Metabolic Surgery and Diabesity: a Systematic Review

Abstract

Bariatric surgery is used to induce weight loss (baros = weight). Evidence has shown that bariatric surgery improves the comorbid conditions associated with obesity such as hypertension, hyperlipidemia, and type 2 diabetes mellitus T2DM. Hence, shifting towards using metabolic surgery instead of bariatric surgery is currently more appropriate in certain subset of patients. Endocrine changes resulting from operative manipulation of the gastrointestinal tract after metabolic surgery translate into metabolic benefits with respect to the comorbid conditions. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect. The aim of this systematic review is to examine clinical trials regarding long-term effects of bariatric and metabolic surgery on patients with T2DM and to evaluate the potential mechanisms leading to the improvement in the glycaemic control.

Weight Management in Patients with Type 2 Diabetes: a Multidisciplinary Real-world Approach

“…Bariatric surgery is increasingly used for obesity management in patients with diabetes [ 60 ]. It should be considered as a valid option for patients with T2D and class 2 and 3 obesity who are unable to reduce their body weight after 6 months of intensive lifestyle intervention.…”

Influence of glucometric ‘dynamical’ variables on duodenal‐jejunal bypass liner (DJBL) anthropometric and metabolic outcomes

“…In recent years, there has been a call for the design of new algorithms in order to select appropriate candidates for metabolic surgery . Recent studies have proposed different score systems to predict the metabolic response to bariatric surgery . Main variables include age, insulin dependence, diabetes medication use and HbA1c levels.…”

“…The pathophysiology beneath its effects is not fully understood . Besides the weight loss associated with DJBL implantation, a combination of neuroendocrine and metabolic mechanisms has been proposed, including a reduced secretion of diabetogenic hormones in the proximal intestine due to the lack of nutrients‐induced stimuli (foregut hypothesis), or an increased secretion of incretins in response to undigested food in the distal small intestine (hindgut hypothesis) . More recently, changes in other gut hormones and bile acids along with their regulator fibroblast growth factor 19 have also been implied …”

Obesity and Related Type 2 Diabetes: A Failure of the Autonomic Nervous System Controlling Gastrointestinal Function?

“…It was found that GLP-1 levels increase up to six times after RYGB surgery [64]. Although the topic has been the subject of much debate [83], despite this high increase, GLP-1 cannot be considered the main actor of the improvements because the same effects are obtained in animals deficient for the GLP-1 receptor [84]; the administration of the analog of GLP1, liraglutide, does not achieve the same effects [84] and when Exenedine-9 (the GLP-1 receptor antagonist) was administered after RYGB, although worsening of glycemic control was observed, there was no return to the initial altered glucose tolerance [85]. It should also be borne in mind that the activity of enteric hormones is predominantly local (paracrine, on vagal fiber receptors) as they are rapidly degraded.…”