scholarly journals Metabolic Effects of Bariatric Surgery

2018 ◽  
Vol 64 (1) ◽  
pp. 72-81 ◽  
Author(s):  
Piriyah Sinclair ◽  
Neil Docherty ◽  
Carel W le Roux
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Metabolic Surgery ◽  
Positive Impact ◽  
Metabolic Effects ◽  
Beneficial Effects ◽  
Treatment Of Obesity ◽  
The Impact ◽  
The Brain

Abstract BACKGROUND Obesity can be defined as a chronic subcortical brain disease, as there is an important neurophysiological component to its etiology based on changes in the functioning of those areas of the brain controlling food intake and reward. Extensive metabolic changes accompany bariatric surgery-based treatment of obesity. Consequently, the term “metabolic” surgery is being increasingly adopted in relation to the beneficial effects these procedures have on chronic diseases like type 2 diabetes. CONTENT In the present review, we focus on the key biochemical and physiological changes induced by metabolic surgery and highlight the beneficial effects accrued systemically with the use of an organ-based approach. Understanding the impact on and interactions between the gut, brain, adipose tissue, liver, muscle, pancreas, and kidney is key to understanding the sum of the metabolic effects of these operations. SUMMARY Further mechanistic studies are essential to assess the true potential of metabolic surgery to treat metabolic comorbidities of obesity beyond type 2 diabetes. Approaches that may mitigate the metabolic side effects of surgery also require attention. Understanding the positive impact of metabolic surgery on metabolic health may result in a wider acceptance of this intervention as treatment for metabolic, comorbid conditions.

The Impact of Bariatric Surgery in Patients with Type-2 Diabetes Mellitus

2011 ◽  
Vol 7 (3) ◽  
pp. 185-189 ◽  
Author(s):  
Richdeep S. Gill ◽  
Arya M. Sharma ◽  
David P. Al-Adra ◽  
Daniel W. Birch ◽  
Shahzeer Karmali
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
The Impact

scholarly journals Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study

2021 ◽  
Author(s):  
Erman O. Akpinar ◽  
Ronald S.L. Liem ◽  
Simon W. Nienhuijs ◽  
Jan Willem M. Greve ◽  
Perla J. Marang-van de Mheen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Population Based ◽  
Metabolic Effects ◽  
Population Based Study

scholarly journals Targeting the Incretin/Glucagon System With Triagonists to Treat Diabetes

2018 ◽  
Vol 39 (5) ◽  
pp. 719-738 ◽  
Author(s):  
Megan E Capozzi ◽  
Richard D DiMarchi ◽  
Matthias H Tschöp ◽  
Brian Finan ◽  
Jonathan E Campbell
Keyword(s):  
Metabolic Disease ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Drug Class ◽  
Clinical Findings ◽  
Metabolic Dysfunction ◽  
Multiple Receptors ◽  
Insulinotropic Peptide ◽  
The Brain

Abstract Glucagonlike peptide 1 (GLP-1) receptor agonists have been efficacious for the treatment of type 2 diabetes due to their ability to reduce weight and attenuate hyperglycemia. However, the activity of glucagonlike peptide 1 receptor–directed strategies is submaximal, and the only potent, sustainable treatment of metabolic dysfunction is bariatric surgery, necessitating the development of unique therapeutics. GLP-1 is structurally related to glucagon and glucose-dependent insulinotropic peptide (GIP), allowing for the development of intermixed, unimolecular peptides with activity at each of their respective receptors. In this review, we discuss the range of tissue targets and added benefits afforded by the inclusion of each of GIP and glucagon. We discuss considerations for the development of sequence-intermixed dual agonists and triagonists, highlighting the importance of evaluating balanced signaling at the targeted receptors. Several multireceptor agonist peptides have been developed and evaluated, and the key preclinical and clinical findings are reviewed in detail. The biological activity of these multireceptor agonists are founded in the success of GLP-1-directed strategies; by including GIP and glucagon components, these multireceptor agonists are thought to enhance GLP-1’s activities by broadening the tissue targets and synergizing at tissues that express multiple receptors, such at the brain and pancreatic isletβ cells. The development and utility of balanced, unimolecular multireceptor agonists provide both a useful tool for querying the actions of incretins and glucagon during metabolic disease and a unique drug class to treat type 2 diabetes with unprecedented efficacy.

scholarly journals Review of multimodal treatment for type 2 diabetes: combining metabolic surgery and pharmacotherapy

2019 ◽  
Vol 10 ◽  
pp. 204201881987540 ◽  
Author(s):  
Alexis Sudlow ◽  
Carel W le Roux ◽  
Dimitri J Pournaras
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Metabolic Surgery ◽  
Multimodal Treatment ◽  
Turning Point ◽  
Traditional Approach ◽  
Novel Approach ◽  
Multimodal Care

Treating type 2 diabetes mellitus (T2DM) in patients with obesity remains a challenge for physicians, endocrinologists and surgeons, a fact supported by uncontroverted evidence from studies looking at mortality and associated morbidity. Metabolic surgery remains the most effective treatment for obesity and T2DM with evidence demonstrating an improvement or resolution of symptoms of T2DM and a reduction in a mortality and rates of cardiovascular events compared with pharmacotherapy alone. While these results are promising, two important limitations must be recognized and addressed. With regards to long-term remission of T2DM, the metabolic benefits of bariatric surgery appear to fatigue with time and a proportion of patients will not maintain normoglycaemia without pharmacotherapy. Second, there has been noteworthy progress in the development of several classes of medications for the treatment of T2DM which were unavailable when the original studies comparing the effects of bariatric surgery with pharmacotherapy were conducted. Recognizing the need for further treatment following metabolic surgery for long-term disease control in conjunction with the availability of newer medications offering more effective, nonsurgical treatment presents a critical turning point in treatment treating obesity. While the traditional approach would be to determine the superiority (or non-inferiority) of these agents compared with surgery, clinicians and surgeons must acknowledge the limitations of this attitude towards treatment given evidence from fields such as cancer, where a combinational approach is the gold standard. Recent advances in pharmacotherapy, present not only a novel approach to medical therapy but a renewed impetus to investigate what can be achieved through multimodal care.

scholarly journals Multiagonist Unimolecular Peptides for Obesity and Type 2 Diabetes: Current Advances and Future Directions

2020 ◽  
Vol 13 ◽  
pp. 117955142090584 ◽  
Author(s):  
Annie Hasib
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Hormone Receptors ◽  
Gut Hormones ◽  
Metabolic Effects ◽  
Therapeutic Approaches ◽  
Obesity And Diabetes ◽  
Gut Hormone ◽  
Prevalence Of Obesity

The ever-increasing prevalence of obesity and Type 2 diabetes has necessitated the development of newer and more effective approaches for achieving efficient glycemic control and weight loss. Conventional treatment methods often result in weight gain, further deteriorating the already impaired metabolic control in people with obesity/Type 2 diabetes. Alleviation of obesity and diabetes achieved after bariatric surgeries highlight the therapeutic importance of gut-brain axis and entails development of more patient-friendly approaches replicating the positive metabolic effects of bariatric surgery. Given the potential involvement of several gut hormones in the success of bariatric surgery, the therapeutic importance of synergistic interaction between these hormones for improved metabolism cannot be ignored. Many unimolecular multiagonist peptides are in preclinical and clinical trials as they maximize the combinatorial metabolic efficacy by concurrent activation of multiple gut hormone receptors. This review summarizes the ongoing developments of multiagonist peptides as novel therapeutic approaches against obesity-diabetes.

scholarly journals THE WAY TO PREDICT THE EFFECTIVENESS OF BARIATRIC SURGERY IN PATIENTS WITH COMORBID OBESITY IN POST-PANDEMIC PERIOD

2020 ◽  
pp. 91-94
Author(s):  
M. I. Marushchak ◽  
I. Ya. Krynytska ◽  
I. Ya. Dzyubanovskyі
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Arterial Hypertension ◽  
Lifestyle Changes ◽  
Atherogenic Dyslipidemia ◽  
Short Term ◽  
Treatment Of Obesity

Summary. It is estimated that from 650 million to 2 billion adults worldwide, are overweight or obese, the numbers indicating epidemic levels of disease. In individuals, body mass index (BMI) exceeding 27 kg/m2 is associated with a high risk of mortality and the presence of comorbid pathologies, in particular, atherogenic  dyslipidemia, arterial hypertension (AH), type 2 diabetes mellitus (T2D), thromboembolism, hepatic steatosis, etc. Preliminary data indicate that obesity is among key risk factors in severe and fatal cases of COVID-19, when comorbid with AH and T2D. The aim of this study – to analyze the possibility of developing an optimized model utilizing anamnestic, clinical, biochemical and genetic parameters for predicting the outcomes of bariatric surgery in the patients with obesity, type 2 diabetes mellitus (T2D) and/or arterial hypertension (AH). Results. Lifestyle changes and conservative treatment of obesity usually only result in a short-term effect, since the measures aiming to induce weight loss consign the person to a constant struggle with natural homeostatic processes. Recurrence of obesity in such patients is observed in 95 % of the cases. Therefore, the International Association of Endocrinologists recommends that patients with a BMI greater than 40 kg/m2, as well as with a BMI of 35.0 to 39.9 kg/m2 and metabolic syndrome undergo a surgical treatment of obesity using minimally invasive techniques. At the same time, a number of issues associated with bariatric laparoscopic interventions remain unresolved, since these procedures are invasive and carry all the risks accompanying surgery, general  anesthesia, and the postoperative recovery period. An  innovative surgical approach, the X-ray endovascular bariatric embolization of the gastric arteries (BAE) is proposed as an alternative to laparoscopic intervention. However, the indications for the use of BAE are undefined, especially in the cases of comorbid obesity; there are no clear algorithms and guidelines for its use. Conclusions. There have been no comprehensive studies of short-term, intermediate and long-term outcomes of BEA in Ukraine. This warrants the need to develop an optimal model for predicting the outcomes of both classical bariatric laparoscopic surgery with regulated gastric band and innovative BEA procedure in patients with comorbid obesity in post-pandemic period  using anamnestic, clinical, biochemical and genetic predictors.

scholarly journals The impact of bariatric surgery on incident microvascular complications in patients with type 2 diabetes: A matched controlled population-based retrospective cohort study

2020 ◽  
Author(s):  
Pushpa Singh ◽  
Nicola Adderley ◽  
Anuradhaa Subramanian ◽  
Krishna Gokhale ◽  
Rishi Singhal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Cohort Study ◽  
Microvascular Complications ◽  
Population Based ◽  
Type2 Diabetes ◽  
Foot Disease ◽  
The Impact ◽  
Surgical Group

Aim: To assess the impact of bariatric surgery (BS) on incident microvascular complications [diabetes-related foot disease (DFD), sight threatening diabetic retinopathy (STDR), chronic kidney disease (CKD)] in patients with type 2 diabetes and obesity. <p>Methods: <a>A retrospective matched, controlled population-based cohort study of adults with type 2 diabetes between 1/1/1990 and 31/1/2018 using </a><a>IQVIA Medical Research Data (IMRD), </a>a database of primary care electronic records. <a>Each patient with type2 diabetes who subsequently had BS (surgical) was matched on index date with up to 2 patients with type 2 diabetes did not have BS (non-surgical) within the same general practice by age, sex, pre-index body mass index and diabetes duration</a>.</p> <p>Results: 1126 surgical and 2219 non-surgical participants were included. In the study population, 2261 (68%) were women; Mean (SD) age was 49.87 (9.3) vs 50.12 (9.3) years and BMI was 46.76 (7.96) kg/m<sup>2</sup> vs 46.14 (7.49) kg/m<sup>2</sup> in surgical vs non-surgical group respectively. In surgical group, 22.1%, 22.7%, 52.2% and 1.1% patients had gastric band, sleeve gastrectomy, gastric bypass & duodenal switch respectively.</p> <p>Over median (IQR) follow-up was 3.9 years (1.8-6.4), BS was associated with reduction in incident combined microvascular complications (adjusted HR 0.63, 95% CI 0.51 to 0.78, p<0.001), DFD (0.61, 0.50 to 0.75, p<0.001), STDR (0.66, 0.44 to 1.00, p<0.001), CKD (0.63, 0.51 to 0.78, p<0.001). Analysis based on the type of surgery showed that all types of surgery were associated with favourable impact on the incident of composite microvascular complications, greatest reduction RYGB.</p> <p>Conclusions: BS was associated with a significant reduction in incident diabetes-related microvascular complications. </p>

scholarly journals Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

2013 ◽  
Vol 258 (4) ◽  
pp. 628-637 ◽  
Author(s):  
Stacy A. Brethauer ◽  
Ali Aminian ◽  
Héctor Romero-Talamás ◽  
Esam Batayyah ◽  
Jennifer Mackey ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Effects ◽  
Obese Patients
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