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Pinheiro LCHT, Rossi M, dos Santos CAF, Oliveira LVF, Vencio S, de Paula Vieira R, Juliano Y, Armond J, Silva CHM, Fonseca AL, França CN, Bachi ALL. Prevalence of associations among sarcopenia, obesity, and metabolic syndrome in Brazilian older adults. Front Med (Lausanne) 2023; 10:1206545. [PMID: 37746072 PMCID: PMC10514480 DOI: 10.3389/fmed.2023.1206545] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although aging is a process associated with the development of obesity, metabolic syndrome (MetS), and sarcopenia, the prevalence of these conditions in older adults from São Paulo, Brazil, is unclear. Methods Therefore, the current study aimed to investigate the prevalence of obesity, sarcopenia, and MetS, both separately and together, in a community-based sample of older adults from São Paulo, Brazil. Data from the medical records of 418 older adults of both genders, aged 60 years or older (mean age 69.3 ± 6.5 years), who were not physically active, were used to conduct this retrospective cross-sectional study. Anthropometric variables were used to determine both body mass index (BMI) and Conicity index (C index). Sarcopenia and MetS were defined according to the criteria of the European Working Group on Sarcopenia in Older People and by the Brazilian Society of Endocrinology and Metabolism, respectively. Results Based on BMI, the group of older men (n = 91) showed a predominance of adequate weight (n = 49) and the group of older women (n = 327) showed a predominance of obesity (n = 181). In association with obesity, while only the group of older women presented with sarcopenia (n = 5), 52 older women and 9 older men presented with MetS, and two older women presented with sarcopenia + MetS [prevalence ratio = 0.0385, 95% CI (0.007;0.1924)]. Based on the C index, 58 older women and 11 older men presented with MetS, while the occurrence of sarcopenia or MetS + sarcopenia was found in 32 and 5 older women, respectively [prevalence ratio = 0.0910, 95% CI (0.037;0.2241)]. Discussion Our results suggest that obesity, as measured by BMI or the C Index, was more closely associated with the occurrence of MetS than sarcopenia, regardless of gender, and also that sarcopenic obesity was only found in the group of older women. Additionally, the prevalence ratio of obesity, sarcopenia, and MetS evidenced using the C index was 2.3 times higher than the values found using the BMI classification.
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Affiliation(s)
| | - Marcelo Rossi
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Carlos André Freitas dos Santos
- Discipline of Geriatrics and Gerontology, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Postgraduate Program in Translational Medicine, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luis Vicente Franco Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania, Brazil
| | - Rodolfo de Paula Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
- Post-graduation Program in Science of Human and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, Brazil
| | - Yara Juliano
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Jane Armond
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Carlos Hassel Mendes Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
| | - Adriano Luís Fonseca
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
| | - Carolina Nunes França
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
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Moreira SMBP, Bachi ALL, Jirjos EI, Malheiros CA, Vencio S, Alves VLS, Sousa ART, Felipe LA, Perez EA, Lino MEM, Souza SKA, Santos JMB, Oliveira MC, Fonseca AL, Silva CHM, Vieira RP, Insalaco G, Freitas Júnior WR, Oliveira LVF. Roux-en-Y Gastric Bypass Improves Adiponectin to Leptin Ratio and Inflammatory Profile in Severely Obese Women with and without Metabolic Syndrome: A Randomized Controlled Trial. Nutrients 2023; 15:3312. [PMID: 37571250 PMCID: PMC10421521 DOI: 10.3390/nu15153312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Obesity is a troubling public health problem as it increases risks of sleep disorders, respiratory complications, systemic arterial hypertension, cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome (MetS). As a measure to counteract comorbidities associated with severe obesity, bariatric surgery stands out. This study aimed to investigate the adiponectin/leptin ratio in women with severe obesity with and without MetS who had undergone Roux-en-Y gastric bypass (RYGB) and to characterize the biochemical, glucose, and inflammatory parameters of blood in women with severe obesity before and after RYGB. Were enrolled females with severe obesity undergoing RYGP with MetS (n = 11) and without (n = 39). Anthropometric data and circulating levels of glucose, total cholesterol, high-density lipoprotein (HDL), non-HDL total cholesterol, low-density lipoprotein (LDL), adiponectin, and leptin were assessed before and 6 months after RYGB. Significant reductions in weight, body mass index, and glucose, total cholesterol, LDL, and leptin were observed after surgery, with higher levels of HDL, adiponectin, and adiponectin/leptin ratio being observed after surgery compared to the preoperative values of those. This study demonstrated that weight loss induced by RYGB in patients with severe obesity with or without MetS improved biochemical and systemic inflammatory parameters, particularly the adiponectin/leptin ratio.
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Affiliation(s)
- Sandra M. B. P. Moreira
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - André L. L. Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, SP, Brazil;
| | - Elias I. Jirjos
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Carlos A. Malheiros
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania 74175-100, GO, Brazil;
| | - Vera L. S. Alves
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Alan R. T. Sousa
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Lucenda A. Felipe
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Eduardo A. Perez
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Maria E. M. Lino
- Scientific Initiation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.E.M.L.); (S.K.A.S.)
| | - Shayra K. A. Souza
- Scientific Initiation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.E.M.L.); (S.K.A.S.)
| | - Juliana M. B. Santos
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo 05360-000, SP, Brazil;
| | - Miriã C. Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Adriano L. Fonseca
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Carlos H. M. Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Rodolfo P. Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Giuseppe Insalaco
- Institute of Translational Pharmacology, National Research Council of Italy (CNR), 90146 Palermo, Italy;
| | - Wilson R. Freitas Júnior
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Luis V. F. Oliveira
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
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Felipe LA, Bachi ALL, Oliveira MC, Moreira SMBP, Afonso JPR, Lino MEM, Paixão V, Silva CHM, Vieira RP, Vencio S, Jirjos EI, Malheiros CA, Insalaco G, Júnior WRF, Oliveira LVF. Effects of Roux-en-Y gastric bypass on the metabolic profile and systemic inflammatory status of women with metabolic syndrome: randomized controlled clinical trial. Diabetol Metab Syndr 2023; 15:19. [PMID: 36788619 PMCID: PMC9930348 DOI: 10.1186/s13098-023-00986-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Obesity remains a public health problem worldwide. The high prevalence of this condition in the population raises further concerns, considering that comorbidities are often associated with obesity. Among the comorbidities closely associated with obesity, metabolic syndrome (MS) is particularly important, which potentially increases the risk of manifestation of other disorders, such as the prothrombotic and systemic pro-inflammatory states. METHODS A randomized, controlled clinical trial was performed involving female patients (n = 32) aged between 18 and 65 years, with a clinical diagnosis of MS, with severe obesity undergoing Roux-en-Y gastric bypass (RYGB). The study design followed the Consolidated Standards of Reporting Trials statement (CONSORT). Lipid profile, blood glucose and adipokines (adiponectin, leptin, and resistin) and (cytokines IL-1β, IL-6, IL-17, IL-23, and TNF-α) in blood plasma samples were evaluated before and six months after RYGB. RESULTS Patients undergoing RYGB (BSG) showed a significant improvement from preoperative grade III obesity to postoperative grade I obesity. The results showed that while HDL levels increased, the other parameters showed a significant reduction in their postoperative values when compared not only to the values observed before surgery in the BSG group, but also to the values obtained in the control group (CG). As for systemic inflammatory markers adiponectin, leptin, resistin, IL-1β, IL-6, IL-17, IL-23 and TNF- α it was observed that the levels of resistin and IL-17 in the second evaluation increased significantly when compared to the levels observed in the first evaluation in the CG. In the BSG group, while the levels of adiponectin increased, the levels of the other markers showed significant reductions in the postoperative period, in relation to the respective preoperative levels. The analysis of Spearman's correlation coefficient showed a significant positive correlation between IL-17 and IL-23 in the preoperative period, significant positive correlations between TNF-α and IL-6, TNF-α and IL-17, IL-6 and IL-17, and IL-17 and IL-23 were observed postoperatively. CONCLUSIONS According to our results, the reduction of anthropometric measurements induced by RYGB, significantly improves not only the plasma biochemical parameters (lipid profile and glycemia), but also the systemic inflammatory status of severely obese patients with MS. Trials registration NCT02409160.
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Affiliation(s)
- Lucenda A Felipe
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - André L L Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, SP, Brazil
| | - Miriã C Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Sandra M B P Moreira
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - João Pedro R Afonso
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Maria E M Lino
- Scientific Initiation Program, Evangelical University of Goiás, (UniEVANGELICA), Anápolis, GO, Brazil
| | - Vitória Paixão
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04021-001, Brazil
| | - Carlos H M Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Rodolfo P Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania, (GO), Brazil
| | - Elias I Jirjos
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Carlos A Malheiros
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Giuseppe Insalaco
- Institute for Biomedical Research and Innovation, National Research Council of Italy (CNR), 90146, Palermo, Italy
| | - Wilson R Freitas Júnior
- Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil
| | - Luis V F Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, GO, Brazil.
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Mosenzon O, Alguwaihes A, Leon JLA, Bayram F, Darmon P, Davis TME, Dieuzeide G, Eriksen KT, Hong T, Kaltoft MS, Lengyel C, Rhee NA, Russo GT, Shirabe S, Urbancova K, Vencio S. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol 2021; 20:154. [PMID: 34315481 PMCID: PMC8317423 DOI: 10.1186/s12933-021-01344-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background There is a paucity of global data on cardiovascular disease (CVD) prevalence in people with type 2 diabetes (T2D). The primary objective of the CAPTURE study was to estimate the prevalence of established CVD and its management in adults with T2D across 13 countries from five continents. Additional objectives were to further characterize the study sample regarding demographics, clinical parameters and medication usage, with particular reference to blood glucose-lowering agents (GLAs: glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors) with demonstrated cardiovascular benefit in randomized intervention trials. Methods Data were collected from adults with T2D managed in primary or specialist care in Australia, China, Japan, Czech Republic, France, Hungary, Italy, Argentina, Brazil, Mexico, Israel, Kingdom of Saudi Arabia, and Turkey in 2019, using standardized methodology. CVD prevalence, weighted by diabetes prevalence in each country, was estimated for the overall CAPTURE sample and participating countries. Country-specific odds ratios for CVD prevalence were further adjusted for relevant demographic and clinical parameters. Results The overall CAPTURE sample included 9823 adults with T2D (n = 4502 from primary care; n = 5321 from specialist care). The overall CAPTURE sample had median (interquartile range) diabetes duration 10.7 years (5.6–17.9 years) and glycated hemoglobin 7.3% (6.6–8.4%) [56 mmol/mol (49–68 mmol/mol)]. Overall weighted CVD and atherosclerotic CVD prevalence estimates were 34.8% (95% confidence interval [CI] 32.7–36.8) and 31.8% (95% CI 29.7–33.8%), respectively. Age, gender, and clinical parameters accounted for some of the between-country variation in CVD prevalence. GLAs with demonstrated cardiovascular benefit were used by 21.9% of participants, which was similar in participants with and without CVD: 21.5% and 22.2%, respectively. Conclusions In 2019, approximately one in three adults with T2D in CAPTURE had diagnosed CVD. The low use of GLAs with demonstrated cardiovascular benefit even in participants with established CVD suggested that most were not managed according to contemporary diabetes and cardiology guidelines. Study registration NCT03786406 (registered on December 20, 2018), NCT03811288 (registered on January 18, 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01344-0.
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Affiliation(s)
- Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Hebrew University Hospital, PO Box 12000, 91120, Jerusalem, Israel.
| | - Abdullah Alguwaihes
- King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Jose Luis Arenas Leon
- Centro de Atención E Investigación Cardiovascular del Potosí, San Luis Potosí, Mexico
| | - Fahri Bayram
- Department of Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Patrice Darmon
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Australia
| | - Guillermo Dieuzeide
- Centro de Atención Integral en Diabetes, Endocrinología Y Metabolismo, Chacabuco, Buenos Aires, Argentina
| | | | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | | | | | | | - Giuseppina T Russo
- Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Messina, Messina, Italy
| | | | | | - Sergio Vencio
- Instituto de Ciencias Farmaceuticas, Goiânia, Goiás, Brazil
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Matthews D, Del Prato S, Mohan V, Mathieu C, Vencio S, Chan JCN, Stumvoll M, Paldánius PM. Insights from VERIFY: Early Combination Therapy Provides Better Glycaemic Durability Than a Stepwise Approach in Newly Diagnosed Type 2 Diabetes. Diabetes Ther 2020; 11:2465-2476. [PMID: 32975711 PMCID: PMC7547931 DOI: 10.1007/s13300-020-00926-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/10/2020] [Indexed: 12/26/2022] Open
Abstract
The treatment aims for type 2 diabetes are to prevent complications and premature mortality, and improve quality of life. Glycaemic control is central to these aims; clinical guidelines have sought to achieve this with a stepwise approach starting with lifestyle measures and metformin, adding further medications once glycated haemoglobin (HbA1c) levels rise above a predefined threshold. However, treatment intensification can be delayed when HbA1c levels increase, and HbA1c levels become inadequately controlled in many patients. Clinical inertia can result in sustained elevated levels of HbA1c; when combined with a late diagnosis, this negatively impacts patients' prognosis. Early combination therapy using medications with complementary modes of action could achieve optimal glycaemic targets and alter the course of the disease more than metformin alone. The multinational VERIFY study (clinicaltrials.gov NCT01528254) provided evidence accrued over 5 years, demonstrating the potential of early combination therapy: time to loss of glycaemic control was nearly doubled, and more than twice the number of patients experienced extended glycaemic control, with a vildagliptin-metformin combination therapy versus metformin alone. The study also showed a delay in secondary treatment failure in patients receiving the combination. Early combination therapy therefore offers a different trajectory to the stepwise approach. Translating these findings into clinical practice will require early detection and diagnosis of type 2 diabetes plus a shift in disease management. Nonetheless, the potential benefits of sustained and continuous disease control that early combination therapy offers represent the start of a new era in early diagnosis and intensive management, to achieve the treatment aims of type 2 diabetes.
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Affiliation(s)
- David Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
- Harris Manchester College, Oxford, UK.
| | - Stefano Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, 600086, India
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sergio Vencio
- ICF Instituto de Ciências Farmacêuticas de Estudos e Pesquisas Ltda, Aparecida de Goiânia, GO, Brazil
- Aparecida Municipal Hospital, HMAP, Aparecida de Goiânia, GO, Brazil
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Michael Stumvoll
- Division of Endocrinology and Diabetes, University Hospital Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG), Helmholtz Zentrum München, University of Leipzig, Leipzig, Germany
| | - Päivi Maria Paldánius
- Global Medical Affairs, Established Medicines, Diabetes, Novartis Pharma AG, Basel, Switzerland
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Scartezini M, Ferreira CEDS, Izar MCO, Bertoluci M, Vencio S, Campana GA, Sumita NM, Barcelos LF, Faludi AA, Santos RD, Malachias MVB, Aquino JL, Galoro CADO, Sabino C, Gurgel MHC, Turatti LAA, Hohl A, Martinez TLDR. Positioning about the Flexibility of Fasting for Lipid Profiling. Arq Bras Cardiol 2017; 108:195-197. [PMID: 28443960 PMCID: PMC5389867 DOI: 10.5935/abc.20170039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | | | | | - Marcello Bertoluci
- Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brazil
| | - Sergio Vencio
- Sociedade Brasileira de Diabetes, São Paulo, SP, Brazil
| | - Gustavo Aguiar Campana
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, Rio de Janeiro, RJ, Brazil
| | - Nairo Massakazu Sumita
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, Rio de Janeiro, RJ, Brazil
| | | | - André A Faludi
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Raul D Santos
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Cleide Sabino
- Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brazil
| | | | | | - Alexandre Hohl
- Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brazil
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Pecoits-Filho R, Fortes J, Volaco A, Vencio S, Sposito AC. Current management of diabetic patients with kidney disease: a renal‑cardio‑endocrine perspective. Panminerva Med 2016; 59:67-75. [PMID: 27701367 DOI: 10.23736/s0031-0808.16.03254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetic kidney disease (DKD) is one of the most frequent and dangerous complications of diabetes mellitus type 2, affecting about one‑third of the patients. DKD results in increased hospitalizations and mortality rates, especially due to cardiovascular complications. This high burden of kidney disease is mainly due to the increasing complexity of in- outpatient care for patients with DM. There is a strikingly complex interaction of kidney dysfunction with many aspects of diabetes care, such as redefinition of targets of treatment, interactions of traditional and non‑traditional risk factors, and pharmacological issues related to pharmacokinetic and side effects of drugs. Particularly when not carefully managed, DKD increases the demand for renal replacement therapies, such as dialysis and kidney transplants. The combined economic and social costs of this disease are high and of concern to the world's health systems. The main objective of this review is to provide insight into the recommendations for the evaluation and stratification of DKD and how the presence of kidney disease changes the optimal management of diabetic patients from an integrated renal‑cardio‑endocrine perspective.
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Affiliation(s)
- Roberto Pecoits-Filho
- Division of Cardiology, Endocrinology and Nephrology, School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil -
| | - José Fortes
- Division of Cardiology, Endocrinology and Nephrology, School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
| | - Aléxei Volaco
- Division of Cardiology, Endocrinology and Nephrology, School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
| | - Sergio Vencio
- Federal University of Goiás-Postgraduate Program, Goiania, Brazil
| | - Andrei C Sposito
- Cardiology Division, State University of Campinas, Unicamp, Campinas, SP, Brazil
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Pecoits-Filho R, Abensur H, Betônico CCR, Machado AD, Parente EB, Queiroz M, Salles JEN, Titan S, Vencio S. Interactions between kidney disease and diabetes: dangerous liaisons. Diabetol Metab Syndr 2016; 8:50. [PMID: 27471550 PMCID: PMC4964290 DOI: 10.1186/s13098-016-0159-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/10/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) globally affects 18-20 % of adults over the age of 65 years. Diabetic kidney disease (DKD) is one of the most frequent and dangerous complications of DM2, affecting about one-third of the patients with DM2. In addition to the pancreas, adipocytes, liver, and intestines, the kidneys also play an important role in glycemic control, particularly due to renal contribution to gluconeogenesis and tubular reabsorption of glucose. METHODS In this review article, based on a report of discussions from an interdisciplinary group of experts in the areas of endocrinology, diabetology and nephrology, we detail the relationship between diabetes and kidney disease, addressing the care in the diagnosis, the difficulties in achieving glycemic control and possible treatments that can be applied according to the different degrees of impairment. DISCUSSION Glucose homeostasis is extremely altered in patients with DKD, who are exposed to a high risk of both hyperglycemia and hypoglycemia. Both high and low glycemic levels are associated with increased morbidity and shortened survival in this group of patients. Factors that are associated with an increased risk of hypoglycemia in DKD patients include decreased renal gluconeogenesis, deranged metabolic pathways (including altered metabolism of medications) and decreased insulin clearance. On the other hand, decrease glucose filtration and excretion, and inflammation-induce insulin resistance are predisposing factors to hyperglycemic episodes. CONCLUSION Appropriate glycaemic monitoring and control tailored for diabetic patients is required to avoid hypoglycaemia and other glycaemic disarrays in patients with DM2 and kidney disease. Understanding the renal physiology and pathophysiology of DKD has become essential to all specialties treating diabetic patients. Disseminating this knowledge and detailing the evidence will be important to initiate breakthrough research and to encourage proper treatment of this group of patients.
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Affiliation(s)
- Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR 80215-901 Brazil
| | - Hugo Abensur
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carolina C. R. Betônico
- Hospital Regional de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil
| | | | | | - Márcia Queiroz
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Silvia Titan
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania, Brazil
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Strain WD, Cos X, Hirst M, Vencio S, Mohan V, Vokó Z, Yabe D, Blüher M, Paldánius PM. Time to do more: addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Res Clin Pract 2014; 105:302-12. [PMID: 24956964 DOI: 10.1016/j.diabres.2014.05.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/16/2014] [Indexed: 01/13/2023]
Abstract
AIMS Clinical inertia, the tendency to maintain current treatment strategies despite results demanding escalation, is thought to substantially contribute to the disconnect between clinical aspirations for patients with diabetes and targets achieved. We wished to explore potential causes of clinical inertia among physicians and people with diabetes. METHODS A 20-min online survey of 652 adults with diabetes and 337 treating physicians in six countries explored opinions relating to clinical inertia from both perspectives, in order to correlate perceptions and expectations relating to diagnosis, treatment, diabetes complications and therapeutic escalation. RESULTS Physicians had low expectations for their patients, despite the belief that the importance of good glycaemic control through lifestyle and pharmacological interventions had been adequately conveyed. Conversely, people with diabetes had, at best, a rudimentary understanding of the risks of complications and the importance of good control; indeed, only a small proportion believed lifestyle changes were important and the majority did not intend to comply. CONCLUSIONS The principal findings of this survey suggest that impairments in communication are at the heart of clinical inertia. This manuscript lays out four key principles that we believe are achievable in all environments and can improve the lives of people with diabetes.
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Affiliation(s)
- W D Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School, Barrack Road, Exeter EX25AX, UK.
| | - X Cos
- Sant Marti de Provençals Primary Health Care Centre, Institut Català de la Salut, Generalitat de Catalunya, C/ Fluvià 211, 08020 Barcelona, Spain
| | - M Hirst
- International Diabetes Federation, Glentirran House, Kippen, Stirlingshire FK8 3DY, Scotland, UK
| | - S Vencio
- Catholic University of Goiás, Goiânia, Avenida T4 number 313, Setor Bueno, Goiania CEP 74230-030, Brazil
| | - V Mohan
- Dr. Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, Conran Smith Road, Gopalapuram, Chennai 600086, India
| | - Z Vokó
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Syreon Research Institute, Thökölly út 119, 1146 Budapest, Hungary
| | - D Yabe
- Center for Diabetes, Endocrinology and Metabolism and Center for Metabolism and Clinical Nutrition, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka 553-0003, Japan
| | - M Blüher
- University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - P M Paldánius
- Novartis Pharma AG, Postfach CH-4002, Basel, Switzerland
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DePaula AL, Stival AR, DePaula CCL, Halpern A, Vencio S. Surgical treatment of type 2 diabetes in patients with BMI below 35: mid-term outcomes of the laparoscopic ileal interposition associated with a sleeve gastrectomy in 202 consecutive cases. J Gastrointest Surg 2012; 16:967-76. [PMID: 22350720 DOI: 10.1007/s11605-011-1807-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 08/11/2011] [Accepted: 11/01/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35. METHODS The procedures were performed on 202 consecutive patients. Mean age was 52.2 ± 7.5. Mean duration of T2DM was 9.8 ± 5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%. RESULTS Mean follow-up was 39.1 months (range, 25-61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m(2), mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A(1c) (HbA(1c)) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA(1c) below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications. CONCLUSION Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI <35. Beyond glycemic control, other benefits were achieved.
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Affiliation(s)
- Aureo L DePaula
- Department of Surgery, Hospital de Especialidades, Av. 136, no. 961, 14° andar, Setor Marista, 74.093-250, Goiânia, Goiás, Brazil.
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Vencio S, Stival A, Halpern A, Depaula CCL, DePaula AL. Early mechanisms of glucose improvement following laparoscopic ileal interposition associated with a sleeve gastrectomy evaluated by the euglycemic hyperinsulinemic clamp in type 2 diabetic patients with BMI below 35. Dig Surg 2011; 28:293-8. [PMID: 21894016 DOI: 10.1159/000330272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/21/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic ileal interposition associated with a sleeve gastrectomy (LII-SG) is a safe and effective operation for the treatment of type 2 diabetic (T2DM) patients with BMI below 35. The aim of this study was to evaluate insulin sensitivity (IS) and β-cell function using the euglycemic hyperinsulinemic clamp (EHC) with the intravenous glucose tolerance test (IVGTT). METHODS This was a prospective study of 24 T2DM patients submitted to a 3-hour EHC-IVGTT before and 1 month after LII-SG. Mean BMI was 29.0, mean age was 54.8 years and mean duration of T2DM was 10.2 years; insulin therapy was used by 62.5% of the patients. RESULTS Mean BMI decreased from 29.0 to 25.8 (p < 0.001). Mean fasting plasma glucose and mean postprandial glucose were 202 and 251.3 mg/dl and dropped to 127.7 and 131.8 mg/dl (p < 0.001), respectively. Mean preoperative IS was 1.4 mmol·min(-1)·nmol(-1) and increased to 2.2 mmol· min(-1)·nmol(-1) postoperatively (p < 0.001). Mean C-peptide AUC was 488 pmol·nmol(-1) and increased to 777 pmol· nmol(-1) (p = 0.37). The disposition index increased from 9.4 to 36.4 postoperatively (p = 0.01). CONCLUSIONS According to the clamp technique, II-SG significantly improved IS and β-cell function as early as 30 days postoperatively in a T2DM population with a BMI of 21.9-33.8.
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DePaula AL, Stival AR, Halpern A, Vencio S. Surgical treatment of morbid obesity: mid-term outcomes of the laparoscopic ileal interposition associated to a sleeve gastrectomy in 120 patients. Obes Surg 2011; 21:668-75. [PMID: 20652440 DOI: 10.1007/s11695-010-0232-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition associated to a sleeve gastrectomy (LII-SG) for the treatment of morbid obesity. The procedure was performed in 120 patients: 71 women and 49 men with mean age of 41.4 years. Mean body mass index (BMI) was 43.4 ± 4.2 kg/m². Patients had to meet requirements of the 1991 NIH conference criteria for bariatric operations. Associated comorbidities were observed in all patients, including dyslipidemia in 51.7%, hypertension in 35.8%, type 2 diabetes in 15.8%, degenerative joint disease in 55%, gastroesophageal reflux disease in 36.7%, sleep apnea in 10%, and cardiovascular problems in 5.8%. Mean follow-up was 38.4 ± 10.2 months, range 25.2-61.1. There was no conversion to open surgery nor operative mortality. Early major complications were diagnosed in five patients (4.2%). Postoperatively, 118 patients were evaluated. Late major complications were observed in seven patients (5.9%). Reoperations were performed in six (5.1%). Mean postoperative BMI was 25.7 ± 3.17 kg/m², and 86.4% were no longer obese. Mean %EWL was 84.5 ± 19.5%. Hypertension was resolved in 88.4% of the patients, dyslipidemia in 82.3%, and T2DM in 84.2%. The LII-SG provided an adequate weight loss and resolution of associated diseases during mid-term outcomes evaluation. There was an acceptable morbidity with no operative mortality. It seems that chronic ileal brake activation determined sustained reduced food intake and increased satiety over time. LII-SG could be regularly used as a surgical alternative for the treatment of morbid obesity.
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Affiliation(s)
- Aureo L DePaula
- Department of Surgery, Hospital de Especialidades, Goiania, Brazil.
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De Paula AL, Stival AR, Halpern A, DePaula CCL, Mari A, Muscelli E, Vencio S, Ferrannini E. Improvement in insulin sensitivity and β-cell function following ileal interposition with sleeve gastrectomy in type 2 diabetic patients: potential mechanisms. J Gastrointest Surg 2011; 15:1344-53. [PMID: 21557013 DOI: 10.1007/s11605-011-1550-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [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: 01/28/2011] [Accepted: 04/18/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Bariatric surgery in morbidly obese type 2 diabetic (T2DM) patients is associated with high rates of diabetes remission. We investigated the mechanisms of the anti-diabetic effect of the laparoscopic ileal interposition with sleeve gastrectomy (LII-SG) in normal weight (NW), overweight (OW) and obese (OB) T2DM patients. METHODS Ninety-four patients (aged 54 ± 8 years) with long-standing (median 10 years), treated diabetes (median HbA(1c) = 8.6%), who were NW (15), OW (64) or OB (15) based on BMI, underwent LII-SG. Insulin sensitivity and parameters of ß-cell function were measured from an Oral Glycaemic Tolerance Test pre- and post-operatively. RESULTS At a median of 13.4 months post-operatively, weight loss averaged 9.4 ± 1.3, 16.8 ± 0.8 and 23.2 ± 1.7 kg in NW, OW and OB subjects, respectively (p < 0.0001). Insulin sensitivity was fully restored (395 [108] vs 208 [99] ml min⁻¹ m⁻²), fasting insulin secretion rate decreased (68 [52] vs 146 [120] pmol min⁻¹ m⁻²) and total insulin output increased (52 [26] vs 39 [28] nmol m⁻², all p ≤ 0.001). ß-cell glucose sensitivity doubled (37 [33] vs 18 [24] mol min⁻¹ m⁻² mM⁻¹, p < 0.0001). The only parameter predicting remission of diabetes was a lower baseline insulin sensitivity (p = 0.005). CONCLUSIONS LII-SG induced changes on T2DM by mechanisms in part distinct from weight loss, principally involving restoration of insulin sensitivity and improvement of ß-cell function.
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DePaula AL, Stival A, Halpern A, Vencio S. Thirty-day morbidity and mortality of the laparoscopic ileal interposition associated with sleeve gastrectomy for the treatment of type 2 diabetic patients with BMI <35: an analysis of 454 consecutive patients. World J Surg 2011; 35:102-8. [PMID: 21052999 DOI: 10.1007/s00268-010-0799-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the early results of the laparoscopic interposition of a segment of ileum associated with a sleeve gastrectomy (LII-SG) in order to treat patients with type 2 diabetes mellitus (T2DM) and BMI <35. Data regarding morbidly obese diabetic patients subjected to surgery has consistently been validated. To date, there is scarce information about morbidity and mortality related to the surgical treatment of a "true" typical diabetic population with BMI <35. METHODS The procedures were performed in 454 patients (322 male, 132 female). Mean age was 53.6 ± 8 years (range = 27-75). Mean BMI was 29.7 ± 3.6 kg/m(2) (range = 19-34.8). All patients had the diagnosis of T2DM for at least 3 years. Insulin therapy was used by 45.6% of patients. Mean duration of T2DM was 10.8 ± 5.9 years (range = 3-35). Mean hemoglobin A(1c) was 8.8 ± 1.9%. Dyslipidemia was observed in 78.4%, hypertension in 64.8%, nephropathy in 28.6%, retinopathy in 32.6%, neuropathy in 34.6%, and coronary heart disease in 13%. RESULTS There was no conversion to open surgery. All patients were evaluated postoperatively. Mortality was 0.4%. There were 29 major complications (6.4%) in 22 patients (4.8%) and 51 minor complications (11.2%). Reoperations were performed on 8 patients (1.7%). Twenty patients (4.4%) were readmitted to the hospital. Mean postoperative BMI was 25.8 ± 3.5 kg/m(2). Mean fasting plasma glucose decreased from 198 ± 69 to 128 ± 67 mg/dl and mean postprandial plasma glucose decreased from 262 ± 101 to 136 ± 43 mg/dl. CONCLUSIONS The laparoscopic ileal interposition associated with a sleeve gastrectomy was considered a safe operation with low rates of morbidity and mortality in a diabetic population with BMI < 35. An early control of postprandial glycemia was observed.
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Affiliation(s)
- Aureo L DePaula
- Department of Surgery, Hospital de Especialidades, Goiânia, Goias, Brazil.
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De Paula AL, Macedo A, Schraibman V, Queiroz L, Machado C, Vencio S. PL-103: Prospective randomized controlled trial comparing two version of laparoscopic ileal interposition for the treatment of non obese type 2 diabetic patients. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DePaula AL, Macedo ALV, Schraibman V, Mota BR, Vencio S. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20-34. Surg Endosc 2008; 23:1724-32. [PMID: 18830747 DOI: 10.1007/s00464-008-0168-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Accepted: 09/02/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND A group of patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) 20-34 kg/m(2) were submitted to laparoscopic interposition of a segment of ileum into the proximal jejunum or into the proximal duodenum associated to a sleeve gastrectomy. The objective of this study is to evaluate the hormonal changes in the pre- and postoperative period. MATERIALS AND METHODS Hormonal evaluation was done in 58 patients operated between April 2005 and July 2006. Mean age was 51.4 years (40-66 years). Mean BMI was 28.2 (20-34.8) kg/m(2). All patients had had the diagnosis of T2DM for at least 3 years. Mean duration of T2DM was 9.6 years (3-22 years). Two techniques were performed, consisting of different combinations of ileal interposition (II) associated to a sleeve gastrectomy (SG). The following hormones were assayed in the pre- and postoperative period (mean 16 months) at the baseline and following specific food stimulation (30, 60, 120 min): glucogen-like protein 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), insulin, glucagon, C-peptide, amylin, cholecystokinin (CCK), pancreatic polypeptide (PPP), somatostatin, peptide YY (PYY), ghrelin, adiponectin, resistin, leptin, and interleukin-6 (IL-6). RESULTS Thirty patients had II associated to sleeve gastrectomy (II-SG) and 28 had II with diverted sleeve gastrectomy (II-DSG). GLP1 exhibited an important rise following the two operations, especially after II-DSG (p < 0.001). GIP also exhibited an important rise, with both II-SG and II-DSG being equally effective (p < 0.001). Insulin and amylin showed a significant rise at 30 min. Glucagon decreased slightly. CCK measurements were very low after II-DSG. PPP was also slightly altered by the II-DSG. PYY showed an important increase with both operations (p < 0.001). Ghrelin showed a significant decrease following the two operations (p < 0.001). Somatostatin and IL-6 were not affected (p = 0.632). Both leptin and resistin blood levels decreased. Adiponectin showed a slight increase. Mean postoperative follow-up was 19.2 months. Both II-SG and II-DSG were effective in achieving adequate glycemic control (91.2%). CONCLUSIONS There was a significant hormonal change following laparoscopic ileal interposition. These alterations may explain the promising good results associated to these operations for the treatment of T2DM in the nonmorbidly obese population.
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DePaula AL, Macedo ALV, Rassi N, Vencio S, Machado CA, Mota BR, Silva LQ, Halpern A, Schraibman V. Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc 2008; 22:2670-8. [PMID: 18347866 DOI: 10.1007/s00464-008-9808-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 01/11/2008] [Accepted: 01/24/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35. METHODS Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 +/- 6.4 years (range, 27-66 years) and a mean BMI of 30.1 +/- 2.7 (range, 23.6-34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 +/- 4.6 years (range, 3-22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG). RESULTS The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3-19 months). The mean BMI was 23.8 +/- 4.1 kg/m(2), and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure. CONCLUSIONS Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.
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