Comparison of early type 2 diabetes improvement after gastric bypass and sleeve gastrectomy: medication cessation at discharge predicts 1-year outcomes

Heshmati, Keyvan; Harris, David A.; Aliakbarian, Hassan; Tavakkoli, Ali; Sheu, Eric G.

doi:10.1016/j.soard.2019.04.004

Cited by 23 publications

(20 citation statements)

References 27 publications

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“…We have previously shown that within days of surgery, roughly 40 percent of human patients have durable improvement, or resolution, in their diabetes. [5] The mechanisms behind these early, rapid changes are unknown but are critical to understanding the benefits of surgery. Our study in mice suggests that SG leads to an increase in visceral fat glucose uptake and global glucose utilization, which either drives, or is the sequela of, immunologic remodeling.…”

Section: Discussionmentioning

confidence: 99%

“…The latter is in keeping with the clinical reality that the main physiologic driver of diabetes remission occurs within days of surgery and that further improvements may occur with weight loss. [1,2,5,71] Finally, given the nature of our model, we were not able to explore the weight-dependent effects of SG.…”

Section: Limitationsmentioning

confidence: 99%

“…[1][2][3][4] In fact, nearly 40% of patients with diabetes who undergo SG leave the hospital without needing anti-diabetic medications. [5] Interestingly, there has also been increasing evidence that non-obese, metabolically unhealthy patients can have remission of T2D following surgical intervention. [6] Thus, clinically, there are weight-loss independent, SG-induced adaptations that lead to improved glucose homeostasis.…”

Section: Introductionmentioning

confidence: 99%

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Sleeve Gastrectomy enhances glucose utilization and remodels adipose tissue independent of weight loss

Harris

Mina

Čabarkapa

et al. 2019

Preprint

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Objective: Sleeve gastrectomy (SG) induces weight-loss independent improvements in glucose homeostasis by unknown mechanisms. We sought to identify the metabolic adaptations responsible for these improvements.Methods: Non-obese C57Bl6/J mice on standard chow underwent SG or sham surgery. Functional testing and indirect calorimetry were used to capture metabolic phenotypes. Tissuespecific glucose uptake was assessed by 18-FDG PET/CT and RNA sequencing was used for gene expression analysis.Results: In this model, SG induced durable improvements in glucose tolerance despite not causing lasting changes in weight, fat/lean mass, or food intake. Indirect calorimetry revealed post-SG animals had respiratory exchange ratios (RER) nearing 1.0 on average and had daily RER excursions above 1.0, indicating preferential glucose utilization and increased energy demand, respectively. Sham operated mice demonstrate normal RER feeding/fasting excursions. PET/CT showed increased avidity within white adipose depots. Finally, SG led to an upregulation in the transcriptional pathways involved in energy metabolism, adipocyte maturation, and adaptive and innate immune cell chemotaxis and differentiation within the visceral adipose tissue.Conclusions: SG induces a rapid, weight-loss independent shift towards glucose utilization and transcriptional remodeling of metabolic and immune pathways in visceral adipose tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleeve Gastrectomy enhances glucose utilization and remodels adipose tissue independent of weight loss

Harris

Mina

Čabarkapa

et al. 2019

Preprint

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“…Most studies that examined T2D remission rate after bariatric surgery did not asses the characteristics associated with such remissions [12], and were mostly after gastric bypass surgery [6,10,13,14]. The few studies that assessed features associated with T2D remission after SG examined only a few clinical predictors [9,11,15], among small samples [11,16,17], and focused only on complete remission.…”

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confidence: 99%

Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy

Elgenaied

Ansari

Elsherif

et al. 2020

Surgery for Obesity and Related Diseases

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Background: Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown. Objectives: We assessed patients' characteristics associated with T2D remission 1 year post SG. Setting: University hospital. Methods: Retrospective study of 230 T2D patients (18-64 yr) who underwent SG at our institution. We examined pre-and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre-and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve. Results: A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 6 8.84 years. Mean preoperative weight and body mass index were 115.69 6 20.76 kg and 43.53 6 6.98 kg/m 2 , respectively. Approximately two thirds (64.4%) of the sample had diabetes for .5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on 2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 6 6.09 kg/m 2 , percent excess weight loss (%EWL) was 62.29 6 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration 1 pre-HbA1C 1 %EWL 1 insulin therapy 1 age 1 OHA (area under the curve 5 .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration).

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“…While patients experience significant benefit from weight loss, our group and others have shown that improved glycemic control often occurs independent of weight loss following SG. (1)(2)(3)(4) Bariatric surgery affects obesity-induced inflammation through upregulation of adiponectin and IL-10, reduction in pro-inflammatory cytokines, and induction of a reparative T cell phenotype. (18) We showed that SG in rats reduced jejunal IL-17 and IL-23 as well as distal jejunal INFγ, which correlated with weight loss and improved glucose handling.…”

Section: Introductionmentioning

confidence: 99%

Weight and organ specific immune cell profiling of Sleeve Gastrectomy

Harris

Subramaniam

Brenner

et al. 2020

Preprint

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AbstractSleeve gastrectomy (SG) has profound, immediate weight-loss independent effects on obesity related diabetes (T2D). Our prior studies have shown that immunologic remodeling may play a part in this metabolic improvement. However, to date, little is known about how the major immune cell populations change following SG. Using mass cytometry with time of flight analysis (CyTOF) we aimed to broadly explore the organ-specific immune cell repertoire induced by SG. Surgery was performed on obese, insulin resistant and lean mice in order to understand surgery-specific phenotypes. We identified a shift within the splenic B cell compartment with a reduction in follicular and an increase in innate-like B cell subsets in SG animals. There was a concomitant increase in multiple circulating immunoglobulin classes. Further, SG animals had a conserved increase in splenic neutrophils and a tendency toward M2 macrophage polarization. Others have shown that these, weight-loss independent, surgery-specific changes are linked to improved glucose metabolism and thus, may be a major contributor to post SG physiology. Characterizing the complex immune milieu following SG is an important step toward understanding the physiology of SG and the potential therapies therein.

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Comparison of early type 2 diabetes improvement after gastric bypass and sleeve gastrectomy: medication cessation at discharge predicts 1-year outcomes

Cited by 23 publications

References 27 publications

Sleeve Gastrectomy enhances glucose utilization and remodels adipose tissue independent of weight loss

Sleeve Gastrectomy enhances glucose utilization and remodels adipose tissue independent of weight loss

Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy

Weight and organ specific immune cell profiling of Sleeve Gastrectomy

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