scholarly journals Metabolic Profiling of Type 2 Diabetes Patients after Bariatric Surgery by Raman Spectroscopy

2021 ◽  
Vol 11 (22) ◽  
pp. 10710
Author(s):  
Arianna Bonizzi ◽  
Marta Sevieri ◽  
Leopoldo Sitia ◽  
Andrea Rizzi ◽  
Lorenzo Conti ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Raman Spectroscopy ◽  
Surgical Treatment ◽  
Metabolic Profile ◽  
Anthropometric Measures ◽  
Metabolic Fingerprint ◽  
Before And After

Background: Bariatric surgery (BS) is an important procedure used for the treatment of morbid obesity and has been proven to improve, or even cure, type 2 diabetes mellitus (T2DM). However, of the patients with T2DM who initially go into remission, a proportion experience a relapse during the follow-up. In this context, Raman spectroscopy (RS) could be a promising technique for monitoring the metabolic profile of patients after surgical treatment with the aim of improving their postsurgical management. Methods: Fourteen obese patients with T2DM were recruited. Clinical parameters, adipokines, ghrelin, Fibroblast growth factor 19 (FGF-19) values, and Raman spectra were collected and analyzed before and after surgery. RS results were compared with profiles obtained from 23 healthy subjects (HC), to observe whether the metabolic fingerprint of bariatric patients normalized during the surgical follow-up. Results: The reduction in anthropometric measures and improved glycemic control and lipid profile after surgical treatment highlighted the benefits of BS. Consequently, adipokines, ghrelin and FGF-19 concentration returned to normal values after surgery. However, RS data highlighted an altered metabolic profile even after BS. Conclusion: RS suggests that BS does not fully restore the metabolic profile of patients in the immediate follow-up after the surgery.

Insulin Dose Adjustment Following Bariatric Surgery, a Review of Available Literature

2021 ◽  
pp. 193229682110288
Author(s):  
Lynn E. Kassel ◽  
Jessica J. Berei ◽  
Jamie M. Pitlick ◽  
Joel E. Rand
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Appraisal Tool

Bariatric surgery is a known and effective treatment for type 2 diabetes mellitus. Patients with type 1 diabetes mellitus and exogenous insulin-requiring type 2 diabetes mellitus require adjusted insulin dosing after surgery to avoid hypoglycemia. This review describes insulin dose adjustments following a variety of bariatric procedures. After searching the available literature and assessing for eligibility, 8 articles were included. The Johns Hopkins Research Evidence Appraisal Tool for literature appraisal was used. The results of this review reveal insulin dose adjustment varies based upon surgical procedure type and time of follow-up from the procedure.

scholarly journals Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

2021 ◽  
Author(s):  
Kajsa Sjöholm ◽  
Lena MS Carlsson ◽  
Per-Arne Svensson ◽  
Johanna C. Andersson-Assarsson ◽  
Felipe Kristensson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Cancer Risk ◽  
Cancer Incidence ◽  
Diabetes Remission ◽  
Obesity And Diabetes ◽  
Obese Subjects

<b>OBJECTIVE</b> <p>Obesity and type 2 diabetes are associated with serious, adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of which underwent bariatric surgery, and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). </p> <p><b>RESULTS</b></p> <p>During follow-up, the incidence rate for first-time cancer was 9.1 per 1000-person-years (95% CI, 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1000-person-years (95% CI, 11.2-17.7) in patients treated with usual obesity care (HRadj=0.63; 95% CI 0.44-0.89, p=0.008). Moreover, surgery was associated with reduced cancer incidence in women (HRadj=0.58; 0.38-0.90, p=0.016), although the sex-treatment interaction was non-significant (p=0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (HRadj=0.40; 95% CI 0.22-0.74, p=0.003).</p> <p><b>CONCLUSIONS</b></p> <p>These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes, and that durable diabetes remission is associated with reduced cancer risk. </p>

scholarly journals MON-657 The Long-Term Effects of Sleeve Gastrectomy in Veterans with Type 2 Diabetes Mellitus (8-Year Follow-Up Analysis)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Johane Simelane ◽  
Amelia Tisi ◽  
Irma Husain ◽  
Pietra Dale Greenberg
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Friedman Test ◽  
The Mean ◽  
Mental Health Diagnoses

Abstract We previously reported a nonrandomized case control study that showed significant improvements in BMI, HbA1c and HDL levels in 30 diabetic veterans who underwent sleeve gastrectomy (SG) through 2 yrs, compared to 23 controls receiving medical management. BMI decreased from 46 to 34 over two yrs and HbA1c from 7.3 to 5.9% in the SG group. We now report the 8 yr follow up. Since then, bariatric surgery has increasingly become an option for the management of not only obesity but also type 2 diabetes. More data is needed on long term outcomes of bariatric surgery compared to medical care. Our cohort is mainly men with more comorbidities and higher average age than typically included in other cohorts that usually include more women. Objectives: The main objective was to compare long term changes in weight, HbA1C, lipids and creatinine in SG group vs. controls. Secondary objectives analyzed were cardiovascular (CV) and mental health outcomes in SG cases and controls. Methods: Charts for diabetic veterans 18 to 80 yrs were reviewed over an 8 yr period. Data was analyzed using Friedman Test, Wilcoxon Signed Rank test with 2-tailed significance level set at p&lt;05. Results: 23 cases and 22 controls were included in the 8-year data analysis. Mean age was 56 and 96% were male. The mean BMI and HbA1C at baseline were 45 and 7.3 in SG group with 41% on insulin and 42 and 8.4 for controls with 59% on insulin. A Friedman test found significant differences in mean changes in weight for BMI, HbA1C and HDL between SG cases and controls over the 8 yrs. (chi-square = 327.48; df = 4; p&lt;0.000001). Follow up pairwise comparisons used a Wilcoxon test. HDL was higher in the SG group (p&lt;.05) in each yr. Mean change in weight and BMI was significantly better for the SG group in the first 6 yrs after SG (p&lt; .01). Nonetheless, the mean weight and BMI of SG group remained below their mean baseline weight and BMI for the full 8 year-period. The mean change in HbA1C was significantly better for the SG group in only the first 2 yrs (p&lt;0.05). LDL change was significantly worse in SG group but not in all years. There were no significant differences in creatinine. Patients who had SG had fewer CV events 8 yrs after SG (baseline OR: 4.17, yr 8 OR:0.77). However, they also had more mental health diagnoses (yr 8 OR: 1.61). Conclusion:The weight loss in the SG group, as compared to controls, lessened over time remaining statistically significant until yr 6. However, the SG group mean BMI and weight remained below baseline at 8 years. HbA1C change remained significantly better in the SG group compared to controls only during the first 2 yrs. Follow up diabetes management in SG group was less consistent than controls. HDL remained significantly higher among the SG group which may be explain the lower CV events in this group. Awareness of more mental health diagnoses among bariatric surgery patients may lead to improved management and better adherence to a healthy lifestyle.

scholarly journals Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

2021 ◽  
Author(s):  
Kajsa Sjöholm ◽  
Lena MS Carlsson ◽  
Per-Arne Svensson ◽  
Johanna C. Andersson-Assarsson ◽  
Felipe Kristensson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Cancer Risk ◽  
Cancer Incidence ◽  
Diabetes Remission ◽  
Obesity And Diabetes ◽  
Obese Subjects

<b>OBJECTIVE</b> <p>Obesity and type 2 diabetes are associated with serious, adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of which underwent bariatric surgery, and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). </p> <p><b>RESULTS</b></p> <p>During follow-up, the incidence rate for first-time cancer was 9.1 per 1000-person-years (95% CI, 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1000-person-years (95% CI, 11.2-17.7) in patients treated with usual obesity care (HRadj=0.63; 95% CI 0.44-0.89, p=0.008). Moreover, surgery was associated with reduced cancer incidence in women (HRadj=0.58; 0.38-0.90, p=0.016), although the sex-treatment interaction was non-significant (p=0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (HRadj=0.40; 95% CI 0.22-0.74, p=0.003).</p> <p><b>CONCLUSIONS</b></p> <p>These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes, and that durable diabetes remission is associated with reduced cancer risk. </p>

scholarly journals New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

2020 ◽  
Vol 9 (4) ◽  
pp. 1070
Author(s):  
Ana de Hollanda ◽  
Albert Lecube ◽  
Miguel Angel Rubio ◽  
Enric Sánchez ◽  
Núria Vilarrasa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Diabetes Remission ◽  
Dynamic Responses ◽  
Type 2 Diabetes Remission

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the “time-within-remission range” as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, “time-within-remission range” and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m2) underwent primary bariatric procedures. “Time-within-remission range” were 83.3% (33.3–91.6) after gastric bypass, 68.7% (7.1–87.5) after sleeve gastrectomy and 90% (83.3–92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the “time-within-remission range”. The association of bariatric techniques with “time-within-remission range”, using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34–5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40–0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The “time-within-remission range” unveils a superiority of gastric bypass compared to sleeve gastrectomy.

scholarly journals Vitamin D in Type 2 Diabetes: Genetic Susceptibility and the Response to Supplementation

2020 ◽  
Vol 52 (07) ◽  
pp. 492-499
Author(s):  
Marissa Penna-Martinez ◽  
Klaus Badenhoop ◽  
Edith Klahold ◽  
Franziska Bruns ◽  
Christian Seidl ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Vitamin D Insufficiency ◽  
Vitamin D Metabolism ◽  
Risk Alleles ◽  
Before And After ◽  
Cholecalciferol Supplementation ◽  
The Impact

AbstractVariants of vitamin D metabolism-genes may predispose to type 2 diabetes (T2D). This study investigated the impact of these variants on disease susceptibility, Vitamin D, parathyroid hormone, C-peptide and HbA1c levels before and after cholecalciferol supplementation in patients with T2D.Twelve polymorphisms within CYP2R1, CYP27B1, DBP, VDR and CYP24A1 were genotyped in 553 T2D patients and 916 controls. In addition 65 patients receiving either cholecalciferol or placebo were analyzed during 6 months intervention and 6 months follow-up.T2D risk alleles are VDR rs7975232 “G” (pc=0.031), rs1544410 “G” (pc=0.027) and CYP2R1 rs10741657 “A” (pc=0.016). Patients with genotypes CYP27B1 rs10877012 “CC” (pc=4x10-5), DBP rs7041 “GG” (pc=0.003), rs4588 “CC” (pc = 3x10-4), CYP24A1 rs2585426 “CG” (pc=0.006) and rs2248137 “CG” (pc=0.001) showed lower 25(OH)D3 and DBP rs4588 “CC” lower 1,25(OH)2D3 levels (pc=0.005). Whereas DBP rs4588 “CC” (pc=0.009), CYP27B1 rs10877012 “AC” (pc=0.059), VDR rs7975323 “AG” (pc=0.033) and rs1544410 “GG” (pc=0.013) are associated with higher 25(OH)D3 levels at 6 months’ follow-up. Significant PTH suppression was detected for CYP2R1 “AG“ (pc=0.002), DBP rs4588 “CC” (pc<0.001), VDR rs110735810 “CT” (pc<0.001) and CYP24A1 rs2248137 “GG” (pc=0.021).Genetic variants of the vitamin D system predispose to type 2 diabetes and regulate – partially - vitamin D metabolism, concentrations and the vitamin D status. Vitamin D insufficiency is a T2D risk factor. The response to cholecalciferol supplementation can be measured as 25(OH)D3 increment and PTH suppression. This process is regulated by genes of the vitamin D system conferring modest T2D risk.

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 Incretins and their influence on the course of type 2 diabetes in patients with morbid obesity after bariatric oper

2012 ◽  
Vol 9 (2) ◽  
pp. 3-10 ◽  
Author(s):  
I I Dedov ◽  
Yu I Yashkov ◽  
E V Ershova
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Surgical Treatment ◽  
Metabolic Control ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Positive Effect

Most researchers support the important role of incretins, particularly glucagon-like peptide-1 in improving metabolic control in patients with type 2 diabetes after bariatric operations, mostly involving shunting. A positive effect of bariatric surgery for type 2 diabetes is known from numerous publications on the results of surgical treatment of morbid obesity and in this review we try to analyze the mechanisms of this effect.

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