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Changes in Antihypertensive Medication Following Bariatric Surgery. Obes Surg 2022; 32:1312-1324. [PMID: 35083703 DOI: 10.1007/s11695-022-05893-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postoperatively. Roux-en-Y gastric bypass was the most studied surgical approach followed by Laparoscopic Sleeve Gastrectomy. Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the mean number of antihypertensive medications decreased by approximately one. In almost a third of the studies, over 75% of participants experienced hypertension remission. All articles aside from two reported a decrease in systolic BP, with about 40% reporting a decrease of ≥ 10 mm Hg.
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Calisir A, Ece I, Yilmaz H, Alptekin H, Acar F, Yormaz S, Colak B, Sahin M. The Mid-Term Effects of Transit Bipartition with Sleeve Gastrectomy on Glycemic Control, Weight Loss, and Nutritional Status in Patients with Type 2 Diabetes Mellitus: a Retrospective Analysis of a 3-Year Follow-up. Obes Surg 2021; 31:4724-4733. [PMID: 34195935 DOI: 10.1007/s11695-021-05536-1] [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: 12/28/2020] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Metabolic surgery is an effective treatment method for glycemic control and weight loss in obese patients with type 2 diabetes mellitus (T2DM). This study aimed to present the mid-term metabolic effects and weight loss results of the patients with T2DM who underwent transit bipartition with sleeve gastrectomy (TB-SG). METHODS A total of 32 obese patients with T2DM who underwent TB-SG were included in the study. The T2DM remission status after surgery was evaluated. The postoperative glycemic variables, weight loss, lipid profile, and nutritional profile were also compared with the baseline values. RESULTS At 36 months after surgery, T2DM remission occurred in 27 patients (84.3%) and the mean BMI decreased from 44.70 ± 9.34 to 29.75 ± 2.19 kg/m2. The percentage of total weight loss (TWL) and excess weight loss (EWL) was 33.84% and 77.19%, respectively. The mean LDL values significantly decreased compared to baseline; however, the mean HDL did not significantly differ. No significant difference was observed regarding the mean albumin, vitamin B12, and folic acid levels. CONCLUSION TB-SG procedure seems promising in terms of T2DM remission and weight loss with less malnutrition and vitamin deficiency in treating obese patients with T2DM.
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Affiliation(s)
- Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey.
| | - Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Husnu Alptekin
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Fahrettin Acar
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Bayram Colak
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
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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; 10:1945. [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] [Grants] [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.)
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Barocrinology: The Endocrinology of Obesity from Bench to Bedside. Med Sci (Basel) 2020; 8:medsci8040051. [PMID: 33371340 PMCID: PMC7768467 DOI: 10.3390/medsci8040051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity has reached pandemic proportions. Hormonal and metabolic imbalances are the key factors that lead to obesity. South Asian populations have a unique phenotype, peculiar dietary practices, and a high prevalence of consanguinity. Moreover, many lower middle-income countries lack appropriate resources, super-specialists, and affordability to manage this complex disorder. Of late, there has been a substantial increase in both obesity and diabesity in India. Thus, many more patients are being managed by different types of bariatric procedures today than ever before. These patients have many types of endocrine and metabolic disturbances before and after bariatric surgery. Therefore, these patients should be managed by experts who have knowledge of both bariatric surgery and endocrinology. The authors propose “Barocrinology”, a novel terminology in medical literature, to comprehensively describe the field of obesity medicine highlighting the role of knowing endocrine physiology for understating its evolution, insights into its complications and appreciating the changes in the hormonal milieu following weight loss therapies including bariatric surgery. Barocrinology, coined as a portmanteau of “baro” (weight) and endocrinology, focuses upon the endocrine and metabolic domains of weight physiology and pathology. This review summarizes the key pointers of bariatric management from an endocrine perspective.
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Timmerman M, Basille D, Basille-Fantinato A, Baud ME, Rebibo L, Andrejak C, Jounieaux V, Lalau JD. Short-Term Assessment of Obstructive Sleep Apnea Syndrome Remission Rate after Sleeve Gastrectomy: a Cohort Study. Obes Surg 2020; 29:3690-3697. [PMID: 31346929 DOI: 10.1007/s11695-019-04110-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe obesity is associated with a high prevalence of moderate-to-severe obstructive sleep apnea syndrome (OSA). Bariatric surgery has been shown to effectively reduce excess weight and comorbidities. METHODS We evaluated the remission rate of moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15) following sleeve gastrectomy. We performed a single-center retrospective chart review of all patients who underwent preoperative polysomnography (PSG) or polygraphy before primary sleeve gastrectomy. Patients with moderate-to-severe OSA treated by continuous positive airway pressure (CPAP) also underwent postoperative PSG. Bivariate analysis was performed to evaluate the criteria associated with remission of moderate-to-severe OSA. RESULTS From 2013 to 2018, 39 of 162 patients (24.1%) scheduled for sleeve gastrectomy (SG) presented moderate-to-severe OSA requiring CPAP. Postoperative PSG was performed in 36 patients a mean of 9.9 ± 6.1 months after SG. Mean BMI decreased from 47.4 ± 8.4 to 36.3 ± 7.1 kg/m2 (p < 0.001), and all patients reported clinical improvement of OSA symptoms. A remission of moderate-to-severe OSA was observed in 72.2% of patients with a mean decrease of AHI from 45.8 events/h to 11.3 events/h (p < 0.001). Postoperative neck circumference was the only factor associated with OSA remission. CONCLUSION SG is associated with a rapid improvement of moderate-to-severe OSA partially as a result of a reduction of neck circumference. However, the absence of correlation with excess weight loss suggests that other weight-independent factors may also be involved.
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Affiliation(s)
- Marine Timmerman
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Damien Basille
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France.
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France.
| | | | - Mickaël E Baud
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Lionel Rebibo
- Department of Digestive Surgery, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France
| | - Claire Andrejak
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France
- Sleep and Vigilance Disorder Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Vincent Jounieaux
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France
- Sleep and Vigilance Disorder Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- PériTox Unit, UMR-I 01, University Picardie Jules Verne, 80054, Amiens Cedex, France
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Constantin A, Dumitrescu M, Nemecz M, Picu A, Smeu B, Guja C, Alexandru N, Georgescu A, Tanko G. Sera of Obese Type 2 Diabetic Patients Undergoing Metabolic Surgery Instead of Conventional Treatment Exert Beneficial Effects on Beta Cell Survival and Function: Results of a Randomized Clinical Study. Obes Surg 2020; 29:1485-1497. [PMID: 30701387 DOI: 10.1007/s11695-019-03710-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pancreatic beta cells are highly sensitive to oxidative and endoplasmic reticulum (ER) stress, commonly occurring in type 2 diabetes (T2D) and obesity. OBJECTIVE We aimed at investigating cellular responses of human beta cells exposed to sera from obese T2D patients treated differently, namely by conventional therapy or laparoscopic sleeve gastrectomy (LSG). METHODS Serum samples from obese T2D men randomized to conventional treatment or LSG were taken at baseline and 6 months later. After exposing 1.1B4 cells to study patients' sera, the following were assessed: cellular viability and proliferation (by MTT and xCELLigence assays), reactive oxygen species (ROS) production (with DCFH-DA), and expression of ER stress markers, oxidative- or autophagy-related proteins and insulin (by real-time PCR and Western blot). RESULTS At 6-month follow-up, patients undergoing LSG achieved an adequate glycemic control, whereas conventionally treated patients did not. As compared to 1.1B4 cells incubated with baseline sera (control), cells exposed to sera from LSG-treated participants exhibited (i) increased viability and proliferation (p < 0.05); (ii) diminished levels of ROS and p53 (p < 0.05); (iii) enhanced protein expression of autophagy-related SIRT1 and p62/SQSTM1 (p < 0.05); (iv) significantly decreased transcript levels of ER stress markers (p < 0.05); and (v) augmented insulin expression (p < 0.05). Conversely, the 6-month conventional therapy appeared not to impact on circulating redox status. Moreover, 1.1B4 cells exposed to sera from conventionally treated patients experienced mild ER stress. CONCLUSION Circulating factors in patients with improved diabetes after metabolic surgery exerted favorable effects on beta cell function and survival.
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Affiliation(s)
- Alina Constantin
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Mădălina Dumitrescu
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Miruna Nemecz
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Ariana Picu
- Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. Dr N. Paulescu", Bucharest, Romania
| | | | - Cristian Guja
- Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. Dr N. Paulescu", Bucharest, Romania
| | - Nicoleta Alexandru
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Adriana Georgescu
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Gabriela Tanko
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania.
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Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition in Obese Females with Type 2 Diabetes Mellitus: Results After 1-Year Follow-up. Obes Surg 2020; 29:805-810. [PMID: 30448981 DOI: 10.1007/s11695-018-3603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To present the early metabolic effects of sleeve gastrectomy with transit bipartition (SG + TB) procedure in female obese patients with type 2 diabetes mellitus (T2DM). METHODS This prospective clinical study was carried out between January 2016 and June 2017. Inclusion criteria were female participants under 60 years old with T2DM, body mass index ≥ 40 kg/m2 and HbA1c level ≥ 8%. All patients underwent to SG + TB procedure. Primary outcomes were the glycemic control variables, and the secondary outcomes were weight loss and dyslipidemia levels up to the last follow-up point. RESULTS A total of 35 female participants with an average age of 48.8 ± 6.0 years old and a mean preoperative BMI of 42.0 ± 1.3 kg/m2 were included during the study period. Diabetic remission was achieved in 88.6% of patients (n = 31) on the third month without any antidiabetic medications. The mean postoperative BMI of patients was 24.8 ± 1.6 kg/m2, and dyslipidemia levels were significiantly lower at the last follow-up point of all patients. CONCLUSIONS SG + TB procedure may be a potent therapeutic option for the treatment of obese patients with T2DM.
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New insight into the mechanisms of ectopic fat deposition improvement after bariatric surgery. Sci Rep 2019; 9:17315. [PMID: 31754142 PMCID: PMC6872729 DOI: 10.1038/s41598-019-53702-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty-liver disease (NAFLD) is frequent in obese patients and represents a major risk factor for the development of diabetes and its complications. Bariatric surgery reverses the hepatic features of NAFLD. However, its mechanism of action remains elusive. We performed a comprehensive analysis of the mechanism leading to the improvement of NAFLD and insulin resistance in both obese rodents and humans following sleeve-gastrectomy (SG). SG improved insulin sensitivity and reduced hepatic and monocyte fat accumulation. Importantly, fat accumulation in monocytes was well comparable to that in hepatocytes, suggesting that Plin2 levels in monocytes might be a non-invasive marker for the diagnosis of NAFLD. Both in vitro and in vivo studies demonstrated an effective metabolic regeneration of liver function and insulin sensitivity. Specifically, SG improved NAFLD significantly by enhancing AMP-activated protein kinase (AMPK) phosphorylation and chaperone-mediated autophagy (CMA) that translate into the removal of Plin2 coating lipid droplets. This led to an increase in lipolysis and specific amelioration of hepatic insulin resistance. Elucidating the mechanism of impaired liver metabolism in obese subjects will help to design new strategies for the prevention and treatment of NAFLD.
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Azevedo FR, Santoro S, Correa-Giannella ML, Toyoshima MT, Giannella-Neto D, Calderaro D, Gualandro DM, Yu PC, Caramelli B. A Prospective Randomized Controlled Trial of the Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition. Obes Surg 2019; 28:3012-3019. [PMID: 29704228 DOI: 10.1007/s11695-018-3239-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D). METHODS This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m2 and < 35 kg/m2, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months. RESULTS At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%, P = < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%, P = NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m2 versus 30.9 ± 2.5 kg/m2; P = < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL, P < 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL; P = 0.001). CONCLUSIONS SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.
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Affiliation(s)
- Fernanda R Azevedo
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | | | - Maria L Correa-Giannella
- Laboratorio de Carboidratos e Radioimunoinsaio, LIM 18, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Marcos T Toyoshima
- Serviço de Onco-Endocrinologia, ICESP, HCFMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Giannella-Neto
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Danielle M Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Pai C Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil.
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Laursen TL, Hagemann CA, Wei C, Kazankov K, Thomsen KL, Knop FK, Grønbæk H. Bariatric surgery in patients with non-alcoholic fatty liver disease - from pathophysiology to clinical effects. World J Hepatol 2019; 11:138-149. [PMID: 30820265 PMCID: PMC6393715 DOI: 10.4254/wjh.v11.i2.138] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/01/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a significant liver disease, and it covers the disease spectrum from simple steatosis with a risk of development of non-alcoholic steatohepatitis (NASH) to fibrosis, subsequent cirrhosis, end-stage liver failure, and liver cancer with a potential need for liver transplantation. NAFLD and NASH are closely related to obesity, metabolic syndrome, and type 2 diabetes (T2D). The role of gut hormones, especially glucagon-like peptide 1 (GLP-1), is important in NAFLD. Bariatric surgery has the potential for inducing great weight loss and may improve the symptoms of metabolic syndrome and T2D. Recent data demonstrated significant effects of bariatric surgery on GLP-1 and other gut hormones and important lipid metabolic and inflammatory abnormalities in the pathophysiology of NAFLD. Therefore, bariatric surgery may reverse the pathological liver changes in NAFLD and NASH patients. In the present review, we describe NAFLD and NASH pathophysiology and the primary effects of bariatric surgery on metabolic pathways. We performed a systematic review of the beneficial and harmful effects and focused on changes in liver disease severity in NAFLD and NASH patients. The specific focus was liver histopathology as assessed by the invasive liver biopsy. Additionally, we reviewed several non-invasive methods used for the assessment of liver disease severity following bariatric surgery.
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Affiliation(s)
- Tea L Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Christoffer A Hagemann
- Gubra ApS, Hørsholm 2970, Denmark
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, Hellerup 2900, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Chunshan Wei
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
- Department of Hepatology, Shenzhen Traditional Chinese Medicine Hospital, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Konstantin Kazankov
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Karen L Thomsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Filip K Knop
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, Hellerup 2900, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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Panagiotou OA, Markozannes G, Adam GP, Kowalski R, Gazula A, Di M, Bond DS, Ryder BA, Trikalinos TA. Comparative Effectiveness and Safety of Bariatric Procedures in Medicare-Eligible Patients: A Systematic Review. JAMA Surg 2018; 153:e183326. [PMID: 30193303 DOI: 10.1001/jamasurg.2018.3326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The prevalence of obesity in patients older than 65 years is increasing. A substantial number of beneficiaries covered by Medicare meet eligibility criteria for bariatric procedures. Objective To assess the comparative effectiveness and safety of bariatric procedures in the Medicare-eligible population. Evidence Review This systematic review was conducted according to the PRISMA guidelines. Articles were identified through searches of PubMed, Embase, CINAHL, PsycINFO, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and scientific information packages from manufacturers, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and US Food and Drug Administration drugs and devices portals from January 1, 2000, to June 31, 2017. Randomized and nonrandomized comparative studies that evaluated bariatric procedures in the Medicare-eligible population were eligible. Six researchers extracted data on design, interventions, outcomes, and study quality. Findings were synthesized qualitatively; a planned meta-analysis was not undertaken owing to clinical heterogeneity. Findings A total of 11 455 citations were screened for eligibility. Of those, 16 met the eligibility criteria. Compared with no surgery or conventional weight-loss treatment, bariatric surgery results in greater weight loss. Overall mortality after 30 days is lower among bariatric patients (hazard ratio, HR, 0.50; 95% CI, 0.31-0.79, in the study with the longest follow-up of 5.9 years), although, based on 1 study, mortality within 30 days of surgery was higher than in nonsurgically treated controls (1.55% vs 0.53%; P < .001). Bariatric surgery is associated with lower risk of cardiovascular disease (HR, 0.59; 95% CI, 0.44-0.79 in the largest study comparison) and with improvements in respiratory, musculoskeletal, metabolic, and renal outcomes (increase in estimated glomerular filtration rate, 9.84; 95% CI, 8.05-11.62 mL/min/1.73m2). Compared with sleeve gastrectomy (SG) and adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB) appears to be associated with greater weight loss (percent excess weight loss, 23.8% [95% CI, 16.2%-31.4%] at the longest follow-up of 4 years) but the 3 procedures have similar associations with most non-weight loss outcomes. Overall postoperative complications are not statistically significantly different between RYGB and SG, although major and/or serious complications are more common after RYGB. However, these associations are susceptible to at least moderate risk of confounding, selection, or measurement biases. Conclusions and Relevance In the Medicare population, there is low to moderate strength of evidence that bariatric surgery as a weight loss treatment improves non-weight loss outcomes. Well-designed comparative studies are needed to credibly determine the treatment effects for bariatric procedures in this patient population.
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Affiliation(s)
- Orestis A Panagiotou
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island.,Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Georgios Markozannes
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island.,Department of Hygiene & Epidemiology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Gaelen P Adam
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Rishi Kowalski
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island.,Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Abhilash Gazula
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Mengyang Di
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island.,The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island
| | - Beth A Ryder
- Department of General Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Thomas A Trikalinos
- Evidence-based Practice Center, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
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Capoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, Silecchia G, Leonetti F. Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:2289-2296. [PMID: 29497961 DOI: 10.1007/s11695-018-3153-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Obesity is one of the major health challenges throughout the world. The association between obesity and diabetes is well established because 90% of patients with type 2 diabetes mellitus (T2DM) show excess body weight. The aim of the study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on morbid obesity and type 2 diabetes (T2DM) in the long-term follow-up. METHODS One hundred ninety-five obese patients, 78 with T2DM, were evaluated before and after LSG up to 10 years, to identify complete diabetes remission (FPG < 100 mg/dl, A1c < 6.0%), partial remission (FPG 100-125 mg/dl, A1c < 6.5%), or relapse. RESULTS Before surgery, body weight and BMI were 123 ± 21 kg and 44.6 ± 6.8 kg/m2 respectively; at a mean follow-up of 7 years (range 4-10), body weight was 104.9 ± 18 kg and BMI 37 ± 6 kg/m2. Minimum weight was reached after 2 years. T2DM remission was observed in 66, 57, and 52% at short (< 2 years), medium (2-5 years), and long-term (> 5 years) follow-up respectively. Furthermore, 45.2% maintained complete remission for at least 5 years and about 36% showed a persistent but improved diabetes. None of the patients cured from diabetes had a duration disease greater than 8 years and a glycemic control requiring insulin. The prevalence of hypertension and dyslipidemia significantly decreased from 49 to 35% and from 51 to 40% respectively. CONCLUSIONS LSG significantly improves body weight, diabetes, hypertension, and dyslipidemia in long-term follow-up.
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Affiliation(s)
- Danila Capoccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Federica Coccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gloria Guarisco
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Moira Testa
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberta Rendina
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesca Abbatini
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Gianfranco Silecchia
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Frida Leonetti
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Charalampakis V, Seretis C, Daskalakis M, Fokoloros C, Karim A, Melissas J. The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up. Surg Obes Relat Dis 2018; 14:1652-1658. [PMID: 30072237 DOI: 10.1016/j.soard.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/05/2018] [Accepted: 06/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up. OBJECTIVES To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome. SETTING Bariatric Unit, University Hospital of Heraklion, Greece. METHODS Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded. RESULTS A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m2 completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from -.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study. CONCLUSIONS Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome.
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Affiliation(s)
- Vasileios Charalampakis
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece; Department of General Surgery, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom.
| | - Charalampos Seretis
- Department of General Surgery, George Elliot Hospital, Nuneaton, United Kingdom
| | - Markos Daskalakis
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece; Upper GI Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christos Fokoloros
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
| | - Ahmed Karim
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
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Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective. Obes Surg 2018; 28:1711-1723. [DOI: 10.1007/s11695-017-3085-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mazidi M, Rezaie P, Jangjoo A, Tavassoli A, Rajabi MT, Kengne AP, Nematy M. Effect of bariatric surgery on adiposity and metabolic profiles: A prospective cohort study in Middle-Eastern patients. World J Diabetes 2017; 8:374-380. [PMID: 28751961 PMCID: PMC5507835 DOI: 10.4239/wjd.v8.i7.374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/05/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate changes in adiposity and cardio-metabolic risk profile following Roux-en-Y gastric bypass in patients of Middle Eastern ethnicity with severe obesity. METHODS This prospective cohort study involved 92 patients who met the indications of bariatric surgery. Post-procedure markers of obesity and cardiometabolic profile were monitored regularly for a year. RESULTS Mean body mass index decreased by 29.5% from 41.9 to 29.5 kg/m2 between baseline and 12-mo follow-up, while mean fat mass decreased by 45.9% from 64.2 kg to 34.7 kg. An improvement was also observed in the gluco-metabolic profile with both fasting glucose and HbA1c substantially decreasing (P < 0.001). CONCLUSION The present study shows the short to medium term (1 year) health benefits of bariatric surgery for patients of Middle Eastern ethnicity.
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Vuolo G, Voglino C, Tirone A, Colasanto G, Gaggelli I, Ciuoli C, Ferrara F, Marrelli D. Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg 2016; 30:48-55. [PMID: 27109203 DOI: 10.1016/j.ijsu.2016.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a worldwide surgical procedure for morbid obesity. However patients selection is still anecdotal. The aim of this study is to analyse clinical and anthropometric parameters correlated with LSG and to check the validity of this procedure for different categories of obese patients. METHODS Two-hundred one consecutive patients were submitted to LSG as a primary bariatric procedure between 2008 and 2014. One year follow-up was completed in 159 patients. Smaller groups of patients completed 2 and 3 years follow-up (78, 46 patients respectively). Median preoperative body mass index (BMI) was 45.4 kg/m2 (range: 34.8-73.8); 135 patients (80%) had one or more comorbidities. Potential correlations between age, gender, preoperative BMI, preoperative excess weight, early excess weight loss (EWL) and 1 and 3 year-EWL were investigated. RESULTS All procedures were regularly completed with laparoscopic approach without conversion to laparotomy. Postoperative complications occurred in six patients (3.7%); no postoperative mortality was observed. Median one-year BMI and EWL were 32.8 kg/m2 and 55.34%, respectively. Three year-EWL was significantly influenced by age, and early EWL. A complete normalization of glycemic levels after the three-year follow-up was also observed in high percentage of diabetic patients. In patients with preoperative BMI>50 kg/m2 we observed most failure cases in terms of EWL and the worst metabolic results. CONCLUSIONS Our experience indicates that LSG is a safe procedure with satisfactory three-year late weight loss in patients with preoperative BMI <50 kg/m2. Promising results, in terms of improvements of comorbidities, were also observed. These results make LSG one of the most attractive first stage surgical procedure for morbid obesity.
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Affiliation(s)
- Giuseppe Vuolo
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Costantino Voglino
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Andrea Tirone
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Giuseppina Colasanto
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Ilaria Gaggelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Francesco Ferrara
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
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19
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Qin F. Clinical effects of laparoscopic sleeve gastrectomy in obese patients with type 2 diabetes mellitus. Shijie Huaren Xiaohua Zazhi 2015; 23:4595-4601. [DOI: 10.11569/wcjd.v23.i28.4595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the curative effect of laparoscopic sleeve gastrectomy (LSG) in obese patients with type 2 diabetes mellitus (T2DM).
METHODS: The clinical data for 81 obese patients with T2DM who received LSG at Affiliated Hospital of Qinghai University from January 2010 and December 2013 were retrospectively analyzed. Body weight indexes, blood glucose indexes, and blood lipid indexes were measured and compared before and 1, 3, 6, 12 mo after operation. The improvement in all preoperative complications was observed.
RESULTS: LSG was successful in all cases. Postoperative complications occurred in 4 (4.9%) cases, including 3 cases of incision infection and 1 case of subphrenic infection, all of which recovered after symptomatic treatment. Body weight, body mass index (BMI), and waist and hip circumference at each postoperative time point were significantly lower than those before operation (P < 0.05). Waist to hip ratios at 3, 6, and 12 mo after operation were significant lower than that before operation (P < 0.05). All the above indexes gradually decreased over time, while excess weight loss (EWL) gradually increased over time (P < 0.05). For the blood glucose indexes, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and homeostasis model assessment of insulin resistance index (HOMA-IR) at each time point after operation were significantly lower than those before operation (P < 0.05), and they all gradually decreased over time (P < 0.05). Insulin sensitivity index (IAI) at each time point after operation was significantly higher than that before operation (P < 0.05), and it gradually increased over time (P < 0.05). For the blood lipid indexes, triglyceride (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C) at each time point after operation were significantly lower than those before operation (P < 0.05), and they gradually decreased over time (P < 0.05). High density lipoprotein cholesterol (HDL-C) at each time point after operation was significantly higher than that before operation (P < 0.05), and it gradually increased over time (P < 0.05). At 12 mo after operation, all cases complicated with irregular menstruation, degenerative joint disease and sleep apnea hypopnea syndrome (SAHS) were cured or improved, only 2 (2.9%) cases of fatty liver and 1 (3.6%) case of hypertension were not improved.
CONCLUSION: LSG is a safe and effective treatment for obese patients with T2DM, which not only significantly reduces the body weight and blood glucose, and improves insulin resistance and lipid metabolism, but also has a significant effect on other preoperative complications.
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Abstract
Type 2 diabetes mellitus (T2DM) and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes) study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1(st) year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms.
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Consultant Endocrinologist, G.D Hospital and Diabetes Institute, Kolkata, West Bengal, India
| | - Ritu Singh
- Consultant Gynecologist, G.D Hospital and Diabetes Institute, Kolkata, West Bengal, India
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Dillon C, Peddle J, Twells L, Lester K, Midodzi W, Manning K, Murphy R, Pace D, Smith C, Boone D, Gregory D. Rapid Reduction in Use of Antidiabetic Medication after Laparoscopic Sleeve Gastrectomy: The Newfoundland and Labrador Bariatric Surgery Cohort (BaSCo) Study. Can J Hosp Pharm 2015; 68:113-20. [PMID: 25964682 DOI: 10.4212/cjhp.v68i2.1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients who have undergone bariatric surgery generally need fewer medications as they experience improvement in, or even resolution of, various medical conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia. Published data on changes in medication use after laparoscopic sleeve gastrectomy, a type of bariatric surgery that is growing in popularity, are limited. OBJECTIVE To determine whether patients took fewer medications for management of type 2 diabetes, hypertension, and dyslipidemia after laparoscopic sleeve gastrectomy, relative to preprocedure medications. METHODS In this prospective, single-centre cohort study, a nurse practitioner used standard medication reconciliation and study data-extraction forms to interview adult patients who had undergone laparoscopic sleeve gastrectomy and determine their medication use and pertinent demographic data. The data were analyzed using generalized estimating equations and standard statistical software. Outcome measures included changes in the use of antidiabetic, antihypertensive, and antilipemic medications at 1, 3, and 6 months after the surgery. RESULTS A total of 65 patients who underwent laparoscopic sleeve gastrectomy between May 2011 and January 2014 met the study inclusion criteria. Before surgery, the 30 patients with type 2 diabetes were taking an average of 1.9 antidiabetic medications. One month after the procedure, 15 (50%) had discontinued all antidiabetic medications, with a further decline at 3 and 6 months (p < 0.001 at each time point). Among the patients who were taking antihypertensives (n = 48) and antilipemics (n = 33) before surgery, the decline in use occurred at a more modest rate, with 6 (12%) and 2 (6%), respectively, discontinuing these medication classes within 1 month, and 12 (25%) (p = 0.001) and 8 (24%) (p = 0.015) having discontinued by 6 months. CONCLUSIONS These findings suggest that patients with a history of type 2 diabetes mellitus, hypertension, and/or dyslipidemia who undergo laparoscopic sleeve gastrectomy are less likely to require disease-specific medications shortly after surgery.
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Affiliation(s)
- Carla Dillon
- BScPharm, ACPR, PharmD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Justin Peddle
- BScPharm, PharmD, is with the School of Pharmacy, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Laurie Twells
- BA, MSc, PhD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Kendra Lester
- BSc, MSc, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - William Midodzi
- PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | | | - Raleen Murphy
- NP, MSc(A), BSc, is with Eastern Health, St John's, Newfoundland and Labrador
| | - David Pace
- BSc, MBA, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Chris Smith
- BSc(Hons), MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Darrell Boone
- BMedSc, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Deborah Gregory
- BN, MSc, PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
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Capoccia D, Coccia F, Guida A, Rizzello M, De Angelis F, Silecchia G, Leonetti F. Is type 2 diabetes really resolved after laparoscopic sleeve gastrectomy? Glucose variability studied by continuous glucose monitoring. J Diabetes Res 2015; 2015:674268. [PMID: 25954762 PMCID: PMC4411432 DOI: 10.1155/2015/674268] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 02/06/2023] Open
Abstract
The study was carried out on type 2 diabetic obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients underwent regular glycemic controls throughout 3 years and all patients were defined cured from diabetes according to conventional criteria defined as normalization of fasting glucose levels and glycated hemoglobin in absence of antidiabetic therapy. After 3 years of follow-up, Continuous Glucose Monitoring (CGM) was performed in each patient to better clarify the remission of diabetes. In this study, we found that the diabetes resolution after LSG occurred in 40% of patients; in the other 60%, even if they showed a normal fasting glycemia and A1c, patients spent a lot of time in hyperglycemia. During the oral glucose tolerance test (OGTT), we found that 2 h postload glucose determinations revealed overt diabetes only in a small group of patients and might be insufficient to exclude the diagnosis of diabetes in the other patients who spent a lot of time in hyperglycemia, even if they showed a normal glycemia (<140 mg/dL) at 120 minutes OGTT. These interesting data could help clinicians to better individualize patients in which diabetes is not resolved and who could need more attention in order to prevent chronic complications of diabetes.
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Affiliation(s)
- D. Capoccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Policlinico Umberto I, 00161 Rome, Italy
| | - F. Coccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Policlinico Umberto I, 00161 Rome, Italy
| | - A. Guida
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Policlinico Umberto I, 00161 Rome, Italy
| | - M. Rizzello
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University of Rome, 04100 Latina, Italy
| | - F. De Angelis
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University of Rome, 04100 Latina, Italy
| | - G. Silecchia
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University of Rome, 04100 Latina, Italy
| | - F. Leonetti
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Policlinico Umberto I, 00161 Rome, Italy
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Mallipedhi A, Prior SL, Dunseath G, Bracken RM, Barry J, Caplin S, Eyre N, Morgan J, Baxter JN, O'Sullivan SE, Sarmad S, Barrett DA, Bain SC, Luzio SD, Stephens JW. Changes in plasma levels of N-arachidonoyl ethanolamine and N-palmitoylethanolamine following bariatric surgery in morbidly obese females with impaired glucose homeostasis. J Diabetes Res 2015; 2015:680867. [PMID: 25874237 PMCID: PMC4385619 DOI: 10.1155/2015/680867] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 02/07/2023] Open
Abstract
AIM We examined endocannabinoids (ECs) in relation to bariatric surgery and the association between plasma ECs and markers of insulin resistance. METHODS A study of 20 participants undergoing bariatric surgery. Fasting and 2-hour plasma glucose, lipids, insulin, and C-peptide were recorded preoperatively and 6 months postoperatively with plasma ECs (AEA, 2-AG) and endocannabinoid-related lipids (PEA, OEA). RESULTS Gender-specific analysis showed differences in AEA, OEA, and PEA preoperatively with reductions in AEA and PEA in females postoperatively. Preoperatively, AEA was correlated with 2-hour glucose (r = 0.55, P = 0.01), HOMA-IR (r = 0.61, P = 0.009), and HOMA %S (r = -0.71, P = 0.002). OEA was correlated with weight (r = 0.49, P = 0.03), waist circumference (r = 0.52, P = 0.02), fasting insulin (r = 0.49, P = 0.04), and HOMA-IR (r = 0.48, P = 0.05). PEA was correlated with fasting insulin (r = 0.49, P = 0.04). 2-AG had a negative correlation with fasting glucose (r = -0.59, P = 0.04). CONCLUSION Gender differences exist in circulating ECs in obese subjects. Females show changes in AEA and PEA after bariatric surgery. Specific correlations exist between different ECs and markers of obesity and insulin and glucose homeostasis.
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Affiliation(s)
- Akhila Mallipedhi
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
- Department of Diabetes & Endocrinology, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Sarah L. Prior
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Gareth Dunseath
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Richard M. Bracken
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Jonathan Barry
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Scott Caplin
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Nia Eyre
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - James Morgan
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - John N. Baxter
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Saoirse E. O'Sullivan
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK
| | - Sarir Sarmad
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - David A. Barrett
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Stephen C. Bain
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Steve D. Luzio
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Jeffrey W. Stephens
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
- Department of Diabetes & Endocrinology, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
- *Jeffrey W. Stephens:
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Charalampakis V, Bertsias G, Lamprou V, de Bree E, Romanos J, Melissas J. Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study. Surg Obes Relat Dis 2015; 11:70-6. [DOI: 10.1016/j.soard.2014.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/31/2014] [Accepted: 04/15/2014] [Indexed: 12/19/2022]
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Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 2014; 24:437-55. [PMID: 24374842 PMCID: PMC3916703 DOI: 10.1007/s11695-013-1160-3] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We performed a meta-analysis of weight loss and remission of type 2 diabetes mellitus (T2DM) evaluated in randomized controlled trials (RCTs) and observational studies of bariatric surgery vs conventional medical therapy. English articles published through June 10, 2013 that compared bariatric surgery with conventional therapy and included T2DM endpoints with ≥12-month follow-up were systematically reviewed. Body mass index (BMI, in kilogram per square meter), glycated hemoglobin (HbA1C, in degree), and fasting plasma glucose (FPG, in milligram per deciliter) were analyzed by calculating weighted mean differences (WMDs) and pooled standardized mean differences and associated 95 % confidence intervals (95 % CI). Aggregated T2DM remission event data were analyzed by calculating the pooled odds ratio (POR) and 95 % CI. Random effects assumptions were applied throughout; I(2) ≥ 75.0 % was considered indicative of significant heterogeneity. Systematic review identified 512 articles: 47 duplicates were removed, 446 failed inclusion criteria (i.e., n < 10 per arm, animal studies, reviews, case reports, abstracts, and kin studies). Of 19 eligible articles, two not focused on diagnosed T2DM and one with insufficient T2DM data were excluded. In the final 16 included papers, 3,076 patients (mean BMI, 40.9; age, 47.0; 72.0 % female) underwent bariatric surgery; 3,055 (39.4; 48.6, 69.0 %) received conventional or no weight-loss therapy. In bariatric surgery vs conventional therapy groups, the mean 17.3 ± 5.7 month BMI WMD was 8.3 (7.0, 9.6; p < 0.001; I(2) = 91.8), HbA(1C) was 1.1 (0.6, 1.6; p < 0.001; I(2) = 91.9), and FPG, 24.9 (15.9, 33.9; p < 0.001; I(2) = 84.8), with significant differences favoring surgery. The overall T2DM remission rate for surgery vs conventional group was 63.5 vs 15.6 % (p < 0.001). The Peto summary POR was 9.8 (6.1, 15.9); inverse variance summary POR was 15.8 (7.9, 31.4). Of the included studies, 94.0 % demonstrated a significant statistical advantage favoring surgery. In a meta-analysis of 16 studies (5 RCTs) with 6,131 patients and mean 17.3-month follow-up, bariatric surgery was significantly more effective than conventional medical therapy in achieving weight loss, HbA(1C) and FPG reduction, and diabetes remission. The odds of bariatric surgery patients reaching T2DM remission ranged from 9.8 to 15.8 times the odds of patients treated with conventional therapy.
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Affiliation(s)
- G Ribaric
- European Surgical Institute, Ethicon Endo-Surgery (Europe) GmbH, Hamburg, Germany,
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Temporal changes in glucose homeostasis and incretin hormone response at 1 and 6 months after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2014; 10:860-9. [DOI: 10.1016/j.soard.2014.02.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/20/2014] [Accepted: 02/24/2014] [Indexed: 01/26/2023]
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Friedrich AE, Damms-Machado A, Meile T, Scheuing N, Stingel K, Basrai M, Küper MA, Kramer KM, Königsrainer A, Bischoff SC. Laparoscopic sleeve gastrectomy compared to a multidisciplinary weight loss program for obesity--effects on body composition and protein status. Obes Surg 2014; 23:1957-65. [PMID: 23856991 DOI: 10.1007/s11695-013-1036-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND Optimal obesity therapy is a matter of debate. Besides weight reduction, other criteria such as safety and nutritional status are of relevance. Therefore, we compared a favored surgical intervention with the most effective conservative treatment regarding anthropometry and nutritional status. METHODS Fifty-four obese patients were included who underwent laparoscopic sleeve gastrectomy (LSG, n = 27) or a 52-week multidisciplinary intervention program (MIP, n = 27) for weight loss. Body weight, body composition assessed by bioelectrical impedance analysis, and serum protein levels were measured before and within 12 months after intervention. RESULTS After 1 year of observation, excess weight loss was more pronounced following LSG (65 %) compared to MIP (38 %, p < 0.001). In both groups, body fat was clearly reduced, but a higher reduction occurred in the LSG group. However, protein status deteriorated particularly in the LSG group. Within 1 year, body cell mass declined from 37.1 to 26.9 kg in the LSG group, but only from 35.7 to 32.2 kg in the MIP group. This resulted in an increased mean extracellular mass/body cell mass ratio (1.42 versus 1.00, p < 0.001), in a decreased mean phase angle (4.4° versus 6.6°, p < 0.001), and in a lower prealbumin level in serum (p < 0.02) in the LSG group compared to the MIP group. CONCLUSIONS LSG, compared to MIP, was more effective regarding excess weight loss and body fat loss within 1 year, however, induced more pronounced muscle mass and protein loss, possibly requiring particular interventions such as exercise or protein supplements.
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Affiliation(s)
- Asja E Friedrich
- Department of Nutritional Medicine, University of Hohenheim, Fruwirthstraße 12, 70593, Stuttgart, Germany,
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Hoogerboord M, Wiebe S, Klassen D, Ransom T, Lawlor D, Ellsmere J. Laparoscopic sleeve gastrectomy: perioperative outcomes, weight loss and impact on type 2 diabetes mellitus over 2 years. Can J Surg 2014; 57:101-5. [PMID: 24666447 DOI: 10.1503/cjs.024212] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an increasingly performed operation for morbid obesity worldwide. To date there has been limited experience in Canada. We report our intermediate results, assessing whether LSG can be safely performed at a Canadian academic teaching hospital and whether it is effective as a bariatric procedure and as metabolic therapy for type 2 diabetes mellitus. METHODS We performed a retrospective review of all patients who underwent LSG at our institution from Sept. 1, 2007, to June 30, 2011. RESULTS We included 166 patients (mean age 44 yr, 82% female) in our study. The mean preoperative body mass index was 49.61. At baseline, 87 (52%) patients had type 2 diabetes. For this subgroup, mean preoperative HbA1c and AC glucose were 7.6% and 8.3 mmol/L, respectively. The mean duration of surgery was 93 minutes. Major complications included 1 staple line leak (0.6%), and 2 patients required reintervention for bleeding (1.2%). The mean hospital stay was 2.6 days. Two patients required readmission (1.2%). Seven minor complications occurred (4%). Postoperative excess weight loss was 49.3% at 6 months, 54.2% at 12 months and 64.4% at 24 months. In the type 2 diabetes subgroup, resolution occurred in 78% and improvement in 7% of patients at 12 months. CONCLUSION Laparoscopic sleeve gastrectomy can be safely performed at Canadian teaching hospitals. It is effective both as a bariatric procedure and as a therapeutic intervention for type 2 diabetes mellitus.
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Affiliation(s)
| | - Shannon Wiebe
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - Dennis Klassen
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - Tom Ransom
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - Diana Lawlor
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - James Ellsmere
- The Department of Surgery, Dalhousie University, Halifax, NS
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Goldfarb M, Casillas J. Unmet information and support needs in newly diagnosed thyroid cancer: comparison of adolescents/young adults (AYA) and older patients. J Cancer Surviv 2014; 8:394-401. [DOI: 10.1007/s11764-014-0345-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Laparoscopic Greater Curvature Plication in Morbidly Obese Women with Type 2 Diabetes: Effects on Glucose Homeostasis, Postprandial Triglyceridemia and Selected Gut Hormones. Obes Surg 2013; 24:718-26. [DOI: 10.1007/s11695-013-1143-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Natoudi M, Panousopoulos SG, Memos N, Menenakos E, Zografos G, Leandros E, Albanopoulos K. Laparoscopic sleeve gastrectomy for morbid obesity and glucose metabolism: a new perspective. Surg Endosc 2013; 28:1027-33. [PMID: 24185751 DOI: 10.1007/s00464-013-3275-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/08/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Global rise in the incidence of obesity and type 2 diabetes mellitus is widely recognized as one of the most challenging contemporary threats to public health. Weight loss surgery has proven to be an effective and durable solution for morbidly obese adults. Laparoscopic sleeve gastrectomy (LSG) was introduced as a restrictive procedure for obese patients, initially described as a possible first-stage operation, but now commonly performed as a stand-alone bariatric operation for both high-risk and super-morbid-obese patients, as well as for patients with lower body mass index. This study aims to evaluate the progression of glucose metabolism in patients undergoing LSG. METHODS This prospective study investigated 62 patients who underwent LSG by the same surgical team in an 18-month period. Preoperative evaluation included demographic information, complete medical history including comorbidities and medication, clinical examination, evaluation of cardiopulmonary function, measurement of weight and height on a standard electronic scale, upper gastrointestinal endoscopy and upper abdominal ultrasound, as well as interviews with a psychologist and nutritionist. Glucose metabolism was evaluated by oral glucose tolerance test (OGTT), preoperatively and at 3, 6, and 12 months after surgery. RESULTS The OGTT was significantly ameliorated in all groups during follow-up. Nine of 12 diabetic patients (75 %) ceased drug treatment at 3 months postoperatively (p = 0.004), increasing to 100 % at 1-year follow-up (p < 0.001). Normoglycemic patients and patients with borderline OGTT experienced mild or severe hypoglycemia during the glucose tolerance test at 3, 6, and 12 months' follow-up. CONCLUSIONS LSG offers excellent results to morbidly obese patients with regard to type 2 diabetes mellitus. Implementation of OGTT in these patients can be a valuable tool in their postoperative management. Bariatric teams performing LSG for morbid obesity should heighten their sensitivity to postoperative hypoglycemia, even in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Maria Natoudi
- Hippokration Athens General Hospital, 1st Propedeutic Surgical Clinic, Athens University School of Medicine, 10 Pasteur Str, 11521, Athens, Greece
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Affiliation(s)
- Ricardo Cohen
- The Center of Excellence for Metabolic and Bariatric Surgery, Hospital Oswaldo Cruz, Rua Padre João Manuel, 222 #130, 01411-000 São Paulo, Brazil.
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Via MA, Mechanick JI. The Role of Bariatric Surgery in the Treatment of Type 2 Diabetes: Current Evidence and Clinical Guidelines. Curr Atheroscler Rep 2013; 15:366. [DOI: 10.1007/s11883-013-0366-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Siejka A, Jankiewicz-Wika J, Kołomecki K, Cywiński J, Piestrzeniewicz K, Swiętosławski J, Stępień H, Komorowski J. Long-term impact of vertical banded gastroplasty (VBG) on plasma concentration of leptin, soluble leptin receptor, ghrelin, omentin-1, obestatin, and retinol binding protein 4 (RBP4) in patients with severe obesity. Cytokine 2013; 64:490-3. [PMID: 24011638 DOI: 10.1016/j.cyto.2013.07.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/19/2013] [Accepted: 07/21/2013] [Indexed: 11/17/2022]
Abstract
Restrictive type bariatric surgery is an effective therapeutic approach that decreases overall mortality in patients with severe obesity. Several new cytokines, including adipocytokines that control energy metabolism, have been discovered recently, but their role in obesity is not fully recognized. The aim of the study was to evaluate the influence of vertical banded gastroplasty (VBG), one of restrictive type bariatric surgery, on peripheral blood concentrations of some adipocytokines and hormones involved in the control of food intake and energy turnover. The studied group comprised 12 females and 2 males aged from 31 to 59years (46.6±7.4) with simple obesity (BMI: 44.9±7.2) and metabolic syndrome. The patients were examined both before and 3, 6, 12, 24months after bariatric surgery (eight patients were also checked after 36 and six patients after 48months). Measurements of peripheral blood concentration of glucose, insulin, leptin, soluble leptin receptor, obestatin, ghrelin, omentin-1, and retinol binding protein 4 (RBP4) by ELISA method have been performed. After the surgery body weight, BMI and waist circumference significantly decreased. Positive changes considering the components of metabolic syndrome have been noted. Namely glucose, insulin and triglycerides' levels decreased, accompanied by the significantly lower HOMA index. Conversely, HDL cholesterol concentrations increased. Furthermore, peripheral blood concentration of leptin decreased, but the blood levels of soluble leptin receptor and ghrelin gradually increased. The positive correlations between leptin and body weight and BMI were noted as well as between the RBP4 and total cholesterol and LDL cholesterol levels. We did not observe significant differences in levels of obestatin, omentin-1 and RBP4 after surgery. In conclusion, VBG is an effective type of bariatric surgery. Fast decrease of body weight in morbidly obese patients treated by restrictive bariatric surgery leads to significant changes in peripheral blood levels of some adipokines and hormones controlling energy turnover and appetite (leptin and soluble leptin receptor) as well as ghrelin but not omentin-1, obestatin or retinol binding protein (RBP-4).
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Affiliation(s)
- Agnieszka Siejka
- Department of Clinical Endocrinology, Chair of Endocrinology, Medical University of Lodz, 91-425 Lodz, Sterlinga 1/3, Poland.
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Knop FK, Taylor R. Mechanism of metabolic advantages after bariatric surgery: it's all gastrointestinal factors versus it's all food restriction. Diabetes Care 2013; 36 Suppl 2:S287-91. [PMID: 23882061 PMCID: PMC3920787 DOI: 10.2337/dcs13-2032] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Filip K Knop
- Diabetes Research Division, Department of Internal Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
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The effects of bariatric procedures versus medical therapy for obese patients with type 2 diabetes: meta-analysis of randomized controlled trials. BIOMED RESEARCH INTERNATIONAL 2013; 2013:410609. [PMID: 23971035 PMCID: PMC3736516 DOI: 10.1155/2013/410609] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/23/2013] [Accepted: 06/23/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the effects of bariatric surgery versus medical therapy for type 2 diabetes mellitus. METHODS The Cochrane library, PubMed, Embase, Chinese biomedical literature database, and Wanfang database up to February 2012 were searched. The literature searches strategies contained terms ("diabetes*", "surg*", and "medic*" were used), combined with the medical subject headings. Randomized controlled trails (RCTs) of frequently used bariatric surgery for obese patients with type 2 diabetes were included. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS Three randomized controlled trials (RCTs) involving 170 patients in the bariatric surgery groups and 100 patients in the medical therapy group were selected. Compared with medical therapy, bariatric surgery for type 2 diabetes can significantly decrease the levels of HbA1c, FBG, weight, triglycerides, and the dose of hypoglycemic, antihypertensive, and lipid-lowering medicine, while increasing the rate of diabetes remission (RR = 9.74, 95%CI, (1.36, 69.66)) and the levels of high-density lipoprotein. However, there are no statistical differences in serious adverse events between the surgical and medical groups (RR = 1.23, 95%CI, (0.80, 1.87)). CONCLUSIONS Surgical procedures were more likely to help patients achieve benefits than medical therapy alone. Further intensive RCTs of high-quality, multiple centers and long-term followup should be carried out to provide more reliable evidence.
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The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg 2013; 257:791-7. [PMID: 23470577 DOI: 10.1097/sla.0b013e3182879ded] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures. BACKGROUND Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity. METHODS Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery. RESULTS Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities. CONCLUSIONS With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.
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Lau DCW, Teoh H. Benefits of modest weight loss on the management of type 2 diabetes mellitus. Can J Diabetes 2013; 37:128-34. [PMID: 24070804 DOI: 10.1016/j.jcjd.2013.03.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/27/2013] [Accepted: 03/05/2013] [Indexed: 01/06/2023]
Abstract
The epidemic of overweight and obesity is a major driver of the growing prevalence of type 2 diabetes mellitus globally. The risk of type 2 diabetes increases exponentially as body mass index rises above 25 kg/m(2). Obesity currently costs the Canadian economy approximately $7.1 billion annually whereas per capita health care cost for individuals with diabetes are 3 to 4 times that for persons without the disease. Each kilogram of weight lost through health behaviour changes in people with impaired glucose tolerance is associated with a relative diabetes risk reduction of 16%. As 80% to 90% of people with type 2 diabetes are overweight or obese, and adiposity worsens the metabolic and physiologic abnormalities associated with type 2 diabetes, weight loss is recommended as the cornerstone management measure. A modest weight loss of 5% to 10% is an achievable and realistic goal for preventing type 2 diabetes in susceptible individuals and improving glycemic and metabolic control in people with type 2 diabetes. When health behaviour modification fails to achieve glycemic and metabolic goal targets, priority should be given to antihyperglycemic agents that are associated with weight loss or weight neutrality. Every pound of body fat loss matters and every kilogram counts in the management of type 2 diabetes.
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Affiliation(s)
- David C W Lau
- Departments of Medicine, Biochemistry and Molecular Biology, Julia McFarlane Diabetes Research Centre, University of Calgary, Calgary, Alberta, Canada.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2013; 20:156-60. [PMID: 23434800 DOI: 10.1097/med.0b013e32835f8a71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caiazzo R, Pattou F. Adjustable gastric banding, sleeve gastrectomy or gastric bypass. Can evidence-based medicine help us to choose? J Visc Surg 2013; 150:85-95. [PMID: 23623562 DOI: 10.1016/j.jviscsurg.2013.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Topart P. Comment on: Hormone changes and diabetes resolution following biliopancreatic diversion and laparoscopic sleeve gastrectomy. A comparative prospective study. Surg Obes Relat Dis 2013; 9:677-8. [PMID: 23466014 DOI: 10.1016/j.soard.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Philippe Topart
- Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France
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Cavarretta E, Casella G, Calì B, Dammaro C, Biondi-Zoccai G, Iossa A, Leonetti F, Frati G, Basso N. Cardiac remodeling in obese patients after laparoscopic sleeve gastrectomy. World J Surg 2013; 37:565-572. [PMID: 23254944 DOI: 10.1007/s00268-012-1874-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obesity is associated with high morbidity and represents an increasing health care problem worldwide. Laparoscopic sleeve gastrectomy (LSG) has been used effectively for weight loss and co-morbidity remission. In this retrospective study, we evaluated cardiac reverse remodeling at medium-term follow-up by echocardiography, the amount of cardiovascular medications, and the impact of co-morbidities after sleeve gastrectomy. METHODS Altogether, 16 obese patients (4 men, 12 women; 46.4 ± 10.3 years) underwent complete clinical evaluation, laboratory tests, and color Doppler/tissue Doppler imaging echocardiography preoperatively and 12-20 months after bariatric surgery. RESULTS Body weight (mean body mass index) was significantly reduced (from 44.8 ± 8.0 to 31.2 ± 7.8 kg/m2; p = 0.001). Lipid profile significantly improved: total cholesterol and triglycerides decreased (respectively: 215.5 ± 53.8 vs. 205.3 ± 46.6 mg/dl and 184.9 ± 109.3 vs. 116.1 ± 49.9 mg/dl, both p ≤ 0.05), and high-density lipoprotein increased (43.1 ± 10.9 vs. 51.4 ± 12.8 mg/dl, p = 0.005). Systolic blood pressure significantly decreased (from 133.0 ± 17.1 to 120.6 ± 13.7 mmHg; p = 0.04). Diabetes remission was complete in five of six patients (83%) and sleep apnea in four of five (80 %). Echocardiography showed significantly reduced interventricular septum and posterior wall thickness (11.3 ± 1.8 to 9.4 ± 2.1 mm and 10.4 ± 1.7 to 8.6 ± 1.9 mm, respectively; both p < 0.007) and reduced left ventricular mass (absolute value and indexed by height, respectively: 222.41 ± 78.2 to 172.75 ± 66.3 g (p = 0.003) and 55.9 ± 14.3 to 43.8 ± 17.2 g/m(2.7) (p = 0.0004). Antihypertensive drug intake was significantly reduced (p = 0.03), as shown by the 10-year Framingham Risk Score (from 14.2 ± 9.3 to 8.3 ± 9.5%, p = 0.003). CONCLUSIONS Sleeve gastrectomy is associated with marked improvement in terms of weight loss, lipid profile, type 2 diabetes, sleep apnea, hypertension, and left ventricular hypertrophy, with a significantly reduced Framingham Risk Score.
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Affiliation(s)
- Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso Della Repubblica 79, 04100, Latina, Italy
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Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology 2012; 143:897-912. [PMID: 22885332 PMCID: PMC3462491 DOI: 10.1053/j.gastro.2012.07.114] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 12/19/2022]
Abstract
Obesity is an important risk factor for type 2 diabetes mellitus (T2DM). Weight loss improves the major factors involved in the pathogenesis of T2DM, namely insulin action and beta cell function, and is considered a primary therapy for obese patients who have T2DM. Unfortunately, most patients with T2DM fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2DM in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2DM than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early postprandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2DM once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2DM. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2DM.
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Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N. Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Surg Obes Relat Dis 2012; 9:498-502. [PMID: 23290187 DOI: 10.1016/j.soard.2012.09.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/10/2012] [Accepted: 09/12/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the long-term effects of laparoscopic sleeve gastrectomy (LSG) on type 2 diabetes mellitus (T2DM) and other related co-morbidities in severely obese patients. METHODS From May 2003 to July 2008, 33 morbidly obese diabetic patients (20 with body mass index [BMI]>50 kg/m(2)) underwent LSG. A total of 23 females and 10 males participated, with a mean age of 49.3±8 years, mean preoperative BMI of 52.1±8.5 kg/m(2), mean fasting plasma glucose (FPG) of 143.2±47.9 mg/dL, mean glycosylated hemoglobin (HbA1c) of 7.3%±1.4%, and a mean T2DM duration of 7 years. All patients had a 36-month follow-up, and 13 had a 60-month follow-up. RESULTS Twenty-nine patients (87.8%) discontinued antidiabetic medications 3 months after LSG, (mean BMI of 42.8±7.8 kg/m(2); FPG of 104.5±22.1 mg/dL; HbA1c of 5.3%±.4%). At 36 months, 22 of 26 LSG patients (84.6%) had normal FPG and HbA1c values without antidiabetic therapy. At the 60-month follow-up, 10 of 13 patients (76.9%) had normal FPG and HbA1c values without antidiabetic therapy. The Framingham risk score decreased significantly from 9.7% preoperatively to 4.7% postoperatively. No new diabetic retinopathy occurred during the whole period of observation. CONCLUSIONS This study confirms the efficacy of LSG in the treatment of T2DM and indicates that, at both 36- and 60-month follow-ups, LSG can provide a significant percentage of treated patients with a prolonged remission of T2DM, with diminished cardiac risk factors and no development of diabetic retinopathy. These results compare favorably with those reported after standard medical therapy.
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Affiliation(s)
- Francesca Abbatini
- Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza, Italy
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