Bariatric surgery is effective in the management of type 2 diabetes (T2D) and obesity; however, it is not clear whether Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) is the most effective procedure. This review compared T2D remission and weight loss in patients with T2D after GBP or SG. All human SG or GBP studies published in English between 1 Jan 2007 and 30 April 2012 reporting on BMI and T2D outcomes were included. Analyses were performed separately for the most frequent distinct time points reported after surgery. A total of 21 prospective (three randomised control trials) and 12 retrospective studies, involving 1375 patients met eligibility criteria. T2D remission defined by hemoglobin A1c of <6.5 % for GBP and SG respectively was 67 and 56 % at 3 months, 76 and 68 % at 12 months, and 81 and 80 % at 36 months. Greater percent excess BMI loss occurred at 12 months (72.5 % after GBP and 66.7 % after SG) compared with 3 months (45.9 % after GBP and 25.9 % after SG). There was no significant difference in either T2D remission or weight loss with GBP compared with SG. Both GBP and SG result in similar early remission of T2D in 67 and 56 % of patients at 3 months respectively with modest additional T2D remission with time, although weight loss with both procedures increase substantially between 3 and 12 months post-operatively. Further randomised controlled trials comparing SG and GBP in patients with T2D using comparable definitions of diabetes remission with long-term follow-up are needed to evaluate relative benefits.

BackgroundBypass of foregut secreted factors promoting insulin resistance is hypothesized to be one of the mechanisms by which resolution of type 2 diabetes (T2D) follows roux-en-y gastric bypass (GBP) surgery.AimTo identify insulin resistance-associated proteins and metabolites which decrease more after GBP than after sleeve gastrectomy (SG) prior to diabetes remission.MethodsFasting plasma from 15 subjects with T2D undergoing GBP or SG was analyzed by proteomic and metabolomic methods 3 days before and 3 days after surgery. Subjects were matched for age, BMI, metformin therapy and glycemic control. Insulin resistance was calculated using homeostasis model assessment (HOMA-IR). For proteomics, samples were depleted of abundant plasma proteins, digested with trypsin and labeled with iTRAQ isobaric tags prior to liquid chromatography-tandem mass spectrometry analysis. Metabolomic analysis was performed using gas chromatography-mass spectrometry. The effect of the respective bariatric surgery on identified proteins and metabolites was evaluated using two-way analysis of variance and appropriate post-hoc tests.ResultsHOMA-IR improved, albeit not significantly, in both groups after surgery. Proteomic analysis yielded seven proteins which decreased significantly after GBP only, including Fetuin-A and Retinol binding protein 4, both previously linked to insulin resistance. Significant decrease in Fetuin-A and Retinol binding protein 4 after GBP was confirmed using ELISA and immunoassay. Metabolomic analysis identified significant decrease of citrate, proline, histidine and decanoic acid specifically after GBP.ConclusionGreater early decrease was seen for Fetuin-A, Retinol binding protein 4, and several metabolites after GBP compared to SG, preceding significant weight loss. This may contribute to enhanced T2D remission observed following foregut bypass procedures.

GBP and SG have a similar acute impact on reducing glycaemia to caloric restriction; however, with a superior impact on glucose tolerance.

1. The present study describes the use of reverse transcription-polymerase chain reaction (RT-PCR) to detect weakly expressed neurotransmitter receptor mRNA in tissue micropunched from the rostral ventrolateral medulla (RVLM) and other discrete areas of the medulla oblongata of the rat. 2. Micropunches were made from 240 microns transverse medullary sections. Punched regions included the RVLM, hypoglossal nucleus (XIIn), ventrolateral subnucleus of the nucleus tractus solitarius (NTS) and spinal trigeminal nucleus (STN). RNA was extracted and reverse transcribed into cDNA, which was probed for the presence of seven genes: glyceraldehyde phosphate dehydrogenase (GAPDH), neuron-specific enolase (NSE), tyrosine hydroxylase (TH), phenylethanolamine N-methyltransferase (PNMT), glucocorticoid receptor (GCR), mineralocorticoid receptor (MCR) and the adenosine 5'-triphosphate (ATP) receptor subunit P2X2-1. Each transcript was detected using a semi-nested PCR protocol, which used three primers. 3. Tyrosine hydroxylase was detected in the RVLM and NTS and PNMT was also detected in the RVLM, which agrees with the distribution of catecholamine neurons in the medulla. Expression of GCR mRNA was detected in the RVLM and the XIIn but not in the NTS (it was not probed for in the STN punches). The P2X2-1 receptor message was detected in all areas. Expression of MCR mRNA was detected in the RVLM only. 4. This method offers a simple way to detect the presence of low-abundance receptor mRNA in discrete brain regions.

No abstract