Control of Hypertension After Roux-en-Y Gastric Bypass Among Obese Diabetic Patients

Cazzo, Everton; Gestic, Martinho Antônio; Machado, Ricardo Rossetto; Pareja, José Carlos; Chaim, Élinton Adami

doi:10.1590/s0004-28032014000100005

Cited by 12 publications

(4 citation statements)

References 29 publications

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“…Although these hormones have been identified in the early 1970s, they really rose to prominence after the growth of bariatric surgery and the observation of the critical impact of these procedures on their release and, consequently, on the glucose homeostasis and improvement of metabolic syndrome and its clinical features (16)(17)(18)(19)(20)(21)(22)(28)(29)(30)(31)(32)(33)(34) . In this study, we observed that the GLP-1 levels did not differ among non-diabetic individuals with morbid obesity, diabetic individuals with mild obesity and healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Levels of C-Reactive Protein, GLP-1 and GLP-2 Among Individuals With Diabetes, Morbid Obesity and Healthy Controls: An Exploratory Study

Cazzo

Pareja

Chaim

et al. 2018

Arq. Gastroenterol.

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-Background -The glucagon-like peptides 1 and 2 (GLP-1/GLP-2) are gut hormones that may directly affect the glucose homeostasis and their activity seems to be significantly affected by chronic inflammation. Objective -To evaluate the postprandial levels of glucagon-like peptides 1 and 2 (GLP-1/GLP-2), C-reactive protein (CRP), and the postprandial glucose and insulin levels among individuals with obesity, type 2 diabetes, and healthy controls. Methods -An exploratory cross-sectional study, which involved individuals awaiting for bariatric/metabolic surgery and healthy controls. Postprandial levels of GLP-1, GLP-2, glucose, and insulin were obtained after a standard meal tolerance test. Inflammation was assessed by means of CRP. Results -There were 30 individuals enrolled in the study, divided into three groups: non-diabetic with morbid obesity (NDO; n=11 individuals), diabetic with mild obesity (T2D; n=12 individuals), and healthy controls (C; n=7 individuals). The mean CRP levels were significantly higher in the NDO group (6.6±4.7 mg/dL) than in the T2D (3.3±2.2 mg/dL) and C groups (2.5±3.2 mg/dL) (P=0.038). The GLP-1 levels following standard meal tolerance test and the area under the curve of GLP-1 did not differ among the three groups. The GLP-2 levels were significantly lower in the NDO and T2D than in the C group following standard meal tolerance test at all the times evaluated. The area under the curve of the GLP-2 was significantly lower in the NDO and T2D groups than in the C group (P=0.05 and P=0.01, respectively). Conclusion -GLP-2 levels were impaired in the individuals with obesity and diabetes. This mechanism seems to be enrolled in preventing the worsening of the glucose homeostasis in these individuals. HEADINGS -Glucagon-like peptide 1. Glucagon-like peptide 2. Diabetes mellitus. Obesity. Insulin resistance. Incretins.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Levels of C-Reactive Protein, GLP-1 and GLP-2 Among Individuals With Diabetes, Morbid Obesity and Healthy Controls: An Exploratory Study

Cazzo

Pareja

Chaim

et al. 2018

Arq. Gastroenterol.

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“…Laparoscopic Roux-en-y gastric bypass and laparoscopic vertical sleeve gastrectomy result in EWL of approximately 50-80% (14). Resolution of diabetes, hypertension, hyperlipidemia and sleep apnea are reported as 60-80% with either procedure (15)(16)(17)(18)(19)(20). Despite these known outcomes, many PCPs underestimate EWL and co-morbidity resolution at less than 60% (6).…”

Section: Discussionmentioning

confidence: 99%

A survey of primary care physician referral to bariatric surgery in Manitoba: access, perceptions and barriers

El-Beheiry¹,

Vergis²,

Choi³

et al. 2020

Ann Transl Med

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Background: There is an important disconnect between surgical programs and primary care physicians (PCP) in the delivery of bariatric care. The objective of this study is to assess PCP knowledge and perception of a provincial bariatric surgery program.Methods: A 32-question, IRB approved, survey was developed by bariatric surgery experts and vetted by local PCPs. A single round of paper surveys was administered to 1,000 PCPs between July and September 2015. Continuous variables were assessed by t-test and categorical variables by Chi-square test.Results: There were 131 survey responses (13.1%). Half (54.2%) of respondents did not feel equipped to counsel their patients on operative management strategies. PCPs counselled on average 11.6%±17.0% of their obese patients on bariatric surgery. Many respondents (58.3%) thought excess weight loss from gastric bypass was less than 40% and most believed there was less than 50% resolution of diabetes (62.4%), hypertension (72.3%), dyslipidemia (77.8%) and obstructive sleep apnea (60.6%). PCPs who referred patients to the bariatric program (71.8%) were more comfortable counselling their patients on bariatric surgery options (56.8% vs. 17.1%, P<0.001) and were more comfortable with post-operative care (67.4% vs.38.2%, P=0.004). Additionally, these PCPs estimated higher rates of diabetes and hypertension resolution post-bariatric surgery. The predominant perceived barrier to accessing bariatric surgery was wait times (33.3%).Conclusions: PCPs appear to underestimate the efficacy of bariatric surgery in the treatment of obesity and feel ill-equipped to counsel patients. Further education related to bariatric surgery may improve PCP comfort in counselling and long-term follow-up.

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“…Over the last decades, asthma and obesity reached epidemic proportions worldwide and lead to harmful effects both for the individuals affected and for the health system; hence, to understand and gain insight on the pathophysiological aspects that interconnect both diseases may provide significant targets for the conjoint therapeutic strategies involving both diseases. Bariatric surgery has become the gold standard treatment option for refractory morbid obesity; it leads to significant long-term weight loss and resolution of comorbidities, as well as a decrease of the all-cause mortality among individuals with obesity [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Influence of weight loss on pulmonary function and levels of adipokines among asthmatic individuals with obesity: One-year follow-up

Baltieri

Cazzo

Souza

et al. 2018

Respiratory Medicine

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Background: Individuals with obesity are more likely to develop asthma, but the exact mechanism is still uncertain and several hypotheses have been raised, such as the release of inflammatory mediators secreted by adipose tissue. Objective: To assess the effects of weight loss in patients submitted to bariatric surgery on pulmonary and systemic inflammation. Method: The study evaluated patients undergoing bariatric surgery (Roux-en-Y gastric bypass) with the diagnosis of asthma, except smokers. The patients were evaluated at the time of entry into a preoperative weight loss group (T1), just before bariatric surgery (T2), six months after surgery (T3), and 12 months after surgery (T4). The following were measured: anthropometric data, dosage of systemic inflammatory markers by means of blood collection, pulmonary inflammatory markers obtained by induced sputum collection, pulmonary function parameters, and asthma activity assessed by a Asthma Control Test (ACT) questionnaire. Results: Nineteen patients participated in the study. There were significant reductions in the systemic levels of interleukin (IL)-8 (p = 0.002), C-reactive protein (CRP) (p = 0.003), leptin (p = 0.001) and tumor necrosis factor (TNF)-α (p = 0.007), and significant increase in the systemic levels of IL-6 (p = 0.004) over time and adiponectin in T2 (p = 0.025). In regards to pulmonary inflammation, there were significant reductions in the sputum levels of TNF-α (p < 0.001). There was no significant improvement of the pulmonary function parameters (p > 0.05) and significant improvement in asthma activity scores (p < 0.0001). Conclusion: Weight loss was associated with significant changes in the systemic and pulmonary inflammatory profiles of individuals with asthma, leading to a better asthma control as a result of an increase in some antiinflammatory mediators and a reduction of pro-inflammatory mediators.

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Control of Hypertension After Roux-en-Y Gastric Bypass Among Obese Diabetic Patients

Cited by 12 publications

References 29 publications

Comparison of the Levels of C-Reactive Protein, GLP-1 and GLP-2 Among Individuals With Diabetes, Morbid Obesity and Healthy Controls: An Exploratory Study

Comparison of the Levels of C-Reactive Protein, GLP-1 and GLP-2 Among Individuals With Diabetes, Morbid Obesity and Healthy Controls: An Exploratory Study

A survey of primary care physician referral to bariatric surgery in Manitoba: access, perceptions and barriers

Influence of weight loss on pulmonary function and levels of adipokines among asthmatic individuals with obesity: One-year follow-up

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