Prediction of Type 2 Diabetes Remission at Long-term Following Biliopancreatic Diversion: the Relative Role of Different Metabolic Attitudes

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.

Download Full-text

In-and-Out Molecular Changes Linked to the Type 2 Diabetes Remission after Bariatric Surgery: An Influence of Gut Microbes on Mitochondria Metabolism

International Journal of Molecular Sciences ◽

10.3390/ijms19123744 ◽

2018 ◽

Vol 19 (12) ◽

pp. 3744 ◽

Cited By ~ 7

Author(s):

Paulina Samczuk ◽

Hady Hady ◽

Edyta Adamska-Patruno ◽

Anna Citko ◽

Jacek Dadan ◽

...

Keyword(s):

Mass Spectrometry ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Gut Microbiota ◽

Diabetes Remission ◽

Gas Chromatography Mass Spectrometry ◽

Molecular Changes ◽

Type 2 Diabetes Remission

Different kinds of gastrointestinal tract modulations known as “bariatric surgery” are actually the most effective treatment for obesity and associated co-morbidities, such as type 2 diabetes (T2DM). The potential causes of those effects have yet to be explained. In our study, we focused on molecular changes evoked by laparoscopic sleeve gastrectomy leading to T2DM remission. Two complementary metabolomics techniques, namely, liquid chromatography coupled with mass spectrometry (LC-MS) and gas chromatography mass spectrometry (GC-MS), were used to study those effects in a group of 20 obese patients with T2DM selected from a cohort of 372 obese individuals who underwent bariatric surgery and did not receive anti-diabetic treatment afterward. Modified levels of carnitines, lipids, amino acids (including BCAA) and α- and β-hydroxybutyric acids were detected. Presented alterations suggest a major role of mitochondria activity in T2DM remission process. Moreover, some of the observed metabolites suggest that changes in gut microbiota composition may also correlate with the tempo of diabetes recovery. Additional analyses confirmed a relationship between biochemical and clinical parameters and the aforementioned metabolites, thereby, highlighting a role of mitochondria and microbes. Our data suggests that there is a previously undescribed relationship between mitochondria and gut microbiota, which changes after the bariatric surgery. More investigations are needed to confirm and explore the observed findings.

Download Full-text

Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores

Diabetic Medicine ◽

10.1111/dme.13532 ◽

2017 ◽

Vol 35 (3) ◽

pp. 360-367 ◽

Cited By ~ 32

Author(s):

A. Pucci ◽

U. Tymoszuk ◽

W. H. Cheung ◽

J. M. Makaronidis ◽

S. Scholes ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Diabetes Remission ◽

Type 2 Diabetes Remission

Download Full-text

PL-128 Acute insulin response and type 2 diabetes remission after biliopancreatic diversion

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2011.04.207 ◽

2011 ◽

Vol 7 (3) ◽

pp. 349

Author(s):

Nicola Scopinaro ◽

Gabriele D'Alessandro ◽

Andrea Weiss ◽

Francesca Pagliardi ◽

Corrado Parodi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Biliopancreatic Diversion ◽

Insulin Response ◽

Diabetes Remission ◽

Acute Insulin Response ◽

Type 2 Diabetes Remission

Download Full-text

Impact of metabolic surgery on type-2 diabetes remission

Current Diabetes Reviews ◽

10.2174/1573399817999201214224920 ◽

2020 ◽

Vol 17 ◽

Author(s):

Cejana de Abrantes Figueiredo Baiocchi ◽

Diana Aristótelis Rocha de Sá ◽

Alberto Krayyem Arbex

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Literature Review ◽

Latin American ◽

Metabolic Surgery ◽

Communicable Disease ◽

Diabetes Remission ◽

Type 2 Diabetes Remission

Abstract:: Diabetes Mellitus is characterized by numerous metabolic disorders, which have in common the serum elevation of glucose, caused for a pancreatic malfunction in insulin secretion and / or its action. It is a non-communicable disease, considered major public health problems and generalized growth worldwide, being a chronic disease, which can generate a high treatment cost. Metabolic surgery is a safe treatment, regulated by the Federal Council of Medicine and useful in treating people with BMI over 30 years of age, who are unable to control pathologies associated with obesity, especially type 2 diabetes. The general objective of this study is to understand through a literature review the main impacts of metabolic surgery about the remission of DM 2. This present study it is an exploratory and descriptive study carried out through a literature review. Data were collected through research in virtual health databases, at the Virtual Health Library - VHL, Latin American and Caribbean Health Sciences Information System, LILACS, National Library of Medicine - MEDLINE, Scielo, USP database, PUBMED theses and books. Metabolic surgery proof be a good and effective treatment for having and maintaining good weight loss, as well as a significant clinical and metabolic improvement that extends beyond weight loss. Metabolic surgery is a satisfactory way of achieving long-term weight reduction in obese individuals, increasing survival for these patients. Obese patients with DM2 have a long-term remission of DM2 after bariatric / metabolic surgery. Therefore, it concludes that such procedure is effective in the treatment of the disease and other diseases associated with obesity. 1

Download Full-text