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Morissette A, Mulvihill EE. Cardioprotective benefits of metabolic surgery and GLP-1 receptor agonist-based therapies. Trends Endocrinol Metab 2025; 36:316-329. [PMID: 39127552 DOI: 10.1016/j.tem.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
Individuals with excessive adipose tissue and type 2 diabetes mellitus (T2DM) face a heightened risk of cardiovascular morbidity and mortality. Metabolic surgery is an effective therapy for people with severe obesity to achieve significant weight loss. Additionally, metabolic surgery improves blood glucose levels and can lead to T2DM remission, reducing major adverse cardiovascular outcomes (MACE). Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are a class of medication that effectively reduce body weight and MACE in patients with T2DM. This review explores the potential mechanisms underlying the cardioprotective benefits of metabolic surgery and GLP-1RA-based therapies and discusses recent evidence and emerging therapies in this dynamic area of research.
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Affiliation(s)
- Arianne Morissette
- The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, Ontario, KIY 4W7, Canada
| | - Erin E Mulvihill
- The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, Ontario, KIY 4W7, Canada; Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, The University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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Morissette A, Mulvihill EE. Obesity management for the treatment of type 2 diabetes: emerging evidence and therapeutic approaches. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:13065. [PMID: 38903652 PMCID: PMC11186996 DOI: 10.3389/jpps.2024.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024]
Abstract
Excess adiposity can contribute to metabolic complications, such as type 2 diabetes mellitus (T2DM), which poses a significant global health burden. Traditionally viewed as a chronic and irreversible condition, T2DM management has evolved and new approaches emphasizing reversal and remission are emerging. Bariatric surgery demonstrates significant improvements in body weight and glucose homeostasis. However, its complexity limits widespread implementation as a population-wide intervention. The identification of glucagon-like peptide 1 (GLP-1) and the development of GLP-1 receptor agonists (GLP-1RAs) have improved T2DM management and offer promising outcomes in terms of weight loss. Innovative treatment approaches combining GLP-1RA with other gut and pancreatic-derived hormone receptor agonists, such as glucose-dependant insulinotropic peptide (GIP) and glucagon (GCG) receptor agonists, or coadministered with amylin analogues, are demonstrating enhanced efficacy in both weight loss and glycemic control. This review aims to explore the benefits of bariatric surgery and emerging pharmacological therapies such as GLP-1RAs, and dual and triple agonists in managing obesity and T2DM while highlighting the caveats and evolving landscape of treatment options.
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Affiliation(s)
| | - Erin E. Mulvihill
- The University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology and Immunology, The University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
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Wafa A, Bashir A, Cohen RV, Haddad A. The Alarming Rate of Malnutrition after Single Anastomosis Sleeve Ileal Bypass. A single Centre Experience. Obes Surg 2024; 34:1742-1747. [PMID: 38532145 DOI: 10.1007/s11695-024-07192-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Single anastomosis sleeve ileal (SASI) bypass is a modification of sleeve gastrectomy with transit bipartition (SG + TB). This study aims to assess the safety and efficacy of SASI as a primary metabolic and bariatric surgery (MBS). METHODS This is a retrospective case series of 30 patients who underwent SASI bypass from January to December 2021. All patients completed at least 12 months of follow-up. RESULTS Among the 30 patients, 93.3% were women, the mean age was 37.4 years, and the mean body mass index (BMI) was 45.6 kg/m2. The percentage of total body weight loss (TWL%) was 42.7%, the percent excess body weight loss (EWL%) was 92.7%, and the mean BMI at 12 months went from 45.6(35.2-58.4) to 25.8 kg/m2 (19.2-33.4). The obesity-associated complications remission rate was 87.5% for type 2 diabetes (T2D), 71.4% for hypertension (HTN) and 100% for obstructive sleep apnea (OSA). Thirteen patients (43.3%) had diarrhea, 7 (23.3%) had hypoalbuminemia, defined as serum albumin < 3 g/dl, and 6 (20%) underwent reversal of their index SASI. As for other nutritional issues, iron deficiency anemia was present in 21 patients (70%), while 19 patients (63.3%) had vitamin D, and 2(6.6%) had vitamin B12 deficiency. CONCLUSION Despite good short-term weight loss and improvement of obesity-associated complications, SASI is accompanied by high alarming malnutrition, even in short-term follow-up. Novel MBS should be judged for their long-term effects and compared to well-tested standard operations before they are used in routine clinical practice.
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Affiliation(s)
- Ala Wafa
- Aljazeera International Hospital, Misurata University School of Medicine, Misurata, Libya.
| | - Ahmad Bashir
- Gastrointestinal Bariatric and Metabolic Surgery Center (GBMC), Jordan Hospital, Amman, Jordan
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
| | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Surgery Center (GBMC), Jordan Hospital, Amman, Jordan
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Engin A. Bariatric Surgery in Obesity: Metabolic Quality Analysis and Comparison of Surgical Options. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1460:697-726. [PMID: 39287870 DOI: 10.1007/978-3-031-63657-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Obesity is a constantly growing health problem which reduces quality of life and life expectancy. Bariatric surgery (BS) for obesity is considered when all other conservative treatment modalities have failed. Comparison of the multidisciplinary programs with BS regarding to the weight loss showed that substantial and durable weight reduction have been achieved only with bariatric surgical treatments. Although laparoscopic sleeve gastrectomy is the most popular BS, it has high long-term failure rates, and it is claimed that one of every three patients will undergo another bariatric procedure within a 10-year period. Although BS provides weight loss and improvement of metabolic comorbidities, in long-term follow-up, weight gain is observed in half of the patients, while decrease in bone mass and nutritional deficiencies occur in up to 90%. Moreover, despite significant weight loss, several psychological aspects of patients are worsened in comparison to preoperative levels. Nearly one-fifth of postoperative patients with "Loss-of-eating control" meet food addiction criteria. Therefore, the benefits of weight loss following bariatric procedures alone are still debated in terms of the proinflammatory and metabolic profile of obesity.
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Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey.
- Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
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Fair L, Waddimba AC, Strothman P, Dwyer D, Anderton P, Bittle A, Ogola GO, Leeds S, Davis D. The use of a total bowel length measurement protocol may reduce reoperations and complications after single-anastomosis duodenal switch. Surg Endosc 2023; 37:9310-9317. [PMID: 37884731 DOI: 10.1007/s00464-023-10505-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Most surgeons who perform single-anastomosis duodeno-ileal switches (SADI-S) use a pre-determined common channel length without measuring total bowel length (TBL). However, TBL varies between patients, and a standardized common channel length could contribute to malabsorptive complications and reoperations following SADI-S. The purpose of this study was to determine whether using a TBL measurement protocol to individualize common channel length would be associated with reduced reoperations and complications. METHODS A prospectively maintained data registry was retrospectively reviewed to identify all patients who underwent SADI-S between September 2017 and February 2022. In April 2021, we began using TBL measurements during SADI-S with 40% of the TBL used as the length for the common channel. Outcomes pre-TBL and post-TBL measurement protocol were compared. RESULTS A total of 119 SADI-S recipients (59 pre-TBL; 60 post-TBL) were included. The pre-TBL group had a higher frequency of reoperations (23.7% vs 1.7%, p < 0.001) and late complications (29.3% vs 3.3%, p < 0.001). The mean time to reoperation was 13.7 months in the pre-TBL group and 6.7 months in the post-TBL group (p = 0.347). Patients in the post-TBL group had significantly higher serum albumin levels at 3 months (4.2 g/dL vs 3.5 g/dL, p < 0.001), 6 months (4.1 g/dL vs 3.6 g/dL, p < 0.001), and 12 months (4.2 g/dL vs 3.8 g/dL, p = 0.023) postoperatively when compared to the pre-TBL group. CONCLUSION Using TBL measurements to individualize common channel length was associated with a significant reduction in reoperations and late complications following SADI-S.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Anthony C Waddimba
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Phillip Strothman
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Darby Dwyer
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA
| | - Priscilla Anderton
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA
| | - Anella Bittle
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Gerald O Ogola
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Steven Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA
- Center for Advanced Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Daniel Davis
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Medical and Weight Loss Management, Baylor University Medical Center, Dallas, TX, USA.
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA.
- Center for Metabolic and Weight Loss Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA.
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Papadia F, Carlini F, Longo G, Rubartelli A, Battistini M, Drago B, Adami GF, Marinari G, Camerini G. Pyrrhic victory? Long-term results of biliopancreatic diversion on patients with type 2 diabetes and severe obesity. Surg Obes Relat Dis 2023; 19:1110-1117. [PMID: 37156659 DOI: 10.1016/j.soard.2023.04.300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/22/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The long-term results after biliopancreatic diversion (BPD) in patients with type 2 diabetes (T2D) and severe obesity is still being debated. OBJECTIVE Retrospective evaluation of the long-term metabolic and clinical conditions of patients with T2D following BPD. SETTING University hospital. METHODS A total of 173 patients with T2D and severe obesity were investigated prior to and at 3-5 and 10-20 years after BPD. Anthropometric, biochemical, and clinical findings preoperatively and throughout follow-up were considered. The long-term data were compared with those of a cohort of 173 T2D patients with obesity treated with conventional therapy. RESULTS T2D resolved within the first postoperative phases in most patients, and in the long and very long term, the fasting blood glucose level remained above the normal range in only 8% of patients. Likewise, a stable improvement of blood lipid pattern was observed (follow-up rate 63%). In contrast, in nonsurgical patients in the long term, the glucose and lipid metabolic parameters remained in the pathologic range in all cases. In the BPD group, a very high number of severe BPD-related complications was recorded, and 27% of the BPD patients died, whereas in the control group, 87% of patients were still alive at the end of the follow-up period (P < .02). CONCLUSION Despite the high T2D stable resolution rate and the normalization of most metabolic data at 10-20 years following surgery, these results indicate that BPD should be indicated with caution in the surgical treatment of T2D in patients with severe obesity.
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Affiliation(s)
| | - Flavia Carlini
- Department of Surgery, University of Genoa, Genoa, Italy
| | - Gaia Longo
- Department of Surgery, University of Genoa, Genoa, Italy
| | | | - Micaela Battistini
- Department of Surgery, University of Genoa, Genoa, Italy; Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Beatrice Drago
- Department of Surgery, University of Genoa, Genoa, Italy
| | - Gian Franco Adami
- Department of Surgery, University of Genoa, Genoa, Italy; Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Giuseppe Marinari
- Bariatric Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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Valadez LZM, Frigolet ME, Dominguez RM, Pescarus R, Zerrweck C, Boudreau V, Doumouras A, Cookson T, Anvari M. Metabolic and Bariatric Surgery in Diabetes Management. THE DIABETES TEXTBOOK 2023:673-690. [DOI: 10.1007/978-3-031-25519-9_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Sewefy AM, Atyia AM, Mohammed MM, Kayed TH, Hamza HM. Single anastomosis sleeve jejunal (SAS-J) bypass as a treatment for morbid obesity, technique and review of 1986 cases and 6 Years follow-up. Retrospective cohort. Int J Surg 2022; 102:106662. [PMID: 35568310 DOI: 10.1016/j.ijsu.2022.106662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/16/2022] [Accepted: 05/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Santoro's operation is a sleeve gastrectomy with transit bipartition. The operation aims to maintain passage to the duodenum to minimize nutritional deficiency. This procedure is rapidly changed to single anastomosis sleeve ileal (SASI) bypass. SAS-J bypass is a modification of SASI with a short biliary limb. MATERIAL AND METHODS This study is a retrospective study of prospectively collected data. The study includes a comprehensive review of 1986 patients who underwent SAS-J bypass over 6 years. The total number is used to evaluate the perioperative data. One- and two-year follow-up was used to evaluate weight loss and comorbidities; follow-up of more than 5 years was used to obtain long-term results. RESULTS In this study, 70.4% of patients were female and 29.6% were male. The mean body mass index (BMI) was 44.7. The mean age was 42 years. Regarding comorbidities, 25.8% of the patients had type 2 diabetes, 31% were hypertensive, 14.2% had sleep apnea syndrome, 6.6% had gastroesophageal reflux disease (GERD), and 39.6% had hyperlipidemia. Of the 1294 patients who complete one-year follow up, %EWL reached 87%. Blood glucose levels were normalized in 98.5% of patients, hypertension remitted in 93%, hyperlipidemia improved in 97%, SAS is improved in all cases, and GERD improved in 89% of patients. After 5 years, 94 patients' BMI decreased from 44.3 to 28.3 without significant nutritional deficiency. CONCLUSIONS Laparoscopic SAS-J bypass is an effective and simple alternative bariatric procedure at short- and long-term follow-up.
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Affiliation(s)
- Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Egypt.
| | - Ahmed M Atyia
- Department of Surgery, Minia University Hospital, Egypt
| | | | - Taha H Kayed
- Department of Surgery, Minia University Hospital, Egypt
| | - Hosam M Hamza
- Department of Surgery, Minia University Hospital, Egypt
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Papadia FS, Carlini F, Rubartelli A, Battistini M, Cordera R, Adami GF, Camerini G. Diabetes Resolution at 10 Years After Biliopancreatic Diversion in Overweight and Class 1 Obese Patients with Type 2 Diabetes. Obes Surg 2022; 32:845-851. [PMID: 35013895 PMCID: PMC8866270 DOI: 10.1007/s11695-021-05870-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
Background Long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients were investigated reporting the results at 10 years after BPD performed in severely non-obese T2DM patients. Material and Methods Thirty T2DM patients with BMI lower than 35 kg/m2 were investigated at 1, 5, and 10 years after BPD, and the results are compared with those of 30 T2DM patients followed for 10 years on pharmacological and/or behavioral conventional therapy. Results Mean levels of fasting blood glucose (FBG) and serum glycated hemoglobin (HbA1C) showed a marked reduction 1 year after BPD, values remaining slightly above the diabetic range throughout the entire follow-up. T2DM remission was observed in about 50% of the cases at 5 and 10 years after the operation. In 16 patients (53%), severe BPD-related complications developed, in ten cases requiring a surgical revision of the operation. In the BPD group, one patient died for malignant lymphoma and two patients after surgical revision. Within the control group, during the 10-year follow-up, no changes in the diabetic status were observed, being the FBG and HbA1C mean values higher than those recorded in the BPD patients at any follow-up time. All T2DM subjects of the control group were alive at the end of the 10-year follow-up. Conclusion Despite satisfactory long-term metabolic outcomes, these data indicate that BPD should be used with caution as a metabolic procedure in the treatment of T2DM in overweight or class 1obese patients. Graphical abstract ![]()
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Affiliation(s)
| | - Flavia Carlini
- Department of Surgery, University of Genova, Genova, Italy
| | | | - Micaela Battistini
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy
| | - Renzo Cordera
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy
| | - Gian Franco Adami
- Department of Internal Medicine, University of Genova, 8, Viale Benedetto XV, 16132, Genova, Italy.
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Ceriani V, Pinna F, Galantino A, Zakaria AS, Manfrini R, Pontiroli AE, Folli F. Biliopancreatic Diversion (BPD), Long Common Limb Revisional Biliopancreatic Diversion (BPD + LCL-R), Roux-en-Y Gastric Bypass [RYGB] and Sleeve Gastrectomy (SG) mediate differential quantitative changes in body weight and qualitative modifications in body composition: a 5-year study. Acta Diabetol 2022; 59:39-48. [PMID: 34453598 PMCID: PMC8758656 DOI: 10.1007/s00592-021-01777-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 01/01/2023]
Abstract
AIMS Bariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study. METHODS We analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL-R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital. RESULTS In a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL-R; with RYGB and SG both BMI and FM slightly increased in the years 3-5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL-R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered. CONCLUSIONS All surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3-5, while BPD and BPD + LCL-R showed a slight further decreases in the same time interval.
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Affiliation(s)
| | | | - Antonio Galantino
- Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Ahmed S Zakaria
- Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Roberto Manfrini
- Endocrinologia E Malattie Metaboliche, Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Unità Dipartimentale Di Diabetologia E Malattie Metaboliche, ASST Santi Paolo E Carlo, Milan, Italy
| | - Antonio E Pontiroli
- Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
| | - Franco Folli
- Endocrinologia E Malattie Metaboliche, Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
- Unità Dipartimentale Di Diabetologia E Malattie Metaboliche, ASST Santi Paolo E Carlo, Milan, Italy.
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Akkus G, Tetiker T. Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies? World J Diabetes 2021; 12:1312-1324. [PMID: 34512896 PMCID: PMC8394232 DOI: 10.4239/wjd.v12.i8.1312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus (T2DM). Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM. There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM, but remission rates of T2DM after metabolic surgery can display great variability. AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy, adjustable gastric banding, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures. RESULTS In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patient with T2DM, but further studies are needed to clarify better the rate of diabetes remission. CONCLUSION In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patients with T2DM, but further studies are needed to clarify better the rate of diabetes remission.
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Affiliation(s)
- Gamze Akkus
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
| | - Tamer Tetiker
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
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Evaluation of Lipoprotein Profile and Residual Risk Three Years After Bariatric Surgery. Obes Surg 2021; 31:4033-4044. [PMID: 34245426 DOI: 10.1007/s11695-021-05543-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Obesity is a chronic disease associated with other comorbidities, including atherogenic dyslipidemia (AD). Bariatric surgery (BS) has shown to reduce cardiovascular risk (CVR) by achieving a significant weight reduction and improving the lipid profile. Different surgical techniques may have a different effect on the lipoprotein profile. PURPOSE To evaluate the lipid profile at 3 years after BS according to the surgical technique used and to determine which variables predict variation in the lipid profile at 3 years after BS. METHODS Retrospective observational study of 206 patients who underwent BS between 2010 and 2019. We analyzed the variation of lipid parameters in the 3 years of follow-up according to the surgical technique, including a group analysis of patients according to whether they had dyslipidemia and whether they were treated or untreated and determined which variables predict variation in the lipid profile at 3 years after BS. RESULTS There was a significant increase in high-density lipoprotein cholesterol (HDL-c) with sleeve gastrectomy (SG) and a significant decrease in total cholesterol (TC), LDL-cholesterol (LDL-c), non-HDL, and LDL/non-HDL with biliopancreatic diversion (BPD). Variables predicting lipid profile variation were surgical technique and pre-surgery lipoprotein level. CONCLUSIONS Malabsorptive techniques achieve a greater decrease in TC and LDL-c throughout follow-up and could also improve residual cardiovascular risk (non-HDL and LDL/non-HDL). The type of surgical technique and the presurgery lipid profile predict variation after 3 years of BS.
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Reluctance in duodenal switch adoption: an international survey among bariatric surgeons. Surg Obes Relat Dis 2021; 17:1760-1765. [PMID: 34330622 DOI: 10.1016/j.soard.2021.06.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Duodenal switch (DS) still comprises less than 1% of the overall primary procedures in the United States. Our aim is to explore the reasons behind surgeons' reluctance to DS adoption. OBJECTIVES To determine perceived reasons for the widespread lack of adoption of the DS. SETTING Worldwide survey of closed bariatric surgery social media groups. METHODS A standardized questionnaire was posted on 2 closed social media bariatric groups. DS was used as an umbrella term that includes traditional BPD with duodenal switch, single anastomosis duodeno-ileostomy (SADI) and loop DS. The questionnaire link was accessible to bariatric surgeons only for a period of 1 week. RESULTS Survey responses (n = 193) were analyzed. The majority (75%) were fellowship-trained bariatric surgeons, and 58% were practicing in the United States. Although 72.9% believed DS to be a good bariatric procedure, it was not being performed by 64% of the respondents. The main reasons behind DS nonadoption included a perceptible high long-term complication rate (43.5%), lack of training (38.1%), and procedure seldomly demanded by patients (31.5%). For surgeons who perform DS, 16.4% use it as a revisional procedure, mainly following sleeve gastrectomy (40.5%). Finally, 29.5% of surgeons believed that the American Society of Metabolic and Bariatric Surgery endorsement of SADI will encourage them to add DS to their practice. They are mostly planning to do so by visiting other surgeons and getting proctored (42.6%). CONCLUSION This survey will help guide bariatric societies and governing bodies in addressing the issues and concerns preventing surgeons from adopting DS in their practice by elucidating the chief reasons and circumstances behind this occurrence.
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Fultang J, Chinaka U, Rankin J, Bakhshi A, Ali A. Preoperative Bariatric Surgery Predictors of Type 2 Diabetes Remission. J Obes Metab Syndr 2021; 30:104-114. [PMID: 33436532 PMCID: PMC8277586 DOI: 10.7570/jomes20084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
Obesity represents a significant proportion of the global public health burden, with the World Health Organization (WHO) estimating more than 600 million people are affected worldwide. Unfortunately, the epidemic of obesity is linked to the increased prevalence of associated metabolic diseases such as type 2 diabetes mellitus (T2DM). Bariatric surgery as an intervention has been shown to provide sustainable weight loss, and also leads to superior short- and long-term metabolic benefits including T2DM remission. Despite this added advantage conferred by bariatric surgery, emerging evidence has shown that not all patients with T2DM achieve remission postoperatively. As such, to improve patient selection and optimize preoperative counselling, research has focused on the preoperative predictors of T2DM remission following bariatric surgery. Herein, we provide a critical review of the current literature addressing preoperative predictors of T2DM remission and highlight the current gaps in the literature. The review comprised a multistage advanced electronic search of the Ovid/Medline, Embase, and Cochrane online libraries to identify available studies published over the last decade.
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Affiliation(s)
- Joshua Fultang
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Ugochukwu Chinaka
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Jean Rankin
- School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Andisheh Bakhshi
- School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Abdulmajid Ali
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
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15
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Ziogas IA, Zapsalis K, Giannis D, Tsoulfas G. Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know! World J Hepatol 2020; 12:709-721. [PMID: 33200011 PMCID: PMC7643217 DOI: 10.4254/wjh.v12.i10.709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Metabolic syndrome (MS) is defined as the constellation of obesity, insulin resistance, high serum triglycerides, low high-density lipoprotein cholesterol, and high blood pressure. It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare, cost, and quality of life associated consequences. MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease. Conservative treatment, which includes diet, exercise, and antidiabetic agents, is the mainstay of treatment, but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations. Bariatric surgery has recently emerged as an appropriate alternative treatment with promising long-term results. Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates. Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with non-alcoholic steatohepatitis has increased more than fivefold over the past 15 years. In this review, we summarize current state of evidence on the surgical treatment of MS.
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Affiliation(s)
- Ioannis A Ziogas
- Aristotle University School of Medicine, Thessaloniki 54124, Greece
| | | | - Dimitrios Giannis
- Center for Health Innovations and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Manhasset, NY 11030, United States
| | - Georgios Tsoulfas
- The First Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
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16
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The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up). Surg Endosc 2020; 35:5698-5704. [PMID: 32989534 DOI: 10.1007/s00464-020-08029-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/16/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Santoro's operation is a sleeve gastrectomy with transit bipartition. The aim of the procedure is to keep pass to the duodenum to decrease nutritional deficiency and to allow endoscopic management of obstructive jaundice. To be easier, this procedure was rapidly altered to a single anastomosis sleeve ileal bypass (SASI). In this study, we shifted the anastomosis up to the jejunum to evaluate the effect of laparoscopic single anastomosis sleeve jejunal (SASJ) bypass as a treatment for morbid obesity and related comorbidities. In addition, the effect of the SASJ procedure on nutritional deficiency was examined. METHODS In this study, 150 morbidly obese patients underwent SASJ bypass with a biliary limb length of 200-250 cm. All patients were followed up at 1, 3, 6, 12, 18, and 24 months. We evaluated all cases by assessing BMI, complications, nutritional status, and obesity-related comorbidities. RESULTS The mean age of participants was 30.6 years, and the mean body mass index (BMI) was 44.6 kg/m2. Of the patients, 35 (23.2%) had type two diabetes and 47 (31.3%) were hypertensive. Postoperative bleeding occurred in two cases (1.3%). One patient developed a gastric leak (0.7%), and five patients developed biliary gastritis (3.3%). One patient (0.7%) developed a pulmonary embolism. The %EWL reached 85% in 1 year. Normalization of blood glucose occurred within 2 months after surgery in all diabetic patients. Hypertension underwent remittance in 89% of hypertensive patients. All patients were gradually weaned from four types of multivitamin regimens to only one multivitamin regimen without apparent nutritional deficiency. CONCLUSIONS Laparoscopic SASJ bypass is an effective, safe, and simple procedure for treating morbid obesity and comorbid conditions with least nutritional deficiency. However, long-term studies are needed.
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17
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Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2020; 16:1701-1712. [PMID: 32800734 DOI: 10.1016/j.soard.2020.06.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/10/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) confers the highest rate of type 2 diabetes (T2D) remission compared with other bariatric procedures. Previous studies suggest that type of antidiabetic therapy used before surgery and duration of disease influence postsurgical glycemic outcomes. Short-term, progressive improvement in insulin sensitivity and beta-cell function after metabolic surgery in patients with noninsulin-treated T2D has been demonstrated. Whether patients with more advanced disease can achieve sustained remission remains unclear. OBJECTIVE The aim of this study was to assess long-term glycemic outcomes in insulin-treated patients with T2D after BPD-DS and identify predictors of sustained diabetes remission or relapse. SETTING University-affiliated tertiary care center. METHODS Data from 141 patients with insulin-treated T2D who underwent BPD-DS between 1994 and 2006 with 10 years of follow-up data were collected from a prospective electronic database. RESULTS Follow-up was available in 132 patients (91%). At 10 years after metabolic surgery, 90 patients (68.1%) had a complete remission of diabetes, 3 (2.3%) had a partial remission, 21 (15.9%) had an improvement, and 3 (2.3%) were unchanged in their diabetes status. Fourteen patients died during the 10-year follow-up period. Relapse after an initial period of remission occurred in 15 (11.4%) patients. Insulin discontinuation was achieved in 97%. Duration of diabetes was an independent predictor of nonremission at 10 years. CONCLUSIONS The BPD-DS maintains remission at 10 years postoperatively in patients with more advanced diabetes. Long-term benefits of the BPD-DS on weight loss and glycemic control should be considered when offering metabolic surgery to patients with insulin-treated T2D.
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18
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Biliopancreatic Diversion in the Surgical Treatment of Morbid Obesity: Long-Term Results and Metabolic Consequences. Obes Surg 2020; 30:4234-4242. [PMID: 32562130 DOI: 10.1007/s11695-020-04777-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE In the multidisciplinary therapeutic approach to obesity, bariatric surgery is considered the most effective treatment in weight reduction and the decrease in associated comorbidities. The objective of this work is to describe the long-term clinical and metabolic results in obese patients undergoing biliopancreatic diversion (BPD) according to Scopinaro's technique. MATERIALS AND METHODS Patients undergoing surgery were followed by the same multidisciplinary team in a study period of 15 years (1999-2015). A retrospective study based on a prospective database was designed, where data on the evolution of obesity-related diseases and nutritional parameters were studied. RESULTS Two hundred seventy-seven patients were collected; 75.5% were women. The preoperative body mass index (BMI) decreased from 52.5 kg/m2 to 34.9 kg/m2 10 years after surgery. A resolution or improvement of diabetes has been observed in 85.38% of the patients; a decrease in arterial hypertension and obstructive sleep apnea syndrome were in 65.61% and 89.14%, respectively. Throughout the monitoring of the sample, protein malnutrition increased, from 1.8% after the first year of surgery to 4.5% 10 years after the operation. CONCLUSION Even if Scopinaro's technique is beginning to be replaced by other malabsorptive techniques, it can still be considered as an effective surgical procedure in terms of weight loss, quality of life, and evolution of obesity-related diseases. In order to avoid nutritional deficiencies, the operated patients need a strict follow-up and a supplementation adjusted to the technique.
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19
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Madyan A, Emile SH, Abdel-Razik MA, Ellithy R, Elbanna HG, Elshobaky A. Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients With Morbid Obesity: Technical Description and Short-term Outcomes. Surg Laparosc Endosc Percutan Tech 2020; 30:e13-e17. [PMID: 32032329 DOI: 10.1097/sle.0000000000000763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Morbid obesity has been recognized as a public health crisis, particularly in developed countries. Single anastomosis sleeve ileal (SASI) bypass has been introduced as a novel bariatric and metabolic procedure. The present study aimed to describe the technical steps and assess the short-term outcomes of SASI bypass in patients with super morbid obesity. PATIENTS AND METHODS Adult patients of both sexes with body mass index (BMI) ≥50 kg/m underwent SASI bypass and were followed for 12 months postoperatively. Changes in BMI, excess weight loss (EWL), and improvement in comorbidities were recorded on follow-up. RESULTS Twenty patients (17 female) of the mean age of 35.4 years were included in the study. The mean preoperative BMI (53.7±5.9) showed a significant decrease at 6 months (39.9±5.2) and then at 12 months (33.6±6) postoperatively. The mean %EWL was 44.3±7.8 at 6 months and 65.2±12.6 at 12 months. All patients with diabetes mellitus, osteoarthritis, and reflux esophagitis showed resolution at 12 months after the SASI bypass. Complications were recorded in 2 patients and no mortality was reported. CONCLUSIONS SASI bypass is an effective and safe bariatric procedure that confers significant loss of weight and improvement in medical comorbidities. As compared with previous studies on patients with lower BMI, patients with super morbid obesity attained lower %EWL but similar resolution of diabetes mellitus at 12 months after SASI bypass.
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Affiliation(s)
- Amr Madyan
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
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20
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Mahdy T, Emile SH, Madyan A, Schou C, Alwahidi A, Ribeiro R, Sewefy A, Büsing M, Al-Haifi M, Salih E, Shikora S. Evaluation of the Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients with Morbid Obesity: a Multicenter Study. Obes Surg 2020; 30:837-845. [PMID: 31734889 DOI: 10.1007/s11695-019-04296-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Single anastomosis sleeve ileal (SASI) bypass is a newly introduced bariatric and metabolic procedure. The present multicenter study aimed to evaluate the efficacy of the SASI bypass in the treatment of patients with morbid obesity and the metabolic syndrome. METHODS This is a retrospective, seven-country, multicenter study on patients with morbid obesity who underwent the SASI bypass. Data regarding patients' demographics, body mass index (BMI), percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and improvement in comorbidities at 12 months postoperatively and postoperative complications were collected. RESULTS Among 605 patients who underwent the SASI, 54 were excluded and 551 (390; 70.8% female) were included. At 12 months after the SASI, a significant decrease in the BMI was observed (43.2 ± 12.5 to 31.2 ± 9.7 kg/m2; p < 0.0001). The %TWL was 27.4 ± 13.4 and the %EWL was 63.9 ± 29.5. Among the 279 patients with type 2 diabetes mellitus (T2DM), complete remission was recorded in 234 (83.9%) patients and partial improvement in 43 (15.4%) patients. Eighty-six (36.1%) patients with hypertension, 104 (65%) patients with hyperlipidemia, 37 (57.8%) patients with sleep apnea, and 70 (92.1%) patients with GERD achieved remission. Fifty-six (10.1%) complications and 2 (0.3%) mortalities were recorded. Most complications were minor. All patients had 12 months follow-up. CONCLUSIONS The SASI bypass is an effective bariatric and metabolic surgery that achieved satisfactory weight loss and improvement in medical comorbidities, including T2DM, hypertension, sleep apnea, and GERD, with a low complication rate.
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Affiliation(s)
- Tarek Mahdy
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street Dakahlia, Mansoura, 35516, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street Dakahlia, Mansoura, 35516, Egypt.
| | - Amr Madyan
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street Dakahlia, Mansoura, 35516, Egypt
| | | | | | - Rui Ribeiro
- Clinica De Santo Antonio, Lusiadas, Amadora, Lisbon, Portugal
| | - Alaa Sewefy
- General Surgery Department, Minia Faculty of Medicine, Minia University, Minya, Egypt
| | - Martin Büsing
- Klinikum Vest, Dorstenerstr, 151, 45657, Recklinghausen, Germany
| | | | | | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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21
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Sudlow A, le Roux CW, Pournaras DJ. The metabolic benefits of different bariatric operations: what procedure to choose? Endocr Connect 2020; 9:R28-R35. [PMID: 31917678 PMCID: PMC6993254 DOI: 10.1530/ec-19-0467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
Bariatric surgery is established as a highly effective treatment for obesity and related metabolic complications. Although once seen as a last resort for patients with obesity, given the data demonstrating the profound weight loss, improvement in comorbidity and safety, perceptions have since shifted. There is evidence from 12 RCTs demonstrating its safety and efficacy in terms of weight loss which is sustained in the long term with a resultant improvement in co-morbidity. Clinicians are increasingly recognising the importance of timely intervention to maximise the effects of bariatric surgery, particularly in light of the low likelihood of being able to adequately manage patients with medication or lifestyle interventions alone. The inclusion of bariatric surgery in the standard treatment algorithm has been a step forward in the approach to treating patients with obesity. What remains challenging for clinicians is knowing which procedure is most beneficial to patients. There is no level one data demonstrating the superiority of one procedure over another. Head to head RCTs are ongoing which may shed light on this question; however, it is likely that there is no single procedure that will be demonstrated to be the gold standard. Herein we review the most commonly performed procedures along with the evidence available to support their effects with regards to weight loss and metabolic changes along with their limitations and recognised risks. The aim is to provide a general framework to allow clinicians to take advantage of the variety of operative approaches to tailor their treatment strategy to the individual patient.
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Affiliation(s)
- Alexis Sudlow
- Department of Upper GI Surgery, Southmead Hospital, Bristol, UK
| | - Carel W le Roux
- Department of Experimental Pathology, University College Dublin, Dublin, Ireland
- Correspondence should be addressed to C le Roux:
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22
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O'Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, Crosthwaite G, Brown W. Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding. Obes Surg 2020; 29:3-14. [PMID: 30293134 PMCID: PMC6320354 DOI: 10.1007/s11695-018-3525-0] [Citation(s) in RCA: 471] [Impact Index Per Article: 94.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up. Methods Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented. Results Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques. Conclusion All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.
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Affiliation(s)
- Paul E O'Brien
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia. .,Centre for Bariatric Surgery, Melbourne, Australia.
| | - Annemarie Hindle
- School of Behavioural and Health Sciences, Centre for Eating, Weight and Body Image, Australian Catholic University, Melbourne, Australia
| | - Leah Brennan
- School of Behavioural and Health Sciences, Centre for Eating, Weight and Body Image, Australian Catholic University, Melbourne, Australia
| | - Stewart Skinner
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia.,Centre for Bariatric Surgery, Melbourne, Australia
| | - Paul Burton
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia.,Centre for Bariatric Surgery, Melbourne, Australia
| | - Andrew Smith
- Centre for Bariatric Surgery, Melbourne, Australia
| | | | - Wendy Brown
- Centre for Obesity Research and Education, The Alfred Centre, Monash University Clinical School, 99 Commercial Road, Melbourne, 3004, Australia.,Centre for Bariatric Surgery, Melbourne, Australia
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23
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Patel N, Mohanaruban A, Ashrafian H, Le Roux C, Byrne J, Mason J, Hopkins J, Kelly J, Teare J. EndoBarrier®: a Safe and Effective Novel Treatment for Obesity and Type 2 Diabetes? Obes Surg 2019; 28:1980-1989. [PMID: 29450844 PMCID: PMC6018591 DOI: 10.1007/s11695-018-3123-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Aims Obesity associated with diabetes mellitus is a significant worldwide problem associated with considerable health care costs. Whilst surgical intervention is effective, it is invasive, costly and associated with complications. This study aims to evaluate the safety and efficacy of the EndoBarrier®, a duodenal-jejunal sleeve bypass as an alternative treatment of diabetes mellitus in obese patients. Materials and Methods This was a multi-centre, non-randomised trial recruiting obese patients with type 2 diabetes from three sites in the UK. Eligible participants had a BMI of 30–50 kg/m2 and HbA1c levels of 7.5–10%. The study comprised a 12-month period with the EndoBarrier® inserted and a 6-month follow-up period after it had been explanted. The primary study outcomes were weight, BMI, HbA1c levels and fasting insulin and glucose levels. Results Forty-five patients were recruited and 31 patients (69%) completed the 12-month study period. Significant reductions in weight (95%CI 0.62–29.38; p < 0.05) and BMI (95%CI 1.1–8.7; p < 0.005) were documented 12 months after device insertion. The mean HbA1c was significantly reduced (95%CI 0.1–1.6; p < 0.05) after the device insertion period and reductions in metabolic parameters (fasting insulin and glucose levels) were also documented during the study. Adverse events were also assessed in all patients, the vast majority of which were reported as mild. Conclusions The EndoBarrier® appears to be a safe and effective treatment strategy in overweight patients with poor glycaemic control despite medical therapy, or in those who are eligible but decline bariatric surgery.
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Affiliation(s)
- Nisha Patel
- St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
| | | | - Hutan Ashrafian
- St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
| | - Carel Le Roux
- Metabolic Medicine, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - James Byrne
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - John Mason
- Trafford Hospitals, Central Manchester University Hospitals NHS Foundation Trust, Moorside Road, Davyhulme, Manchester, M41 5SL, UK
| | - James Hopkins
- North Bristol NHS Trust, Southmead Hospital Bristol, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jamie Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Julian Teare
- St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK.
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Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: Fact or Fiction? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173171. [PMID: 31480306 PMCID: PMC6747427 DOI: 10.3390/ijerph16173171] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 02/07/2023]
Abstract
Although type 2 diabetes mellitus (T2DM) has been traditionally viewed as an intractable chronic medical condition, accumulating evidence points towards the notion that a complete remission of T2DM is feasible following a choice of medical and/or surgical interventions. This has been paralleled by increasing interest in the establishment of a universal definition for T2DM remission which, under given circumstances, could be considered equivalent to a “cure”. The efficacy of bariatric surgery in particular for achieving glycemic control has highlighted surgery as a candidate curative intervention for T2DM. Herein, available evidence regarding available surgical modalities and the mechanisms that drive metabolic amelioration after bariatric surgery are reviewed. Furthermore, reports from observational and randomized studies with regard to T2DM remission are reviewed, along with concepts relevant to the variety of definitions used for T2DM remission and other potential sources of discrepancy in success rates among different studies.
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25
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Bhandari M, Fobi MAL, Buchwald JN. Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg 2019; 29:309-345. [PMID: 31297742 DOI: 10.1007/s11695-019-04032-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Affiliation(s)
- Mohit Bhandari
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India.
| | - M A L Fobi
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
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Type 2 Diabetes Remission and Control in Overweight and in Mildly Obese Diabetic Patients at Long-Term Follow-Up After Biliopancreatic Diversion. Obes Surg 2018; 29:239-245. [DOI: 10.1007/s11695-018-3511-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abdelaal M, le Roux CW, Docherty NG. Validated Scoring Systems for Predicting Diabetes Remission After Bariatric Surgery. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Mahmoud Abdelaal
- Conway Institute, Diabetes Complications Research Centre, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
| | - Carel W. le Roux
- Conway Institute, Diabetes Complications Research Centre, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Investigative Science, Imperial College London, London, United Kingdom
| | - Neil G. Docherty
- Conway Institute, Diabetes Complications Research Centre, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Serum Leptin and Adiponectin Concentration in Type 2 Diabetes Patients in the Short and Long Term Following Biliopancreatic Diversion. Obes Surg 2017; 26:2442-8. [PMID: 26989058 DOI: 10.1007/s11695-016-2126-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A deranged adipokine system is implicated in obesity and in type 2 diabetes mellitus (T2DM), and the lack of remission of T2DM after bariatric surgery could be also accounted for by the postoperative persistence of this condition. METHODS Thirty T2DM patients undergoing biliopancreatic diversion (BPD) with a wide range of baseline body mass index (BMI) were evaluated prior to and at 1 and 5 years following BPD. Besides the usual clinical evaluations, acute insulin response (AIR) to intravenous glucose load as a parameter of insulin secretion and the serum leptin and adiponectin concentration were measured throughout the follow-up period in all patients. RESULTS A long-term T2DM remission was observed in 21 patients (70 %). Serum leptin level reduced at the first year and remained substantially unchanged at a long term in both the remitter and non-remitter patients, while following the operation, a progressive significant increase of serum adiponectin level was observed only in remitter patients (from 9.2 to 12.3 μg/mL at 1 year and to 15.18 μg/mL at 5 years in the remitters and from 8.8 to 8.75 μg/mL at 1 year and to 11.8 μg/mL at 5 years in the non-remitters). Serum leptin mean values were positively associated with the BMI ones both prior to and following BPD (p < 0.005), while serum adiponectin values were positively related (p < 0.04) to the postoperative AIR data. CONCLUSIONS The improvement of the pattern of cytokine production, as evidenced by postoperative rise in serum adiponectin concentration, might play a role in T2DM remission after bariatric surgery.
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Cardiovascular Risk Factors After Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): a New Effective Therapeutic Approach? Curr Atheroscler Rep 2017; 19:58. [PMID: 29116413 DOI: 10.1007/s11883-017-0688-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Shouhed D, Steggerda J, Burch M, Noureddin M. The role of bariatric surgery in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Expert Rev Gastroenterol Hepatol 2017; 11:797-811. [PMID: 28712339 DOI: 10.1080/17474124.2017.1355731] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) affects between 25% and 33% of the population, is more common in obese individuals, and is the most common cause of chronic liver disease in the United States. However, despite rising prevalence, effective treatments remain limited. Areas covered: We performed a literature search across multiple databases (Pubmed, Medline, etc.) to identify significant original research and review articles to provide an up-to-date and concise overview of disease pathogenesis and diagnostic evaluation and to expand on available treatment options with a specific focus on the potential role of bariatric surgery. Here we provide the most comprehensive review of bariatric surgery for the management of NAFLD, noting benefits from different procedures and multiple reports showing improvements in steatosis, inflammation and fibrosis over the duration of follow-up. Expert commentary: The morbidity of NAFLD is significant as it may become the most common indication for liver transplantation within the next 5 years. In addition to known benefits of weight loss and diabetes resolution, bariatric surgery has the potential to halt and reverse disease progression and future controlled trials should be performed to further define its benefit in the treatment of NAFLD in morbidly obese patients.
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Affiliation(s)
- Daniel Shouhed
- a Department of Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Bariatric Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Justin Steggerda
- a Department of Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Miguel Burch
- a Department of Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Bariatric Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Mazen Noureddin
- c Fatty Liver Disease Program, Division of Digestive and Liver Diseases, Department of Medicine , Comprehensive Transplant Center, Cedars-Sinai Medical Center , Los Angeles , CA , USA
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Does Bariatric Surgery Improve Obesity Associated Comorbid Conditions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:545-570. [PMID: 28585216 DOI: 10.1007/978-3-319-48382-5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Obesity is a constantly growing health problem which reduces quality of life and life expectancy. Bariatric surgery for obesity is taken into account when all other conservative treatment modalities have failed. Comparison of the multidisciplinary programs with bariatric surgery regarding to weight loss showed that substantial and durable weight reduction have been achieved only with bariatric surgical treatments. However, the benefits of weight loss following bariatric procedures are still debated regarding the pro-inflammatory and metabolic profile of obesity.
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Taha O, Abdelaal M, Abozeid M, Askalany A, Alaa M. Outcomes of One Anastomosis Gastric Bypass in 472 Diabetic Patients. Obes Surg 2017; 27:2802-2810. [PMID: 28534188 DOI: 10.1007/s11695-017-2711-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The positive impact of Roux-en-Y gastric bypass (RYGB) on metabolic syndrome and glycemic control has been proven in obese patients. One anastomosis gastric bypass (OAGB) is a simple, effective and easy to learn procedure. OAGB provides encouraging results for the treatment of diabetes obese patients, but does it have the ability to be an alternative procedure to RYGB in the treatment of these patients? The aim of this study is to evaluate the outcomes of OAGB on diabetic obese patients at the bariatric centre of our university hospital. By extension, we evaluated the possibility of BMI and the preoperative antidiabetic medication usage to be predictive factors for postoperative diabetes resolution. METHODS This is a retrospective single-centre study of 472 diabetic patients who underwent OAGB from November 2009 to December 2015. All patients were followed-up for at least 1 year, and up to 3 years, where available. Weight, HbA1c, and anti-diabetic medications were recorded at baseline, 3, 6, 12, 24 and 36 months. RESULTS A total of 472 patients have been followed-up for 1 year and 361 for 3 years. The mean BMI decreased from 46.8 ± 7.2 to 29.5 ± 2.8 kg/m2 and HbA1c from 9.6 ± 1.3 to 5.7 ± 1.5% at the 12-month follow-up. At the 3-year follow-up, the mean BMI was 32.1 ± 3.3 and HbA1c mean was 5.8 ± 0.9%. Diabetes remission was achieved by 84.1% of patients. CONCLUSIONS OAGB can be an excellent alternative to RYGB for the treatment of diabetes and obesity. Pre-operative medications may be used to predict postoperative diabetes remission, but not BMI.
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Affiliation(s)
- Osama Taha
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.,Overweight Clinics, Cairo, Egypt
| | - Mahmoud Abdelaal
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Mohamed Abozeid
- General Surgery Department, Ain Shams University hospital, Cairo, Egypt
| | - Awny Askalany
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt
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Bonaventura A, Liberale L, Carbone F, Scopinaro N, Camerini G, Papadia FS, Cordera R, Dallegri F, Adami GF, Montecucco F. High baseline C-reactive protein levels predict partial type 2 diabetes mellitus remission after biliopancreatic diversion. Nutr Metab Cardiovasc Dis 2017; 27:423-429. [PMID: 28284664 DOI: 10.1016/j.numecd.2017.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Several studies demonstrated that surgery can improve inflammation parameters, such as C-reactive protein (CRP). Few biomarkers have been investigated to potentially predict type 2 diabetes mellitus (T2DM) remission. We aimed at determining whether pre-surgery serum CRP levels could predict T2DM remission after 3 years in patients undergoing bariatric surgery, especially biliopancreatic diversion (BPD). METHODS AND RESULTS This study was conducted from 2007 to 2009 at the Surgical Department of the University of Genoa, Italy. Forty-four patients with T2DM undergoing BPD (n = 38) or Roux-en-Y gastric bypass (n = 6) were enrolled. The primary endpoint was to evaluate whether pre-surgery CRP levels could predict T2DM partial remission at 3-year follow-up. Secondary endpoints were to assess whether glycaemic, lipid, and inflammatory parameters modified during the follow-up. At baseline, patients with T2DM ranged from overweight to morbid obesity, had mild dyslipidaemia, and a low-grade inflammation. Bariatric surgery improved body weight, lipid and glycaemic profile both at 1- and 3-year follow-up. Pre-surgery CRP levels progressively decreased at 1- and 3-year follow-up. Among inflammatory pre-surgery parameters, only high CRP levels were shown to predict T2DM partial remission after 3 years. Multivariate analysis confirmed the predictive value of pre-surgery CRP levels independently of age, gender, type of surgery, and body mass index. CONCLUSION Bariatric surgery, in particular BPD, improved both metabolic and inflammatory biomarkers at 1- and 3-year follow-up. Pre-surgery high CRP levels predicted 3-year T2DM partial remission, indicating a promising target population to be especially treated with BPD.
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Affiliation(s)
- A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
| | - L Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - F Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - N Scopinaro
- International Federation of Surgery for Obesity, Genoa, Italy; Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - G Camerini
- Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - F S Papadia
- Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - R Cordera
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - F Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - G F Adami
- International Federation of Surgery for Obesity, Genoa, Italy; Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
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Abstract
Insufficient hepatic O2 in animal and human studies has been shown to elicit a hepatorenal reflex in response to increased hepatic adenosine, resulting in the stimulation of renal as well as muscle sympathetic nerve activity and activating the renin angiotensin system. Low hepatic ATP, hyperuricemia, and hepatic lipid accumulation reported in metabolic syndrome (MetS) patients may reflect insufficient hepatic O2 delivery, potentially accounting for the sympathetic overdrive associated with MetS. This theoretical concept is supported by experimental results in animals fed a high fructose diet to induce MetS. Hepatic fructose metabolism rapidly consumes ATP resulting in increased adenosine production and hyperuricemia as well as elevated renin release and sympathetic activity. This review makes the case for the hepatorenal reflex causing sympathetic overdrive and metabolic syndrome in response to exaggerated splanchnic oxygen consumption from excessive eating. This is strongly reinforced by the fact that MetS is cured in a matter of days in a significant percentage of patients by diet, bariatric surgery, or endoluminal sleeve, all of which would decrease splanchnic oxygen demand by limiting nutrient contact with the mucosa and reducing the nutrient load due to loss of appetite or dietary restriction.
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Affiliation(s)
- Michael D Wider
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
Insufficient hepatic O2 in animal and human studies has been shown to elicit a hepatorenal reflex in response to increased hepatic adenosine, resulting in stimulation of renal as well as muscle sympathetic nerve activity and activating the renin angiotensin system. Low hepatic ATP, hyperuricemia, and hepatic lipid accumulation reported in metabolic syndrome (MetS) patients may reflect insufficient hepatic O2 delivery, potentially accounting for the sympathetic overdrive associated with MetS. This theoretical concept is supported by experimental results in animals fed a high fructose diet to induce MetS. Hepatic fructose metabolism rapidly consumes ATP resulting in increased adenosine production and hyperuricemia as well as elevated renin release and sympathetic activity. This review makes the case for the hepatorenal reflex causing sympathetic overdrive and metabolic syndrome in response to exaggerated splanchnic oxygen consumption from excessive eating. This is strongly reinforced by the fact that MetS is cured in a matter of days in a significant percentage of patients by diet, bariatric surgery, or endoluminal sleeve, all of which would decrease splanchnic oxygen demand by limiting nutrient contact with the mucosa and reducing the nutrient load due to the loss of appetite or dietary restriction.
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Affiliation(s)
- Michael D Wider
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Adami GF, Scopinaro N, Cordera R. Adipokine Pattern After Bariatric Surgery: Beyond the Weight Loss. Obes Surg 2016; 26:2793-2801. [DOI: 10.1007/s11695-016-2347-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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37
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Aguilar-Olivos NE, Almeda-Valdes P, Aguilar-Salinas CA, Uribe M, Méndez-Sánchez N. The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome. Metabolism 2016; 65:1196-1207. [PMID: 26435078 DOI: 10.1016/j.metabol.2015.09.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is strongly associated with obesity and metabolic syndrome (MetS). Current treatment of NAFLD is based on weight reduction. Bariatric surgery is the most effective treatment for morbid obesity and its associated metabolic comorbidities. There is evidence indicating that bariatric surgery improves histological and biochemical parameters of NAFLD, but currently is not considered a treatment option for NAFLD. The aim of this work is to review the evidence for the effects of bariatric surgery on NAFLD and the MetS. We found that insulin resistance, alterations in glucose metabolism, hypertension, plasma lipids, transaminases, liver steatosis, steatohepatitis and fibrosis improve after bariatric surgery. Weight loss and improvement of NAFLD are greater after RYGB than after other interventions. These findings were obtained from retrospective or cohort studies. There are no studies designed to evaluate liver-specific mortality, liver transplantation, or quality of life. Patients with indications for bariatric surgery will benefit from the improvements in the MetS and NAFLD.
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Affiliation(s)
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Scopinaro N, Camerini G, Papadia F, Andraghetti G, Cordera R, Adami GF. Long-term clinical and functional impact of biliopancreatic diversion on type 2 diabetes in morbidly and non–morbidly obese patients. Surg Obes Relat Dis 2016; 12:822-827. [DOI: 10.1016/j.soard.2015.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/19/2015] [Accepted: 12/06/2015] [Indexed: 12/25/2022]
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Ahmetasevic E, Pasic F, Beslin MB, Ilic M, Ahmetasevic D, Mesic M. Bariatric Surgery in University Clinic Center Tuzla - Results After 30 Operations. Acta Inform Med 2016; 24:139-42. [PMID: 27147808 PMCID: PMC4851494 DOI: 10.5455/aim.2016.24.139-142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/15/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created. MATERIAL AND METHODS Practical team education was realized in Croatia in hospital "Sisters of Mercy" under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro. RESULTS AND DISCUSSION So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro's BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year's weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious.
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Affiliation(s)
- Emir Ahmetasevic
- Clinic for surgery of University clinic Centre Tuzla, Bosnia and Herzegovina
| | - Fuad Pasic
- Clinic for surgery of University clinic Centre Tuzla, Bosnia and Herzegovina
| | | | - Miroslav Ilic
- Clinic for surgery of hospital "Sisters of mercy" Zagreb, Croatia
| | - Dzenita Ahmetasevic
- Clinic for anesthesiology and reanimation of University clinic Centre Tuzla, Bosnia and Herzegovina
| | - Mirza Mesic
- Clinic for surgery of University clinic Centre Tuzla, Bosnia and Herzegovina
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Burguera B, Jesús Tur J, Escudero AJ, Alos M, Pagán A, Cortés B, González XF, Soriano JB. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study-A Two-Year Randomized Controlled Clinical Trial. Int J Endocrinol 2015; 2015:194696. [PMID: 26257780 PMCID: PMC4518148 DOI: 10.1155/2015/194696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/18/2015] [Indexed: 01/14/2023] Open
Abstract
Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients. Objective. This controlled, clinical trial with a two-year intervention was aimed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery, on body weight changes and metabolic parameters in morbidly obese patients. Methods. Patients were randomized to an Intensive Lifestyle Intervention (ILI) (n = 60) or Conventional Obesity Therapy (COT) (n = 46). The ILI group received behavioral therapy and nutritional counseling. The COT group received standard medical treatment. They were compared with a third group, Surgical Obesity Group (SOG) (n = 37). Results. Patients who received ILI had a greater percentage of weight loss than patients receiving COT (-11.3% versus -1.6%; p < 0.0044). Interestingly 31.4% of patients included in the ILI group were no longer morbidly obese after just six months of intervention, increasing to 44.4% after 24 months of intervention. The percentage weight loss in SOG was -29.6% after that same period of time. Conclusions. ILI was associated with significant weight loss when compared to COT, in a group of patients with obesity. An ILI approach could be an alternative therapy to patients with obesity, who are not candidates to undergo bariatric surgery. This trial is registered with EudraCT 2009-013737-24.
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Affiliation(s)
- Bartolomé Burguera
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Endocrinology and Bariatric Institutes, Cleveland Clinic, 9500 Euclid Avenue M62, Cleveland, OH 44195, USA
| | - Juan Jesús Tur
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Unidad de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Jorge Escudero
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Unidad de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - María Alos
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Alberto Pagán
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Cirugía General, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Baltasar Cortés
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Unidad de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, 28030 Madrid, Spain
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Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques. Obes Surg 2015; 26:5-11. [DOI: 10.1007/s11695-015-1775-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism? Wideochir Inne Tech Maloinwazyjne 2015; 10:213-28. [PMID: 26240621 PMCID: PMC4520841 DOI: 10.5114/wiitm.2015.52062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Insulin resistance (IR), the essential step in development of type 2 diabetes mellitus (T2DM), resolves quickly after bariatric surgery, but the effectiveness depends on the type of the procedure. Although the long-term influence on IR improvement is well documented, the mechanisms of the ultra-fast response after restrictive and bypass procedures require explanation. AIM To determine IR evolution from the initial preparative period to 6 months after the operation, exposing the rapid postoperative response while comparing the 3 bariatric methods, with the belief that the metabolic effect may be correlated with anatomical combinations. MATERIAL AND METHODS From January to December, 2013, a cohort of severely obese, insulin resistant individuals recruited to the prospective study underwent laparoscopic sleeve gastrectomy (SG-30), Roux-en-Y gastric bypass (RYGB-30) and one-anastomosis gastric bypass (OAGB-30). Main laboratory parameters of glucose metabolism were evaluated in fasting patients preoperatively, 4 days and 1, 3 and 6 months after surgery. RESULTS Within the whole observation period the most significant improvement in homeostasis model assessment for IR (HOMA-IR) was observed in the first 4 days after each operation. The decrease of HOMA-IR was higher (p < 0.0001) in gastric bypass groups than in patients after SG (-41%). The difference between bypass groups favors OAGB over RYGB (63 vs. -56%, p = 0.0489). CONCLUSIONS Among all bariatric management factors, operation type is the most important in IR improvement. The significant difference in response after SG vs. RYGB and OAGB supports the concept of metabolic competence of duodeno-jejunal exclusion. Altered bile flow after duodeno-jejunal exclusion may be responsible for enhanced glucose metabolism improvement.
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The long-term impact of biliopancreatic diversion on glycemic control in the severely obese with type 2 diabetes mellitus in relation to preoperative duration of diabetes. Surg Obes Relat Dis 2015; 12:345-9. [PMID: 26381876 DOI: 10.1016/j.soard.2015.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to be effective in severely obese patients with type 2 diabetes mellitus (T2DM). OBJECTIVE Evaluate the long-term efficacy of biliopancreatic diversion (BPD) for the treatment of T2DM depending on the preoperative duration of T2DM. SETTING University Hospital. METHODS Retrospective analysis investigating 2 subsets of severely obese patients who had undergone BPD from 1984 to 1995. The first included 52 patients with a preoperative T2DM duration of ~1 year (SD group - 49 on oral agents and 3 on insulin), and the second included 68 patients who had been diabetic for>5 years before BPD (LD group - 52 on oral agents and 16 on insulin). Postoperatively, T2DM was regarded as in remission when fasting serum glucose (FSG) was lower than 100 mg/dL on regular diet and without antidiabetic therapy. RESULTS In the SD patients, the number of individuals without T2DM remission were lower both at 5-10 (0/31, 0% of patients, versus 8/54, 15% of patients, p<.04) and at>15 years (1/28, 3% of patients, versus 10/41, 24% of patients, p<.0012). Furthermore, after BPD, the number of patients with dyslipidemia strongly reduced (p<.001) in both groups, values at 5-10 years remaining very similar to those observed at>15 years. CONCLUSION These results indicate that severely obese patients with longer T2DM duration have a worse metabolic outcome maintained at long and very long term following BPD.
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Scopinaro N, Adami GF, Papadia FS, Camerini G, Carlini F, Briatore L, Andraghetti G, Catalano M, Cordera R. Effects of gastric bypass on type 2 diabetes in patients with BMI 30 to 35. Obes Surg 2015; 24:1036-43. [PMID: 24647849 DOI: 10.1007/s11695-014-1206-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aims to investigate if the benefits on glycemic control following Roux-en-Y gastric bypass (RYGB) in morbidly obese type 2 diabetes (T2DM) patients are maintained in the 30-35 kg/m(2) BMI (body mass index) range, comparing results with those in literature. METHODS The study participants were twenty T2DM patients aging 35-70 years, BMI 30.0-34.9 kg/m(2), minimum diabetes duration 3 years, glycosylated haemoglobin (HbA1c) ≥7.5% despite good clinical practice medical therapy, submitted to laparoscopic RYGB, and monitored during 36 months. Twenty-seven matched diabetic patients as controls. RESULTS Five females, mean age 57 (42-69) years, weight 96.0 (70-111) kg, BMI 32.9 (30.3-34.9) kg/m(2), waist circumference 112 (100-128) cm, diabetes duration 14 (3-28) years, HbA1c 9.5 (7.5-14.2) %, and C-peptide 3.2 (1,6-9.1) mcg/l. Ten patients were on insulin. There was no mortality, and there were two major late complications. BMI and waist decreased stabilizing around 25 kg/m(2) and 92 cm. Fasting serum glucose and HbA1c reached values around 150 mg/dl and 7%, which subsequently maintained. There was remission in 25% of cases, control 45%, and all the others improved. HOMA-IR and insulin sensitivity index normalized at 1 month, then maintained. AIR and insulinogenic index showed no postoperative changes. Diabetes remission correlated negatively with duration (p < 0.05; r (2) = 0.61), while control positively with C-peptide (p < 0.05; r (2) = 0.19). In the control group, FSG, HbA1c, serum triglyceride, and cholesterol significantly decreased with considerable progressive increase of antidiabetic/antihyperlipemic therapy. All patients had HbA1c >7% at 2-3 years. CONCLUSIONS Glycemic control obtained by RYGB in this study was less good than that reported by others, apparently due to different patient selection criteria. Our results do not support RYGB weight loss-independent effect on beta-cell function in the T2DM patients with BMI 30-35 kg/m(2).
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Affiliation(s)
- Nicola Scopinaro
- Department of Surgery, University of Genoa, School of Medicine, Genoa, Italy,
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Kim MJ, Hur KY. Short-term outcomes of laparoscopic single anastomosis gastric bypass (LSAGB) for the treatment of type 2 diabetes in lower BMI (<30 kg/m(2)) patients. Obes Surg 2015; 24:1044-51. [PMID: 24566662 DOI: 10.1007/s11695-014-1202-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery is an efficient procedure for remission of type 2 diabetes (T2DM) in morbid obesity. However, in Asian countries, mean body mass index (BMI) of T2DM patients is about 25 kg/m(2). Various data on patients undergoing gastric bypass surgery showed that control of T2DM after surgery occurs rapidly and somewhat independent to weight loss. We hypothesized that in non-obese patients with T2DM, the glycemic control would be achieved as a consequence of gastric bypass surgery. METHODS From September 2009, the 172 patients have had laparoscopic single anastomosis gastric bypass (LSAGB) surgery. Among them, 107 patients have been followed up more than 1 year. We analyzed the dataset of these patients. Values related to diabetes were measured before and 1, 2, and 3 years after the surgery. RESULTS The mean BMI decreased during the first year after the surgery but plateaued after that. The mean glycosylated hemoglobin level decreased continuously. The mean fasting and postglucose loading plasma glucose level also decreased. CONCLUSION After LSAGB surgery in non-obese T2DM patients, the control of T2DM was possible safely and effectively. However, longer follow-up with matched control group is essential.
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Affiliation(s)
- Myung Jin Kim
- Department of Surgery, Soonchunhyang University College of Medicine, 59, Daesagwan-ro (657, Hannam-dong), Yongsan-gu, Seoul, South Korea
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Ren Y, Yang W, Yang J, Wang C. Effect of Roux-en-Y gastric bypass with different pouch size in Chinese T2DM patients with BMI 30-35 kg/m2. Obes Surg 2015; 25:457-463. [PMID: 25236397 DOI: 10.1007/s11695-014-1411-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to assess the effect of Roux-en-Y gastric bypass (RYGB) with different pouch size in Chinese type 2 diabetes mellitus (T2DM) patients with measured body mass index (BMI) 30-35 kg/m(2). METHODS In this randomized and prospective study, we evaluated the efficacy of RYGB with smaller size pouch (10-20 ml) versus larger pouch size (25-35 ml) in 76 Chinese obese patients (33 F, 43 M) with T2DM. According to protocol, all patients were divided into two groups, smaller pouch size group and larger pouch size group, and underwent RYGB surgery. Primary inclusion criteria of study were (a) a diagnosis of type 2 diabetes (glycated hemoglobin level >7.0 %), (b) measured BMI of at least 30 kg/m(2) and not yet 35 kg/m(2), and (c) age between 25 and 60 years old, and (d) patients were excluded if they had previously undergone complex abdominal surgery or bariatric surgery. Weight loss, BMI, percentage of excess weight loss (% EWL), glycated hemoglobin, and fasting plasma glucose were obtained at 3, 6, 9, and 12 months after surgery. RESULTS Of these 76 patients, 69 (91 %) patients completed follow-up postoperative 12 months. Weight loss and % EWL at 12 months was greater in smaller pouch size group (mean 15.8 kg, 95 % CI -17.2 to -14.4 and mean 68.9, 95 % CI 62.5-75.2 %) than in larger pouch size group (mean -13.7 kg, 95 % CI -15.3 to -12.1, and mean 59.1, 95 % CI 52.8-65.5) (P = 0.046, P = 0.033, respectively). Glycemic control improved in both two groups, with a mean glycated hemoglobin level of 6.2 % (95 % CI 6.0-6.5 %) in smaller size group, and 6.7 % (95 % CI 6.4-7.0 %) in larger size group (P = 0.025, P < 0.05). The fasting plasma glucose level decreased significantly after surgery, with a mean level of 5.4 mmol/L (95 % CI 5.2-5.5 mmol/L) and 5.6 mmol/L (95 % CI 5.5-5.8 mmol/L) respectively, (P = 0.040, P < 0.05). CONCLUSIONS In this short-term study, in Chinese T2DM patients with BMI 30-35 kg/m(2), we observed a greater efficiency on weight loss and glycemic control with smaller pouch size compared to larger pouch size. In the future, long-term follow-up and large sample study will be necessary to confirm these outcomes.
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Affiliation(s)
- Yixing Ren
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
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Ameri P, Bruzzone S, Mannino E, Sociali G, Andraghetti G, Salis A, Ponta ML, Briatore L, Adami GF, Ferraiolo A, Venturini PL, Maggi D, Cordera R, Murialdo G, Zocchi E. Impaired increase of plasma abscisic Acid in response to oral glucose load in type 2 diabetes and in gestational diabetes. PLoS One 2015; 10:e0115992. [PMID: 25723556 PMCID: PMC4344322 DOI: 10.1371/journal.pone.0115992] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/03/2014] [Indexed: 11/18/2022] Open
Abstract
The plant hormone abscisic acid (ABA) is present and active in humans, regulating glucose homeostasis. In normal glucose tolerant (NGT) human subjects, plasma ABA (ABAp) increases 5-fold after an oral glucose load. The aim of this study was to assess the effect of an oral glucose load on ABAp in type 2 diabetes (T2D) subjects. We chose two sub-groups of patients who underwent an oral glucose load for diagnostic purposes: i) 9 treatment-naive T2D subjects, and ii) 9 pregnant women with gestational diabetes (GDM), who underwent the glucose load before and 8–12 weeks after childbirth. Each group was compared with matched NGT controls. The increase of ABAp in response to glucose was found to be abrogated in T2D patients compared to NGT controls. A similar result was observed in the women with GDM compared to pregnant NGT controls; 8–12 weeks after childbirth, however, fasting ABAp and ABAp response to glucose were restored to normal in the GDM subjects, along with glucose tolerance. We also retrospectively compared fasting ABAp before and after bilio-pancreatic diversion (BPD) in obese, but not diabetic subjects, and in obese T2D patients, in which BPD resulted in the resolution of diabetes. Compared to pre-BPD values, basal ABAp significantly increased 1 month after BPD in T2D as well as in NGT subjects, in parallel with a reduction of fasting plasma glucose. These results indicate an impaired hyperglycemia-induced ABAp increase in T2D and in GDM and suggest a beneficial effect of elevated ABAp on glycemic control.
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Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Santina Bruzzone
- Department of Experimental Medicine, Section of Biochemistry and CEBR, University of Genova, Viale Benedetto XV/1, 16132 Genova, Italy
| | - Elena Mannino
- Department of Experimental Medicine, Section of Biochemistry and CEBR, University of Genova, Viale Benedetto XV/1, 16132 Genova, Italy
| | - Giovanna Sociali
- Department of Experimental Medicine, Section of Biochemistry and CEBR, University of Genova, Viale Benedetto XV/1, 16132 Genova, Italy
| | - Gabriella Andraghetti
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Annalisa Salis
- Department of Experimental Medicine, Section of Biochemistry and CEBR, University of Genova, Viale Benedetto XV/1, 16132 Genova, Italy
| | - Monica Laura Ponta
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Lucia Briatore
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Giovanni F. Adami
- Department of surgical sciences and integrated diagnostic, University of Genova, Largo R. Benzi 8, 16132 Genova, Italy
| | | | - Pier Luigi Venturini
- IRCSS San Martino IST, Largo R. Benzi 10, 16132 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences, University of Genova, Largo P. Daneo, 3, 16132 Genova, Italy
| | - Davide Maggi
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Renzo Cordera
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Giovanni Murialdo
- Department of Internal Medicine, University of Genova, Viale Benedetto XV/6, 16132 Genova, Italy
| | - Elena Zocchi
- Department of Experimental Medicine, Section of Biochemistry and CEBR, University of Genova, Viale Benedetto XV/1, 16132 Genova, Italy
- * E-mail:
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Shuai X, Tao K, Mori M, Kanda T. Bariatric surgery for metabolic syndrome in obesity. Metab Syndr Relat Disord 2015; 13:149-60. [PMID: 25715110 DOI: 10.1089/met.2014.0115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Metabolic syndrome is closely associated with morbid obesity and leads to increased risk of cardiovascular diseases and related mortality. Bariatric surgery is considered an effective option for the management of this condition. We searched MEDLINE, Current Contents, and the Cochrane Library for papers published on bariatric surgery outcomes in English from January 1, 1990, to April 20, 2014. Bariatric surgery can significantly reduce body weight, resolve or cure many of the symptoms of metabolic syndrome, including type 2 diabetes, hypertension, hyperlipidemia, and improve long-term survival. Surgery, in addition to existing therapy, could therefore be considered as an optimal treatment for patients with metabolic syndrome and morbid obesity.
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Affiliation(s)
- Xiaoming Shuai
- 1 Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province, People's Republic of China
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Marceau P, Biron S, Marceau S, Hould FS, Lebel S, Lescelleur O, Biertho L, Simard S, Kral JG. Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion. Obes Surg 2015; 25:1584-93. [DOI: 10.1007/s11695-015-1599-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery. Ann Surg 2015; 260:274-8. [PMID: 24743608 DOI: 10.1097/sla.0000000000000656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. BACKGROUND The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. METHODS Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. RESULTS In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. CONCLUSIONS Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.
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