Weight-centric treatment of type 2 diabetes mellitus

Ghusn, Wissam; Hurtado, Maria D.; Acosta, Andrés

doi:10.1016/j.obpill.2022.100045

Cited by 24 publications

(17 citation statements)

References 103 publications

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“…sulphonylureas and insulin), kidney damage and most importantly, severe hypoglycaemia. [28][29][30][31] The last association has been verified in previous trials 13,32 ; in the VADT trial, 8 severe hypoglycaemic episodes within the previous 3 months were associated with increased risk for CV and all-cause mortality. 32 A similar trend was also observed in the ACCORD trial 33 and ADVANCE trial.…”

Section: Discussionmentioning

confidence: 61%

“…In addition, with the increase of baseline HbA1c, to achieve an abrupt and significant decrease, it requests additional glucose‐lowering medication, which has been linked to an increased risk of CVD and death via weight gain (i.e. sulphonylureas and insulin), kidney damage and most importantly, severe hypoglycaemia 28‐31 . The last association has been verified in previous trials 13,32 ; in the VADT trial, 8 severe hypoglycaemic episodes within the previous 3 months were associated with increased risk for CV and all‐cause mortality 32 .…”

Section: Discussionmentioning

confidence: 88%

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Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post‐hoc machine learning analysis of ACCORD trial data

Jiao,

Kianmehr,

Lin

et al. 2024

Diabetes Obesity Metabolism

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AimThe action to control cardiovascular risk in diabetes (ACCORD) trial showed a neutral average treatment effect of intensive blood glucose and blood pressure (BP) controls in preventing major adverse cardiovascular events (MACE) in individuals with type 2 diabetes. Yet, treatment effects across patient subgroups have not been well understood. We aimed to identify patient subgroups that might benefit from intensive glucose or BP controls for preventing MACE.Materials and methodsAs a post‐hoc analysis of the ACCORD trial, we included 10 251 individuals with type 2 diabetes. We applied causal forest and causal tree models to identify participant characteristics that modify the efficacy of intensive glucose or BP controls from 68 candidate variables (demographics, comorbidities, medications and biomarkers) at the baseline. The exposure was (a) intensive versus standard glucose control [glycated haemoglobin (HbA1c) <6.0% vs. 7.0%‐7.9%], and (b) intensive versus standard BP control (systolic BP <120 vs. <140 mmHg). The primary outcome was MACE.ResultsCompared with standard glucose control, intensive one reduced MACE in those with baseline HbA1c <8.5% [relative risk (RR): 0.79, 95% confidence interval (CI): 0.67‐0.93] and those with estimated glomerular filtration rate ≥106 ml/min/1.73 m2 (RR: 0.74, 95% CI: 0.55‐0.99). Intensive BP control reduced MACE in those with normal high‐density lipoprotein levels (women >55 mg/dl, men >45 mg/dl; RR: 0.51, 95% CI: 0.34‐0.74). Risk reductions were not significant in other patient subgroups.ConclusionsOur findings suggest heterogeneous treatment effects of intensive glucose and BP control and could provide biomarkers for future clinical trials to identify more precise HbA1c and BP treatment goals for individualized medicine.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 88%

Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post‐hoc machine learning analysis of ACCORD trial data

Jiao,

Kianmehr,

Lin

et al. 2024

Diabetes Obesity Metabolism

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“…Results have shown that longer follow-up duration is correlated with higher rates of T2DM relapse. 28 Therefore, by accounting for baseline glycemic control, weight-loss aspect, and follow-up duration for each of these procedures, our study suggests the presence of other potential mechanisms that might explain the discrepancy between RYGB and SG regarding T2DM management and resolution.…”

Section: Discussionmentioning

confidence: 87%

“…29 Considering the mechanism of action of GLP-1, this increased secretion could be a critical factor in weight loss but also in diabetes remission after RYGB. 28 However, multiple studies have found the SG procedure to increase plasma concentration of GLP-1 as well. 30,31 This indicates that other factors may explain the differences between RYGB and SG in terms of T2DM remission.…”

Section: Discussionmentioning

confidence: 99%

A Matched Comparative Analysis of Type-2 Diabetes Mellitus Remission Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Hage,

Ma,

Ghusn

et al. 2024

Surg Innov

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Objective Multiple scores validate long-term type-2 diabetes mellitus (T2DM) remission after metabolic and bariatric surgery (MBS). However, studies comparing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have not adequately controlled for certain parameters, which may influence procedure selection. Methods We conducted a multicenter retrospective review of patients with T2DM who underwent RYGB or SG between 2008 and 2017. Data on demographics, clinical, laboratory, and metabolic values were collected annually for up to 14 years. Each eligible RYGB patient was individually matched to an eligible SG patient based on diabetes severity, weight loss, and follow-up duration. Results Among 1149 T2DM patients, 467 were eligible for matching. We found 97 matched pairs who underwent RYGB or SG. RYGB showed significantly higher T2DM remission rates (46.4%) compared to SG (33.0%) after matching. SG patients had higher insulin usage (35.1%) than RYGB patients (20.6%). RYGB patients also experienced greater decreases in HbA1c levels and diabetes medication usage than SG patients. Conclusions RYGB demonstrates higher efficacy for T2DM remission compared to SG, regardless of baseline characteristics, T2DM severity, weight loss, and follow-up duration. Further studies are needed to understand the long-term metabolic effects of MBS and the underlying pathophysiology of T2DM remission after MBS.

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“…It collaborates with glucagon in regulating blood sugar levels, with insulin facilitating anabolic processes and glucagon driving catabolic ones [52]. By managing blood glucose concentrations and promoting the storage of glucose in the liver, muscles, and fat tissues, insulin contributes to an increase in body weight [53].…”

Section: Insulinmentioning

confidence: 99%

Gut motility and hormone changes after bariatric procedures

Gala,

Ghusn,

Abu Dayyeh

2024

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Metabolic and bariatric surgery (MBS) and endoscopic bariatric therapies (EBT) are being increasingly utilized for the management of obesity. They work through multiple mechanisms, including restriction, malabsorption, and changes in the gastrointestinal hormonal and motility. Recent findings Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) cause decrease in leptin, increase in GLP-1 and PYY, and variable changes in ghrelin (generally thought to decrease). RYGB and LSG lead to rapid gastric emptying, increase in small bowel motility, and possible decrease in colonic motility. Endoscopic sleeve gastroplasty (ESG) causes decrease in leptin and increase in GLP-1, ghrelin, and PYY; and delayed gastric motility. Summary Understanding mechanisms of action for MBS and EBT is critical for optimal care of patients and will help in further refinement of these interventions.

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Weight-centric treatment of type 2 diabetes mellitus

Cited by 24 publications

References 103 publications

Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post‐hoc machine learning analysis of ACCORD trial data

Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post‐hoc machine learning analysis of ACCORD trial data

A Matched Comparative Analysis of Type-2 Diabetes Mellitus Remission Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Gut motility and hormone changes after bariatric procedures

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