From bariatric to metabolic surgery in non-obese subjects: time for some caution

Abstract

Severe obesity is associated with type 2 diabetes mellitus, and both resolve with weight loss after bariatric operations. Intestinal hormones have been identified which are stimulated by rapid nutrient delivery to the lower small bowel after certain weight-loss operations. These incretins stimulate secretion and hypertrophy of the pancreatic beta cells. Surgical procedures are now being performed to treat diabetes in adults of lesser weight, and the importance of ruling out latent autoimmune diabetes in the adult (a variety of type 1) is suggested, before experimenting with these procedures. Arq Bras Endocrinol Metab. 2009;53(2):246-251.Keywords Diabetes mellitus; obesity; bariatric surgery; insulin resistance; GLP-1; C-peptide; BMI resumo A obesidade grau III está francamente associada ao risco e à presença do diabetes tipo 2, sendo as duas condições passíveis de resolução com as cirurgias bariátricas. Hormônios gastrointestinais que formam eixo enteroinsular têm sido identificados, sendo mais intensa e rapidamente liberados após os procedimentos antiobesidade. Esses hormônios, entre os quais as incretinas, estimulam a secreção e a hipertrofia da células betapancreáticas. Novos procedimentos têm sido desenvolvidos para tratar o diabetes tipo 2 em adultos com obesidade em graus menos intensos. No entanto, é necessária a exclusão de pacientes com diabetes autoimune latente do adulto (LADA -uma variedade do diabetes tipo 1) antes da indicação de um procedimento cirúrgico. Arq Bras Endocrinol Metab. 2009;53(2):246-251. Descritores Diabetes melito; obesidade; cirurgia bariátrica; resistência à insulina; GLP-1; peptídeo C; BMI

The Role of Laboratory Testing in Differentiating Type 1 Diabetes from Type 2 Diabetes in Patients Undergoing Bariatric Surgery

“…Pancreatic β-cell function testing has been proposed to be used for diabetes classification prior to bariatric surgery [14, 15]; here, we evaluated several methods. MMT for C-peptide provided detailed data that clearly distinguished Patient X as having lower β-cell function than other participants.…”

“…It has been proposed that all patients with diabetes should be screened prior to bariatric surgery with a C-peptide level and islet cell antibody tests [14, 15]. C-peptide reflects endogenous insulin secretion by pancreatic β-cells which can be measured fasting or with a stimulation test, which is considered to be more accurate [16].…”

Metabolic surgery—principles and current concepts

“…Upregulation of GLP-1 leads to decreased levels of plasma glucagon, and, thus, restrictive or malabsorptive procedures with rapid nutrient transit can cause severe hypoglycemia. It must be strongly advocated to identify those patients before metabolic surgery is performed and select appropriate candidates with care [268][269][270][271].…”

De la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2

“…Le risque hypoglycé-mique, dû à une sécrétion excessive d'insuline, a été mis en avant par certains, même s'il paraît assez exceptionnel [64]. Par ailleurs, plus on s'intéresse à des patients diabétiques avec un IMC < 30 kg/m², plus il existe un risque de sélectionner des patients avec un diabète de type 1 lent plutôt qu'avec un DT2 vrai [65]. Enfin, il faut tenir compte des complications toujours possibles inhérentes à l'opération [54,60].…”