glucose metabolism. A large base of research indicates that bariatric surgeries such as Roux-en-Y gastric bypass (RYGB), vertical sleeve gastrectomy (VSG), and biliopancreatic diversion (BPD) improve diabetes in most patients, with effects frequently evident prior to substantial weight reduction. There is now unequivocal evidence from randomized controlled trials that the efficacy of surgery is superior to intensive life-style/medical management. Despite advances in the clinical understanding and application of bariatric surgery, there remains only limited knowledge of the mechanisms by which these procedures confer such large changes to metabolic physiology. The improvement of insulin sensitivity that occurs with weight loss (e.g., the result of diet, illness, physical training) also accompanies bariatric surgery. However, there is evidence to support specific effects of surgery on insulin clearance, hepatic glucose production, and islet function. Understanding the mechanisms by which surgery affects these parameters of glucose regulation has the potential to identify new targets for therapeutic discovery. Studies to distinguish among bariatric surgeries on key parameters of glucose metabolism are limited but would be of considerable value to assist clinicians in selecting specific procedures and investigators in delineating the resulting physiology. This review is based on literature related to factors governing glucose metabolism and insulin secretion after the commonly used RYGB and VSG, and the less frequently used BPD and adjustable gastric banding.
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Affiliation(s)
- Jonathan D Douros
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - Jenny Tong
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - David A D’Alessio
- Division of Endocrinology, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
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Thereaux J, Lesuffleur T, Czernichow S, Basdevant A, Msika S, Nocca D, Millat B, Fagot-Campagna A. Association Between Bariatric Surgery and Rates of Continuation, Discontinuation, or Initiation of Antidiabetes Treatment 6 Years Later. JAMA Surg 2019; 153:526-533. [PMID: 29450469 DOI: 10.1001/jamasurg.2017.6163] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Few large-scale long-term prospective cohort studies have assessed changes in antidiabetes treatment after bariatric surgery. Objective To describe the association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years after bariatric surgery compared with a matched control obese group. Design, Setting, and Participants This nationwide observational population-based cohort study extracted health care reimbursement data from the French national health insurance database from January 1, 2008, to December 31, 2015. All patients undergoing primary bariatric surgery in France between January 1 and December 31, 2009, were matched on age, sex, body mass index category, and antidiabetes treatment with control patients hospitalized for obesity in 2009 with no bariatric surgery between 2005 and 2015. Exposures Bariatric surgery, including adjustable gastric banding (AGB), gastric bypass (GBP), and sleeve gastrectomy (SG). Main Outcome and Measure Reimbursement for antidiabetes drugs. Mixed-effects logistic regression models estimated factors of discontinuation or initiation of antidiabetes treatment over a period of 6 years. Results In 2009, a total of 15 650 patients (mean [SD] age, 38.9 [11.2] years; 84.6% female; 1633 receiving antidiabetes treatment) underwent primary bariatric surgery, with 48.5% undergoing AGB, 27.7% undergoing GBP, and 22.0% undergoing SG. Among patients receiving antidiabetes treatment at baseline, the antidiabetes treatment discontinuation rate was higher 6 years after bariatric surgery than in controls (-49.9% vs -9.0%, P < .001). In multivariable analysis, the main predictive factors for discontinuation were the following: GBP (odds ratio [OR], 16.7; 95% CI, 13.0-21.4), SG (OR, 7.30; 95% CI, 5.50-9.50), and AGB (OR, 4.30; 95% CI, 3.30-5.60) compared with no bariatric surgery, as well as insulin use (OR, 0.17; 95% CI, 0.13-0.22), dual therapy without insulin (OR, 0.38; 95% CI, 0.32-0.45) vs monotherapy, lipid-lowering treatment (OR, 0.76; 95% CI, 0.63-0.91), antidepressant treatment (OR, 0.67; 95% CI, 0.55-0.81), and age (OR, 0.96; 95% CI, 0.95-0.97) per year. For patients without antidiabetes treatment at baseline, the 6-year antidiabetes treatment initiation rate was much lower after bariatric surgery than in controls (1.4% vs 12.0%, P < .001). In multivariable analysis, protective factors were GBP (OR, 0.06; 95% CI, 0.04-0.09), SG (OR, 0.08; 95% CI, 0.06-0.11), and AGB (OR, 0.16; 95% CI, 0.14-0.20) vs controls, and risk factors were as follows: body mass index category (OR, 2.04; 95% CI, 1.68-2.47 for ≥50.0 vs 30.0-39.9 and OR, 1.68; 95% CI, 1.49-1.90 for 40.0-49.9 vs 30.0-39.9), antihypertensive treatment (OR, 1.49; 95% CI, 1.33-1.67), low income (OR, 1.43; 95 % CI, 1.26-1.62), and age (OR, 1.04; 95 % CI, 1.03-1.05) per year. Conclusions and Relevance Bariatric surgery was associated with a significantly higher 6-year postoperative antidiabetes treatment discontinuation rate compared with baseline and with an obese control group without bariatric surgery.
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Affiliation(s)
- Jérémie Thereaux
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.,Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France.,University of Bretagne Occidentale, Equipe d'Accueil 3878 Groupe d'Étude de la Thrombose en Bretagne Occidentale (GETBO), Brest, France
| | - Thomas Lesuffleur
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Sébastien Czernichow
- Department of Nutrition, Hôpital Européen Georges-Pompidou, Centre Spécialisé Obésité Ile de France Sud, Assistance Publique-Hôpitaux de Paris, Paris, France.,The University Paris Descartes, Paris, France
| | - Arnaud Basdevant
- Department of Heart and Nutrition, The Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.,University Pierre et Marie Curie Paris 6, Paris, France
| | - Simon Msika
- Department of General, Digestive and Metabolic Surgery, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Diderot University Paris 7, Colombes, France
| | - David Nocca
- Department of Surgery, Centre Hospitalier Universitaire Montpellier, Faculty of Medicine of Montpellier, Montpellier, France
| | - Bertrand Millat
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Anne Fagot-Campagna
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
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Fox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. Curr Obes Rep 2019; 8:201-209. [PMID: 31054014 DOI: 10.1007/s13679-019-00347-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. RECENT FINDINGS Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA.
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Megan M Oberle
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
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Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: Fact or Fiction? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173171. [PMID: 31480306 PMCID: PMC6747427 DOI: 10.3390/ijerph16173171] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 02/07/2023]
Abstract
Although type 2 diabetes mellitus (T2DM) has been traditionally viewed as an intractable chronic medical condition, accumulating evidence points towards the notion that a complete remission of T2DM is feasible following a choice of medical and/or surgical interventions. This has been paralleled by increasing interest in the establishment of a universal definition for T2DM remission which, under given circumstances, could be considered equivalent to a “cure”. The efficacy of bariatric surgery in particular for achieving glycemic control has highlighted surgery as a candidate curative intervention for T2DM. Herein, available evidence regarding available surgical modalities and the mechanisms that drive metabolic amelioration after bariatric surgery are reviewed. Furthermore, reports from observational and randomized studies with regard to T2DM remission are reviewed, along with concepts relevant to the variety of definitions used for T2DM remission and other potential sources of discrepancy in success rates among different studies.
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Friedman AN, Wang J, Wahed AS, Docherty NG, Fennern E, Pomp A, Purnell JQ, le Roux CW, Wolfe B. The Association Between Kidney Disease and Diabetes Remission in Bariatric Surgery Patients With Type 2 Diabetes. Am J Kidney Dis 2019; 74:761-770. [PMID: 31331758 DOI: 10.1053/j.ajkd.2019.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/07/2019] [Indexed: 01/08/2023]
Abstract
RATIONALE & OBJECTIVE The association between bariatric surgery, type 2 diabetes, and chronic kidney disease (CKD) is poorly understood. We studied whether remission of type 2 diabetes induced by bariatric surgery influences markers of kidney disease, if CKD is associated with remission of diabetes after bariatric surgery, and if baseline levels of gut hormones and peptides modify these associations. STUDY DESIGN Prospective observational study. STUDY PARTICIPANTS 737 bariatric surgery patients with type 2 diabetes who participated in a multicenter cohort study for up to 5 years. PREDICTORS Demographics, blood pressure, medications, type of bariatric surgery, anthropometrics, markers of kidney disease, and circulating levels of gut hormones and peptides. OUTCOMES Estimated glomerular filtration rate (eGFR), urinary albumin excretion, prognostic risk for CKD, and remission of diabetes. ANALYTICAL APPROACH Linear mixed models for eGFR; generalized linear mixed models with logit link for albuminuria, prognostic risk for CKD, and diabetes remission. RESULTS Remission of diabetes at 5 years post-bariatric surgery was not independently associated with eGFR but was associated with lower risk for moderate/severe increase in albuminuria (risk ratio, 0.66; 95% CI, 0.48-0.90) and stabilization in prognostic risk for CKD. These findings were modified by baseline ghrelin level. Lower preoperative eGFR and greater prognostic risk for CKD were independently associated with reduced likelihood of diabetes remission. The association with preoperative GFR was modified by C-peptide level. Higher baseline circulating ghrelin level was independently associated with a lower prognostic risk for CKD. LIMITATIONS A minority of participants had baseline CKD; lack of comparison group; no information on duration of diabetes, other clinical end points, or kidney biopsy results. CONCLUSIONS Remission of type 2 diabetes 5 years after bariatric surgery was associated with improvements in albuminuria and stabilized prognostic risk for CKD, but not with eGFR. Lower kidney function and greater prognostic risk at the time of bariatric surgery was linked to a lower likelihood of diabetes remission. These results highlight the need to identify the mechanisms through which bariatric surgery may delay the long-term progression of CKD in type 2 diabetes.
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Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
| | - Junyao Wang
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Abdus S Wahed
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Neil G Docherty
- Conway Institute, School of Medicine, University College Dublin, Ireland
| | - Erin Fennern
- Surgical Outcomes Research Center, University of Washington, Seattle, WA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical Center, New York, NY
| | | | - Carel W le Roux
- Department of Pathology, University College Dublin, Dublin, Ireland
| | - Bruce Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, OR
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Costa Pereira LM, Aidar FJ, de Matos DG, de Farias Neto JP, de Souza RF, Sobral Sousa AC, de Almeida RR, Prado Nunes MA, Nunes-Silva A, da Silva Júnior WM. Assessment of Cardiometabolic Risk Factors, Physical Activity Levels, and Quality of Life in Stratified Groups up to 10 Years after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111975. [PMID: 31167365 PMCID: PMC6603870 DOI: 10.3390/ijerph16111975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Abstract
Obesity is a highly prevalent chronic metabolic disease, with an increasing incidence, and is currently approaching epidemic proportions in developing countries. Ouraim was to evaluate the activity levels, quality of life (QoL), clinical parameters, laboratory parameters, and cardiometabolic risk factors afterbariatric surgery (BS). We classified78 patients who underwentBS into four groups, as follows: Those evaluated 1–2 years after BS (BS2), 2–4 years after BS (BS4), 4–6 years after BS (BS6), and 6–10 years after BS (BS+6). Body weight (BW), body mass index (BMI), comorbidities associated with obesity (ACRO), physical activity level, and QoL were evaluated. Patients exhibited improvements in BW, BMI, cardiometabolic risk, hypertension, dyslipidemia, and diabetes and significant changes in lipid profiles in the first postoperative yearafter BS.The physical activity level inthe BS2, BS4, and BS6 groups was increased, compared with that in the first postoperative year, with a decrease in International Physical Activity Questionnaire scores at 1 year in the BS2 (207.50 ± 30.79), BS4 (210.67 ± 33.69), and BS6 (220.00 ± 42.78) groups. The QoL of patients in theBS2 and BS4 groups was excellent and that of patients in the BS4 and BS+6 groupswas very good. These findings suggest that BS promoted improved physical activity levels and QoL and reduced comorbidities in patients with morbid obesity.
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Affiliation(s)
| | - Felipe J Aidar
- Post Graduate Program in Physical Education, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
- Department of Physical Education, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports-GEPEPS, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
- Post Graduate Program in Health Sciences, Federal University of Sergipe-UFS, São Cristovão, SE 49100-000, Brazil.
- Post Graduate Program in Physiological Sciences, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
| | - Dihogo Gama de Matos
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports-GEPEPS, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
| | - Jader Pereira de Farias Neto
- Post Graduate Program in Health Sciences, Federal University of Sergipe-UFS, São Cristovão, SE 49100-000, Brazil.
- Department of Physical Therapy, UniversityHospital, Federal University of Sergipe, Aracaju, SE 49100-000, Brazil.
| | - Raphael Fabrício de Souza
- Department of Physical Education, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
| | | | - Rebeca Rocha de Almeida
- Post Graduate Program in Health Sciences, Federal University of Sergipe-UFS, São Cristovão, SE 49100-000, Brazil.
| | - Marco Antonio Prado Nunes
- Post Graduate Program in Health Sciences, Federal University of Sergipe-UFS, São Cristovão, SE 49100-000, Brazil.
| | - Albená Nunes-Silva
- Exercise's Inflammation and Immunology Laboratory, Sports Center, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
| | - Walderi Monteiro da Silva Júnior
- Post Graduate Program in Physical Education, Federal University of Sergipe, São Cristovão, SE 49100-000, Brazil.
- Department of Physical Therapy, UniversityHospital, Federal University of Sergipe, Aracaju, SE 49100-000, Brazil.
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Scheurlen KM, Probst P, Kopf S, Nawroth PP, Billeter AT, Müller-Stich BP. Metabolic surgery improves renal injury independent of weight loss: a meta-analysis. Surg Obes Relat Dis 2019; 15:1006-1020. [DOI: 10.1016/j.soard.2019.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/10/2019] [Accepted: 03/03/2019] [Indexed: 02/05/2023]
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Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Brandt ML, Xanthakos SA, Dixon JB, Harmon CM, Chen MK, Xie C, Evans ME, Helmrath MA. Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med 2019; 380:2136-2145. [PMID: 31116917 PMCID: PMC7345847 DOI: 10.1056/nejmoa1813909] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery results in weight loss and health improvements in adults and adolescents. However, whether outcomes differ according to the age of the patient at the time of surgery is unclear. METHODS We evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). The two cohorts were participants in two related but independent studies. Linear mixed and Poisson mixed models were used to compare outcomes with regard to weight and coexisting conditions between the cohorts 5 years after surgery. The rates of death and subsequent abdominal operations and selected micronutrient levels (up to 2 years after surgery) were also compared between the cohorts. RESULTS There was no significant difference in percent weight change between adolescents (-26%; 95% confidence interval [CI], -29 to -23) and adults (-29%; 95% CI, -31 to -27) 5 years after surgery (P = 0.08). After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%; risk ratio, 1.27; 95% CI, 1.03 to 1.57) and of hypertension (68% vs. 41%; risk ratio, 1.51; 95% CI, 1.21 to 1.88). Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P = 0.003). More adolescents than adults had low ferritin levels (72 of 132 patients [48%] vs. 54 of 179 patients [29%], P = 0.004). CONCLUSIONS Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT00474318.).
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Affiliation(s)
- Thomas H Inge
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Anita P Courcoulas
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Todd M Jenkins
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Marc P Michalsky
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Mary L Brandt
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Stavra A Xanthakos
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - John B Dixon
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Carroll M Harmon
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Mike K Chen
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Changchun Xie
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Mary E Evans
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Michael A Helmrath
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
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