scholarly journals Bariatric surgery and type 2 diabetes: are there weight loss-independent therapeutic effects of upper gastrointestinal bypass?

2016 ◽  
Vol 280 (5) ◽  
pp. 476-486 ◽  
Author(s):  
M. Chondronikola ◽  
L. L. S. Harris ◽  
S. Klein
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Therapeutic Effects ◽  
Gastrointestinal Bypass ◽  
Upper Gastrointestinal

Abstract 018: Two-year Changes of Adiponectin after Bariatric Surgery and Their Association with Incident Type 2 Diabetes, Cardiovascular Disease, Cancer and Mortality: Results from the Swedish Obese Subjects Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Christian Herder ◽  
Markku Peltonen ◽  
Per-Arne Svensson ◽  
Maren Carstensen ◽  
Peter Jacobson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Control Group ◽  
Incident Type ◽  
Surgery Group ◽  
Obese Subjects

Introduction: Adiponectin has anti-inflammatory, insulin-sensitising and atheroprotective effects in rodents. Although serum adiponectin is uniformly downregulated in obesity, its clinical relevance in humans seems more complex. It is not known whether changes in circulating adiponectin predict type 2 diabetes, cardiovascular disease, cancer and mortality in an obese population. Hypothesis: We hypothesised that adiponectin levels are upregulated substantially after weight loss following bariatric surgery and that pronounced increases of adiponectin should offer better protection for individuals against type 2 diabetes. In addition, findings for type 2 diabetes should be compared to associations with cardiovascular disease, myocardial infarction, stroke, cancer and mortality. Methods: Serum concentrations of total adiponectin were measured in 3,223 participants of the Swedish Obese Subjects (SOS) Study (1,533 in the bariatric surgery group: 229 with gastric bypass, 1056 with vertical banded gastroplasty, 248 with adjustable gastric banding; 1,690 in the control group without surgery) at study baseline and after 2 years. Hazard ratios (HR) and 95% confidence intervals (CI) per 1 standard deviation (SD) of 2-year changes (concentration at year 2 - concentration at baseline) in adiponectin were calculated for incident type 2 diabetes, cardiovascular disease, myocardial infarction, stroke, cancer and mortality in the combined surgery group. Numbers of cases were 93, 122, 78, 55, 82 and 179, respectively. Median follow-up times ranged from 10 years for diabetes up to 16 years for mortality. Results: Mean (SD) levels of adiponectin at baseline were 7,453 (4,150) ng/ml in the combined surgery group and 8,247 (4,846) ng/ml in the control group. During the first 2 years of follow-up, adiponectin levels increased in the surgery group by 4,850 (5,387) ng/ml (parallel to a loss of 24% of body weight) and decreased slightly by 270 (2,650) ng/ml in the control group (parallel to a slight gain of 0.1% body weight). The degree of correlation between changes in adiponectin and weight loss in kg was more pronounced in the surgery groups compared with the control group (p=0.001 for interaction). Two-year increases in adiponectin in the surgery group were associated with decreased risk of type 2 diabetes (HR [95% CI] 0.61 [0.38-0.98], adjusted for baseline data for age, sex, BMI, lipids, blood pressure, alcohol consumption, smoking, anti-hypertensive drugs, glucose, insulin), but not with cardiovascular disease, myocardial infarction, stroke, cancer and mortality (adjusted HR between 0.89 and 1.05). Conclusions: Weight loss after bariatric surgery is paralleled by a substantial increase in circulating adiponectin. The degree of upregulation of adiponectin is associated with protection against future type 2 diabetes, but not with the incidence of cardiovascular outcomes, cancer or mortality.

scholarly journals Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus

2019 ◽  
Vol 2019 ◽  
Author(s):  
Michelle Maher ◽  
Mohammed Faraz Rafey ◽  
Helena Griffin ◽  
Katie Cunningham ◽  
Francis M Finucane
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Glycaemic Control ◽  
Severe Obesity ◽  
Meal Replacement ◽  
Agonist Therapy ◽  
Severely Obese ◽  
Skimmed Milk

Summary A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team. Learning points: Meal replacement programmes are an emerging therapeutic strategy to allow severely obese type 2 diabetes patients to achieve clinically impactful weight loss. Using semi-skimmed milk as a meal replacement substrate might be less costly than commercially available programmes, but is likely to require intensive multidisciplinary bariatric clinical follow-up. For severely obese adults with poor diabetes control who decline bariatric surgery or GLP1 agonist therapy, a milk-based meal replacement programme may be an option. Milk-based meal replacement in patients with insulin requiring type 2 diabetes causes rapid and profound reductions in insulin requirements, so rigorous monitoring of glucose levels by patients and their clinicians is necessary. In carefully selected and adequately monitored patients, the response to oral antidiabetic medications may help to differentiate between absolute and relative insulin deficiency.

scholarly journals Proceedings from the 2018 Association for Chemoreception Annual Meeting Symposium: Bariatric Surgery and Its Effects on Taste and Food Selection

2018 ◽  
Vol 44 (3) ◽  
pp. 155-163 ◽  
Author(s):  
Alan C Spector ◽  
Natasha Kapoor ◽  
Ruth K Price ◽  
M Yanina Pepino ◽  
M Barbara E Livingstone ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Annual Meeting ◽  
Food Selection ◽  
Food Preferences ◽  
Empirical Support ◽  
Clinical Findings

Abstract This article provides a summary of the topics discussed at the symposium titled “Bariatric Surgery and Its Effects on Taste and Food Selection,” which was held at the Fortieth Annual Meeting of the Association for Chemoreception Sciences. Bariatric surgery such as Roux-en-Y gastric bypass (RYGB) is currently one of the most effective treatments available for weight loss and Type 2 diabetes. For this reason, it is of great interest to clinicians as well as to basic scientists studying the controls of feeding and energy balance. Despite the commonly held view by clinicians that RYGB patients change their food preferences away from fats and sugars in favor of less energy dense alternatives such as vegetables, the empirical support for this claim is equivocal. It is currently thought that the taste and palatability of fats and sugars are affected by the surgery. Some key preclinical and clinical findings addressing these issues were evaluated in this symposium.

scholarly journals CRITICAL ANALYSIS OF SURGICAL TREATMENT TECHNIQUES OF MORBID OBESITY

2019 ◽  
Vol 32 (3) ◽  
Author(s):  
Bruno ZILBERSTEIN ◽  
Marco Aurélio SANTO ◽  
Marnay Helbo CARVALHO
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Biliopancreatic Diversion ◽  
Morbidity And Mortality ◽  
Good Resolution ◽  
Obstructive Sleep

ABSTRACT Introduction: Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment. Objective: To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea. Methods: Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria. Results: Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques. Conclusion: The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.

scholarly journals Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies

2020 ◽  
Author(s):  
Ruveena Kaur ◽  
David Kim ◽  
Richard Cutfield ◽  
Michael Booth ◽  
Lindsay Plank ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Acid Decarboxylase ◽  
Gad Antibodies ◽  
C Peptide ◽  
Glycemic Outcomes ◽  
Design And Methods

<i>Objective</i>: To evaluate diabetes remission after bariatric surgery by presence of glutamic acid decarboxylase (GAD) antibody among those with obesity and Type 2 diabetes (T2D). <p> </p><i>Research Design and Methods</i>: Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. 9/16 patients with GAD and 112/205 without GAD proceeded with surgery. Diabetes remission and weight loss was compared by GAD presence. <p> </p><i>Results</i>: GAD titres were 16-91 IU/mL in the first group. Both groups were similar in age, BMI, diabetes duration, insulin treated proportion, HbA1c and C-peptide (1354 ± 548 vs 1358 ± 487pmol/L). At 1 and 5 years post-operatively, both groups achieved similar BMI reduction and diabetes remission (67% vs 73%, p=0.71, and 56% vs 57%, p=1.0). <p><i> </i></p><i>Conclusion</i>: Low-titre GAD in patients with T2D and retained C-peptide, should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.

scholarly journals Evaluation of weight loss and metabolic profile of obese patients with type 2 diabetes mellitus (dm2) versus non-dm2 subjects, one and three years after bariatric surgery

2010 ◽  
Vol 23 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Thiago Fraga Napoli ◽  
Mariana Furieri Guzzo ◽  
Douglas Kawashima Hisano ◽  
Paulo Gustavo Figueiredo Salgado Ribeiro ◽  
Vanessa Junqueira Guedes ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Profile ◽  
Weight Regain ◽  
Density Lipoprotein ◽  
Obese Patients

BACKGROUND: There is a debate over results obtained from type 2 diabetes mellitus (DM2) obese patients and non-DM2 patients, in reference to metabolic control and ponderal loss, after bariatric surgery. AIM: To evaluate weight loss and metabolic profile of obese patients with DM2 versus non-DM2 subjects, one and three years after bariatric surgery. METHODS: Data from 38 non-DM2 patients and 44 DM2 patients submitted to Roux-en-Y gastric-bypass were analysed retrospectively. For the pre-operatory, first and third year of post-operatory, were compared: weight, body mass index (BMI), fasting glucose (FG), high density lipoprotein (HDL) and triglycerides (TG). RESULTS: Preoperatively, both groups were statistically equivalent in regards to weight, BMI (P = 0.90) and HDL (P = 0.73). This was not the case when TG (P = 0.043) and FG (P<0.01) were analyzed. In PO1, both DM2 and non-DM2 groups showed a reduction in weight, BMI and TG, just as FG in the DM2 group (P < 0.05). HDL increased (P < 0.05) in PO1 in both groups. In the following period, between PO1 and PO3, only TG continued to decrease in the non-DM2 group (P = 0.039), while the other variables did not change. In the DM2 group mean A1c in PO3 was 6.2% +- 0.75 (P = 0.027). It was compared both group's post-operative data. HDL's and TG's variation between groups did not differ in PO1 or between PO1 and PO3. Weight in PO1 and PO3, just as BMI in PO1 and PO3, were not significantly different either. CONCLUSION: In PO1, weight loss and metabolic improvement was seen in both groups. This was sustained in PO3, with no significant weight regain or lipid/FG change. A1c found suggests a reasonable control of DM2 surgery. A trend towards a less intense weight loss could be noticed in the DM2 group (P = 0.053).

scholarly journals «Metabolicheskaya» khirurgiya

2011 ◽  
Vol 8 (3) ◽  
pp. 13-17 ◽  
Author(s):  
Yu I Yashkov ◽  
E V Ershova
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Conservative Therapy ◽  
Diet Therapy ◽  
Diabetes Control ◽  
Significant Potential ◽  
Maintain Weight Loss

Despite the developed methods of diet therapy in obesity and a variety of pharmacotherapy drugs for type 2 diabetes up to 60% of patients cannot maintain weight loss within 5 years of observation and more than 60% of patients with type 2 diabetes do not achieve adequate diabetes control. With morbid obesity the efficacy of conservative therapy is only 5-10%. Bariatric surgery has demonstrated a significant potential in compensation of obesity-related disorders, including type 2 diabetes.

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