Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects

Jiménez, Amanda; Casamitjana, Roser; Flores, Lílliam; Viaplana, Judith; Corcelles, Ricard; Lacy, Antonio M.; Vidal, Josep

doi:10.1097/sla.0b013e318262ee6b

Cited by 214 publications

(135 citation statements)

References 30 publications

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“…In fact, surgery leads to a decrease in treatment dose and to suspension in many cases. Findings by a number of researchers support our result that different bariatric procedures have a similar effect in type 2 diabetes mellitus remission [9,11,[25][26][27][28][29]. Contrastingly, other studies show improved type 2 diabetes mellitus remission in patients who underwent gastric bypass compared to patients who underwent other surgical techniques [30,31].…”

Section: Discussionsupporting

confidence: 86%

Remisja cukrzycy typu 2 po leczeniu bariatrycznym — porównanie różnych procedur

Fernández-Soto¹,

Martín-Leyva²,

González-Jiménez³

et al. 2017

Endokrynologia Polska

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Introduction: We aimed to assess the mid-term type 2 diabetes mellitus recovery patterns in morbidly obese patients by comparing some relevant physiological parameters of patients of bariatric surgery between two types of surgical procedures: mixed (roux-en-Y gastric bypass and biliopancreatic diversion) and restrictive (sleeve gastrectomy). Material and methods: This is a prospective and observational study of co-morbid, type 2 diabetes mellitus evolution in 49 morbidly obese patients: 37 underwent mixed surgery procedures and 12 a restrictive surgery procedure. We recorded weight, height, body mass index, and glycaemic, lipid, and nutritional blood parameters, prior to procedure, as well as six and twelve months post-operatively. In addition, we tested for differences in patient recovery and investigated predictive factors in diabetes remission. Results: Both glycaemic and lipid profiles diminished significantly to healthy levels by 6 and 12 months post intervention. Type 2 diabetes mellitus showed remission in more than 80% of patients of both types of surgical procedures, with no difference between them. Baseline body mass index, glycated haemoglobin, and insulin intake, among others, were shown to be valuable predictors of diabetes remission one year after the intervention. Conclusions:The choice of the type of surgical procedure did not significantly affect the remission rate of type 2 diabetes mellitus in morbidly obese patients. (Endokrynol Pol 2017; 68 (1): 18-25)

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Section: Discussionsupporting

confidence: 86%

Remisja cukrzycy typu 2 po leczeniu bariatrycznym — porównanie różnych procedur

Fernández-Soto¹,

Martín-Leyva²,

González-Jiménez³

et al. 2017

Endokrynologia Polska

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“…In the surgical population as a whole and in agreement with the literature (9)(10)(11)(12), the longer the diabetes duration before bariatric surgery and the lower usage of antidiabetic drugs, particularly insulin, the lower the diabetes remission rate. The metric duration of the clinical diagnosis of diabetes together with the type of medication used can be considered a surrogate measure of the preservation of islet secretory capacity, suggesting that the more severe the diabetes, the lower the remission rate.…”

Section: Discussionsupporting

confidence: 83%

Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery

et al. 2015

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OBJECTIVEEligibility criteria for bariatric surgery in diabetes include BMI ‡35 kg/m 2 and poorly controlled glycemia. However, BMI does not predict diabetes remission, and thus, predictors need to be identified. RESEARCH DESIGN AND METHODSSeven hundred twenty-seven patients were included in a database merged from the Swedish Obese Subjects (SOS) study and two randomized controlled studies, with 415 surgical and 312 medical patients in total. Bariatric operations were divided into gastric only (GO) and gastric plus diversion (GD). RESULTSSixty-four percent of patients in the surgical arm and 15.0% in the medical arm experienced diabetes remission (P < 0.001). GO yielded 60% remission, and GD yielded 76% remission. The best predictors of diabetes remission were lower baseline glycemia and shorter diabetes duration. However, when operation type was considered, GD predicted a higher likelihood of remission and greater weight loss. Patients in remission (responders) lost more weight (25% vs. 17%) and waist circumference (18% vs. 13%) and experienced better insulin sensitivity than nonresponders. CONCLUSIONSSurgery is more effective than medical treatment in achieving diabetes remission and tighter glycemic control. Shorter diabetes duration, lower fasting glycemia before surgery, and GD versus GO procedures independently predict higher rates of remission, whereas baseline HbA 1c and waist circumference predict improved glycemic control. The results show the advantage of an early operation together with better controlled glycemia on diabetes remission independently of BMI.The prospective, controlled Swedish Obese Subjects (SOS) study showed that the shortterm rate of remission of diabetes after bariatric surgery is 72% compared with 21% in subjects treated with conventional weight loss methods (1). Randomized controlled studies have revealed diabetes remission rates between 37% and 42% (2) to 73% (3), 24% and 38% (4), and 75% and 95% (5), depending on the criteria used to define diabetes remission and baseline patient characteristics, choice of surgical therapy, and duration of follow-up (1-3 years). Unfortunately, such differences in diabetes remission criteria obscure important questions regarding the determinants of diabetes remission, which in turn affect eligibility criteria for patient selection for bariatric surgery.Historically, only subjects with BMI $35 kg/m 2 in the presence of uncontrolled diabetes were considered as potential candidates for bariatric and metabolic

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“…Participants in study 1 (n = 23) were selected out of our series of T2DM patients who had undergone SG at least 2 years before study entry (n = 55), of whom 18 (33%), 31 (56%), and 6 (11%) presented with nonremission, remission, or relapse of T2DM, respectively (6,7). All subjects in the relapse group and 10 and 7 subjects from the remission and nonremission group with similar sex distribution, presurgical BMI, and length of follow-up volunteered to participate.…”

Section: Methodsmentioning

confidence: 99%

GLP-1 and Glucose Tolerance After Sleeve Gastrectomy in Morbidly Obese Subjects With Type 2 Diabetes

et al. 2014

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Although GLP-1 has been suggested as a major factor for the marked improvement of glucose tolerance commonly seen after sleeve gastrectomy (SG), several observations challenge this hypothesis. To better understand the role of GLP-1 in the remission of type 2 diabetes mellitus (T2DM) long term after SG in humans, we conducted two separate cross-sectional studies: 1) the GLP-1 response to a standardized mixed liquid meal (SMLM) was compared in subjects with T2DM antedating SG but with different long-term (>2 years) T2DM outcomes (remission, relapse, or lack of remission) (study 1) and 2) the effect of GLP-1 receptor blockade with exendin (9-39) on glucose tolerance was examined in subjects with T2DM antedating surgery, who had undergone SG and presented with long-term T2DM remission (study 2). In study 1, we observed a comparable GLP-1 response to the SMLM regardless of the post-SG outcome of T2DM. In study 2, the blockade of GLP-1 action resulted in impaired insulin secretion but limited deterioration of glucose tolerance. Thus, our data suggest the enhanced GLP-1 secretion observed long term after SG is neither sufficient nor critical to maintain normal glucose tolerance in subjects with T2DM antedating the surgery.GLP-1 has been suggested as a critical mediator for the marked improvement of glucose tolerance in subjects with type 2 diabetes mellitus (T2DM) commonly seen after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) (1). However, this view has been challenged by 1) studies in humans-performed long after RYGB using the GLP-1 receptor antagonist exendin (9-39) (Ex 9-39)-showing that blockade of GLP-1 action results in marked decrease in insulin secretion but limited impact on glucose tolerance (2,3); 2) data showing the GLP-1 response to meal stimuli does not differ between T2DM patients who after RYGB presented with lack of remission, partial remission, or relapse of T2DM (4); and 3) mouse data demonstrating that whole-body GLP-1 receptor deficiency does not influence the glycemic response to SG (5).To gain further insight into the role of GLP-1 in the remission of T2DM long term after SG in humans, We conducted two separate cross-sectional studies: 1) we compared the GLP-1 response to a standardized mixed liquid meal (SMLM) in subjects with T2DM antedating SG but with different long-term (.2 years) T2DM outcomes (remission, relapse, or lack of remission) (study 1) and 2) we examined the effect of GLP-1 receptor blockade with Ex 9-39 on glucose tolerance in subjects with T2DM antedating surgery, who had undergone SG and presented with long-term T2DM remission (study 2). RESEARCH DESIGN AND METHODSParticipants in study 1 (n = 23) were selected out of our series of T2DM patients who had undergone SG at least 2 years before study entry (n = 55), of whom 18 (33%), 31 (56%), and 6 (11%) presented with nonremission, remission, or relapse of T2DM, respectively (6,7). All subjects

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Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects

Abstract: Roux-en-Y gastric bypass and SG are associated with comparable remission rates of T2DM. However, insufficient weight loss or weight regain in those with a more advanced disease may hamper the benefits of these surgical techniques on T2DM.

Cited by 214 publications

References 30 publications

Remisja cukrzycy typu 2 po leczeniu bariatrycznym — porównanie różnych procedur

Remisja cukrzycy typu 2 po leczeniu bariatrycznym — porównanie różnych procedur

Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery

GLP-1 and Glucose Tolerance After Sleeve Gastrectomy in Morbidly Obese Subjects With Type 2 Diabetes

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