Cirurgia metabólica, reganho de peso e recidiva do diabete

Campos, Josemberg Marins; Lins, Daniel C.; Silva, Lyz B.; ARAÚJO-JÚNIOR, José Guido C.; Zeve, Jorge L. M.; Ferraz, A.

doi:10.1590/s0102-67202013000600013

Cited by 28 publications

(9 citation statements)

References 21 publications

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“…These effects can probably be attributed to the stimulation of incretins such as GLP-1 and PYY, increasing short- and medium-term insulin sensitivity 8 . Surgical treatment consisting of duodenojejunal bypass with or without ileal segment interposition has been shown to permit clinical control of patients with type 2 diabetes without the need for insulin or oral hypoglycemic agents 7 , 3 .…”

Section: Introductionmentioning

confidence: 99%

Immunological Evaluation of Patients With Type 2 Diabetes Mellitus Submitted to Metabolic Surgery

Borges

Terra

Takeuti

et al. 2015

ABCD, arq. bras. cir. dig.

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Background : Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus. Aim : To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells.Methods : Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient. Results : No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients. Conclusion : These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.

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Section: Introductionmentioning

confidence: 99%

Immunological Evaluation of Patients With Type 2 Diabetes Mellitus Submitted to Metabolic Surgery

Borges

Terra

Takeuti

et al. 2015

ABCD, arq. bras. cir. dig.

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“…In fact, there is a complex interplay of different gut hormones after surgery, along with the anatomical restrictive component of some techniques that are directly related with weight loss and maintenance after surgery. Furthermore, there are behavioral, social, and psychological factors that play significant roles in this regards as well 3 , 4 , 5 , 12 , 19 , 22 . …”

Section: Discussionmentioning

confidence: 99%

Correlation Between Pre and Postoperative Levels of GLP-1/GLP-2 and Weight Loss After Roux-en-Y Gastric Bypass: A Prospective Study

Cazzo¹,

Gestic²,

Pareja³

et al. 2016

ABCD, arq. bras. cir. dig.

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Background: The role of gut hormones in glucose homeostasis and weight loss achievement and maintenance after bariatric surgery appears to be a key point in the understanding of the beneficial effects observed following these procedures. Aim: To determine whether there is a correlation between the pre and postoperative levels of both GLP-1 and GLP-2 and the excess weight loss after Roux-en-Y gastric bypass (RYGB). Methods: An exploratory prospective study which enrolled 11 individuals who underwent RYGB and were followed-up for 12 months. GLP-1 and GLP-2 after standard meal tolerance test (MTT) were determined before and after surgery and then correlated with the percentage of excess loss (%EWL). Results: GLP-2 AUC presented a significant postoperative increase (945.3±449.1 vs.1787.9±602.7; p=0.0037); GLP-1 AUC presented a non-significant trend towards increase after RYGB (709.6±320.4 vs. 1026.5±714.3; p=0.3808). Mean %EWL was 66.7±12.2%. There was not any significant correlation between both the pre and postoperative GLP-1 AUCs and GLP-2 AUCs and the %EWL achieved after one year. Conclusion: There was no significant correlation between the pre and postoperative levels of the areas under the GLP-1 and GLP-2 curves with the percentage of weight loss reached after one year.

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“…Some studies on middle-aged obese patients provided an association between weight regain and diabetes recurrence 53. The effectiveness of bariatric-metabolic surgery in diabetic patients with BMI less than 35 kg/m 2 has not yet been conclusively evaluated 23,42,54.…”

Section: Which Candidate Do I Choose? Which Surgical Option?mentioning

confidence: 99%

Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose?

Raffaelli¹,

Sessa²,

Mingrone³

et al. 2015

DMSO

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The worldwide prevalence of type 2 diabetes is rising in association with an increasing frequency of overweight and obesity. Bariatric-metabolic procedures are considered as additional therapeutic options, allowing improved diabetes control in most patients. Multiple factors play in concert to achieve the improvements in diabetic remission observed after bariatric-metabolic surgery. Several studies have demonstrated that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with conventional nonsurgical medical treatment. Because the best results are achievable in patients with a relatively short history of diabetes and less advanced controlled disease, the surgical option could be considered early, especially in morbid obese subjects (BMI ≥35 kg/m2) after failure of medical treatment. Patients with extensive weight loss are more likely to achieve type 2 diabetes remission after bariatric surgery. At present, Roux-en-Y gastric bypass seems the surgical procedure of choice because it has fewer risks than biliopancreatic diversion, and it is associated with higher weight loss and metabolic improvements compared with adjustable gastric banding. Recent evidences regarding the effectiveness of sleeve gastrectomy in diabetes remission have to be confirmed by controlled trials with longer follow-up.

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Cirurgia metabólica, reganho de peso e recidiva do diabete

Cited by 28 publications

References 21 publications

Immunological Evaluation of Patients With Type 2 Diabetes Mellitus Submitted to Metabolic Surgery

Immunological Evaluation of Patients With Type 2 Diabetes Mellitus Submitted to Metabolic Surgery

Correlation Between Pre and Postoperative Levels of GLP-1/GLP-2 and Weight Loss After Roux-en-Y Gastric Bypass: A Prospective Study

Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose?

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