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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study. Surg Obes Relat Dis 2021; 17:1349-1358. [PMID: 33762128 DOI: 10.1016/j.soard.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery among patients with obesity and type 2 diabetes (T2D) can induce complete remission. However, it remains unclear whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has better T2D remission within a population-based daily practice. OBJECTIVES To compare patients undergoing RYGB and SG on the extent of T2D remission at the 1-year follow-up. SETTING Nationwide, population-based study including all 18 hospitals in the Netherlands providing metabolic and bariatric surgery. METHODS Patients undergoing RYGB and SG between October 2015 and October 2018 with 1 year of complete follow-up data were selected from the mandatory nationwide Dutch Audit for Treatment of Obesity (DATO). The primary outcome is T2D remission within 1 year. Secondary outcomes include ≥20% total weight loss (TWL), obesity-related co-morbidity reduction, and postoperative complications with a Clavien-Dindo (CD) grade ≥III within 30 days. We compared T2D remission between RYGB and SG groups using propensity score matching to adjust for confounding by indication. RESULTS A total of 5015 patients were identified from the DATO, and 4132 (82.4%) had completed a 1-year follow-up visit. There were 3350 (66.8%) patients with a valid T2D status who were included in the analysis (RYGB = 2623; SG = 727). RYGB patients had a lower body mass index than SG patients, but were more often female, with higher gastroesophageal reflux disease and dyslipidemia rates. After adjusting for these confounders, RYGB patients had increased odds of achieving T2D remission (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.14-2.1; P < .01). Groups were balanced after matching 695 patients in each group. After matching, RYGB patients still had better odds of T2D remission (OR, 1.91; 95% CI, 1.27-2.88; P < .01). Also, significantly more RYGB patients had ≥20%TWL (OR, 2.71; 95% CI, 1.96-3.75; P < .01) and RYGB patients had higher dyslipidemia remission rates (OR, 1.96; 95% CI, 1.39-2.76; P < .01). There were no significant differences in CD ≥III complications. CONCLUSION Using population-based data from the Netherlands, this study shows that RYGB leads to better T2D remission rates at the 1-year follow-up and better metabolic outcomes for patients with obesity and T2D undergoing bariatric surgery in daily practice.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands; Dutch Obesity Clinic, The Hague, Netherlands
| | | | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands; Dutch Obesity Clinic South, Heerlen, Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
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Rajput MA, Ali F, Zehra T, Zafar S, Kumar G. The effect of proton pump inhibitors on glycaemic control in diabetic patients. J Taibah Univ Med Sci 2020; 15:218-223. [PMID: 32647517 PMCID: PMC7336010 DOI: 10.1016/j.jtumed.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to evaluate the effect of proton pump inhibitors on glycaemic control amongst diabetic patients taking anti-diabetic medications. Methods This randomised interventional clinical study was conducted in Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Eighty patients of either sex (aged 30–60 years) with type 2 diabetes mellitus and without any known comorbidities were equally divided into two groups (i.e., n = 40 for each group) and were included in this study. Group A received metformin and glimepiride, while Group B, metformin and glimepiride plus omeprazole. The efficacy of the combination medications was evaluated based on fasting blood sugar (FBS) and glycosylated haemoglobin (HbA1c) levels. Serum creatinine and liver function tests were reviewed to evaluate patients' safety profile at the initial visit and after 12 weeks. Results After 12 weeks of omeprazole therapy, we observed a more significant improvement in glycaemic control in group B compared to group A based on the patients' FBS (108 ± 2.37 vs. 126 ± 2.9, P = 0.001) and HbA1c levels (7.29 ± 0.07 vs. 7.47 ± 0.04, P = 0.030). Conclusion The addition of a proton pump inhibitor along with anti-diabetic medications was considered effective in achieving better glycaemic control.
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Affiliation(s)
- Muhammad Ali Rajput
- Department of Pharmacology, Multan Medical and Dental College, Multan, Pakistan
| | - Fizzah Ali
- Department of Pharmacology, Liaquat National Medical College, Karachi, Pakistan
| | - Tabassum Zehra
- Department of Pharmacology, Liaquat National Medical College, Karachi, Pakistan
| | - Shahid Zafar
- Department of Pathology, Liaquat College of Medicine & Dentistry, Karachi, Pakistan
| | - Gunesh Kumar
- Department of Pharmacology, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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Ghadiri-Anari A, Gholami S, Zolfaghari F, Namiranian N. Prediabetes and gastrointestinal (GI) symptoms; a cross-sectional study. Diabetes Metab Syndr 2019; 13:844-846. [PMID: 30641819 DOI: 10.1016/j.dsx.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Abstract
AIMS Prediabetes associate with known micro and macrovascular complications of diabetes. Also gastrointestinal symptoms are present in diabetics higher than general population. The aim of this study was evaluation of gastrointestinal symptoms in subjects with prediabetes. METHODS This analytical cross-sectional study was conducted on 130 persons 30-65 years old, 65 pre-diabetic patients and 65 persons without glucose disorders from 2014 to 2015 in YAZD province. FBS and HbA1c used for diagnosis prediabetes. Demographic and medical history were collected. A questionnaire according to Rome III Criteria was used to collect digestive information (diarrhea, abdominal pain, constipation, abdominal bloating, heartburn, increased gas passing, nausea, intermittent diarrhea and constipation in the last 6 months ago). Frequency of GI symptoms in subjects with and without glucose disorders were compared. Data were analyzed by SPSS software Version 20. Data were reported as mean ± standard deviation or frequency and T-test, Chi Square and Spearman correlation coefficient tests were used. P-value less than 0.05 were considered statistically significant. RESULTS Higher frequency of bloating, early satiety, nausea, heartburn, gas passing and constipation are seen in the pre-diabetes group than in the control group; (p-value 0.0001, 0.0001, 0.0001, 0.0001, 0.001 and 0.0001 respectively). 96.9% in prediabetics had at least one gastrointestinal symptom, while in the normal groups 50% had at least one GI symptom (p-value: 0.0001). CONCLUSIONS Gastrointestinal symptoms were seen in prediabetics higher than healthy persons. So, prediabetes can not be considered an entirely benign and asymptomatic condition. Lifestyle interventions maybe necessary at this state.
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Affiliation(s)
- Akram Ghadiri-Anari
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Somaye Gholami
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fariba Zolfaghari
- Medical Student, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Du YT, Rayner CK, Jones KL, Talley NJ, Horowitz M. Gastrointestinal Symptoms in Diabetes: Prevalence, Assessment, Pathogenesis, and Management. Diabetes Care 2018; 41:627-637. [PMID: 29463666 DOI: 10.2337/dc17-1536] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Abstract
If you haven't measured something, you really don't know much about it.-Karl Pearson (attributed)Gastrointestinal (GI) symptoms represent an important and often unappreciated cause of morbidity in diabetes, although the significance of this burden across the spectrum of patients and the underlying pathophysiology, including the relationship of symptoms with glycemic control, remain poorly defined. The relevance of GI symptoms and the necessity for their accurate assessment have increased with the greater focus on the gut as a therapeutic target for glucose lowering. This review addresses the prevalence, assessment, pathogenesis, and management of GI symptoms in diabetes, beginning with broad principles and then focusing on specific segments of the GI tract. We initially performed a literature search of PubMed by using synonyms and combinations of the following search terms: "gastrointestinal symptoms", "diabetes", "prevalence", "pathogenesis", "diagnosis", and "management". We restricted the search results to English only. Review papers and meta-analyses are presented as the highest level of evidence where possible followed by randomized controlled trials, uncontrolled trials, retrospective and observational data, and expert opinion.
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Affiliation(s)
- Yang T Du
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen L Jones
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
- Karolinska Institute, Stockholm, Sweden
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
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Nandyal S, Suria S, Chogtu B, Bhattacharjee D. Risk of GERD with Diabetes Mellitus, Hypertension and Bronchial Asthma - A Hospital based Retrospective Cohort Study. J Clin Diagn Res 2017; 11:OC25-OC29. [PMID: 28892957 DOI: 10.7860/jcdr/2017/25571.10232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 06/07/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The rise in Gastro-Esophageal Reflux Disease (GERD) prevalence appears to have coincided with a simultaneous increase in the prevalence of diabetes mellitus, hypertension and bronchial asthma amongst the Indian population. Despite being evaluated extensively for their role as a risk factor for GERD, till date this relationship has remained a debatable one. Moreover, literature available on such studies conducted within Indian population remains scarce. AIM The aim of the present study was to examine the risk of developing GERD in patients suffering from diabetes mellitus, hypertension and asthma in a Southern Indian population. The present retrospective, triple cohort and hospital based study was conducted by accessing the patient records from the medical records department of a tertiary care hospital in Southern India. MATERIALS AND METHODS The patient's records were accessed from the year 2011 onwards. Relative Risk (RR) was calculated to determine the risk of development of GERD with every disease. Chi-square test was used to determine the statistical significance of the relationship between each disease and the development of GERD. A p-value of <0.05 was considered statistically significant. RESULTS In view of the time constraints as well as the limitations of the inclusion and exclusion criteria, data pertaining to only 40, 71 and 53 patients in Cohort 1 (diabetics), 2 (hypertensives) and 3 (bronchial asthmatics) respectively could be analyzed in the present study. The relative risk of GERD development was greater than 1 for patients belonging to Cohort 2 and 3, suggesting that the risk of GERD development is higher amongst hypertensives and asthmatics. Surprisingly, the diabetics (Cohort 1) were not associated with a high risk of GERD development. However, the relationship between any of the disease and GERD development was not statistically significant. CONCLUSION The present study found an increased risk of GERD development amongst patients suffering from hypertension and bronchial asthma, but not with diabetes mellitus.
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Affiliation(s)
- Sitara Nandyal
- Undergraduate Student, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sweta Suria
- Undergraduate Student, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Bharti Chogtu
- Associate Professor, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Dipanjan Bhattacharjee
- Postgraduate Candidate, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Khodamoradi Z, Gandomkar A, Poustchi H, Salehi A, Imanieh MH, Etemadi A, Malekzadeh R. Prevalence and Correlates of Gastroesophageal Reflux Disease in Southern Iran: Pars Cohort Study. Middle East J Dig Dis 2017; 9:129-138. [PMID: 28894514 PMCID: PMC5585905 DOI: 10.15171/mejdd.2017.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND
Prevalence of gastroesophageal reflux disease (GERD) is increasing worldwide. We aimed to
estimate the prevalence of GERD in Pars Cohort Study (PCS) and to find its correlates.
METHODS
We used the baseline data from PCS. PCS was conducted in the district of Valashahr in Fars
province in southern Iran from 2012 to 2014. 9264 inhabitants who were 40-75 years old, and
agreed to participate were enrolled. Data were collected by a structured questionnaire and simple
physical examination of all participants.
RESULTS
Generally, 58.50% (95% CI 57.49 - 59.51) of the participants had GERD and 25.10% (95%
CI 24.22 - 25.99) experienced it at least weekly. Approximately, 32.0%, 52.0%, and 24.4% of the
participants reported heart burn sensation, regurgitation, and both symptoms, respectively. Being
female (OR: 1.45, 95% CI 1.27 - 1.65), being older (OR: 1.20, 95% CI 1.06 - 1.36), being divorced/
widowed/separated (OR: 1.38, 95% CI 1.01 - 1.91), and lower education (OR: 1.43, 95% CI 1.02 -
2.03) were associated with frequent GERD.
CONCLUSION
GERD is common in PCS and its prevalence is close to that in western countries. Being female,
higher age, being divorced/widowed/separated, lower education, history of hypertension, anxiety,
insomnia, and non-cigarette tobacco smoking were associated with frequent GERD. We are going to
investigate the causal relationship between these risk factors and GERD in the next stages of PCS.
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Affiliation(s)
- Zohre Khodamoradi
- MPH Department, Student Research Committee, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdullah Gandomkar
- Non-Communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Poustchi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Salehi
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Section of Gastroenterology, Department of Pediatrics, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Etemadi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Division of Cancer Epidemiology and Genetics, National Center Institute, NIH, Bethesda, Maryland, USA
| | - Reza Malekzadeh
- Non-Communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Yi D. Letter: Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Patients with Type 2 Diabetes Mellitus ( Diabetes Metab J 2016;40:297-307). Diabetes Metab J 2016; 40:418-419. [PMID: 27766250 PMCID: PMC5069399 DOI: 10.4093/dmj.2016.40.5.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dongwon Yi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Ha JO, Lee TH, Lee CW. Response: Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Patients with Type 2 Diabetes Mellitus ( Diabetes Metab J 2016;40:297-307). Diabetes Metab J 2016; 40:420-421. [PMID: 27766251 PMCID: PMC5069400 DOI: 10.4093/dmj.2016.40.5.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jun Ouk Ha
- Department of Internal Medicine, Busan St. Mary's Hospital, Busan, Korea
| | - Tae Hee Lee
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Chang Won Lee
- Department of Internal Medicine, Busan St. Mary's Hospital, Busan, Korea
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