Metabolic surgery: A paradigm shift in type 2 diabetes management

Pappachan, Joseph M; Viswanath, Ananth

doi:10.4239/wjd.v6.i8.990

Cited by 10 publications

(9 citation statements)

References 52 publications

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“…Bariatric surgery remains an efficacious treatment for diabetes and obesity. In a recent meta-analysis weight loss ranged between 20% and 50% and rates of diabetes remission between 40% and 90% with the studies included in this analysis having a duration of between 12 and 24 months [127] . Given the metabolic benefits afforded by bariatric surgery it is not surprising that a second meta-analysis has shown marked improvements in liver histology including a 50% reduction in the incidence of steatosis and an 11.9% reduction in the incidence of fibrosis pre and post bariatric surgery [123] .…”

Section: Future Directionsmentioning

confidence: 99%

Non-alcoholic fatty liver disease and diabetes

et al. 2016

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Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are common conditions that regularly co-exist and can act synergistically to drive adverse outcomes. The presence of both NAFLD and T2DM increases the likelihood of the development of complications of diabetes (including both macro- and micro- vascular complications) as well as augmenting the risk of more severe NAFLD, including cirrhosis, hepatocellular carcinoma and death.The mainstay of NAFLD management is currently to reduce modifiable metabolic risk. Achieving good glycaemic control and optimising weight loss are pivotal to restricting disease progression. Once cirrhosis has developed, it is necessary to screen for complications and minimise the risk of hepatic decompensation.Therapeutic disease modifying options for patients with NAFLD are currently limited. When diabetes and NAFLD co-exist, there are published data that can help inform the clinician as to the most appropriate oral hypoglycaemic agent or injectable therapy that may improve NAFLD, however most of these data are drawn from observations in retrospective series and there is a paucity of well-designed randomised double blind placebo controlled studies with gold-standard end-points. Furthermore, given the heterogeneity of inclusion criteria and primary outcomes, as well as duration of follow-up, it is difficult to draw robust conclusions that are applicable across the entire spectrum of NAFLD and diabetes. In this review, we have summarised and critically evaluated the available data, with the aim of helping to inform the reader as to the most pertinent issues when managing patients with co-existent NAFLD and T2DM.

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Section: Future Directionsmentioning

confidence: 99%

Non-alcoholic fatty liver disease and diabetes

et al. 2016

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“…(10,11) Glavni patofiziološki mehanizmi koji posreduju pozitivne efekte metaboličke hirurgije su: povećanje insulinske senzitivnosti (pre svega na nivou jetre i mišića), popravljanje funkcije beta ćelija, promene u sekreciji žučnih kiselina (redukuju hepatičnu glukoneogenezu i povećavaju intestinalnu glukoneogenezu u delovima bez žučnih kiselina), promena sastava i modifikacija crevne mikroflore, povećavanje preuzimanja glukoze na nivou gastrointestinalnog trakta (što je bitno u postprandijalnoj kontroli glikemije) i povećanje količine mrkog masnog tkiva. (12) Najznačajniji mehanizam remisije DM2 je smanjenje telesne mase nakon operacije (13). Rapidno poboljšanje hepatičke insulinske sezitivnosti u kratkom roku nakon operacije rezultat je intenzivne redukcije kalorijskog unosa, dok je popravljanje insulinske senzitivnosti posledica gubitka telesne mase.…”

Section: Mehanizam Remisije Dm2 Nakon Hirurškog Lečenja Gojaznostiunclassified

“…Povećana sekrecija GLP-1, PYY, GDIP i oksintomodulina menjaju energetski metabolizam, kao i posledično smanjenje grelina koji suprimuje signale gladi. (13,14) Faktori koji utiču na postizanje remisije nakon barijatrijske hirurgije su: preoperativna glikemijska kontrola, trajanje bolesti, komplijansa pacijenta, izgubljena telesna masa, tip šećerne bolesti i početne količine visceralnog masnog tkiva. Wang i saradnici su u skorašnjoj metaanalizi 15 studija (n = 1,753) pokazali da su starije životno doba, duže trajanje dijabetesa, upotreba insulina i lošija kontrola bolesti povezani sa manjom verovatnoćom remisije dijabetesa, a da pol i početni indeks telesne mase (BMI) nemaju značaja za postizanje remisije.…”

Section: Mehanizam Remisije Dm2 Nakon Hirurškog Lečenja Gojaznostiunclassified

Remisija diabetes mellitusa tipa 2 kod gojaznih pacijenata

Vidić¹,

Đenić²

2019

Med gl Spec bol štit Zlatibor

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Šećerna bolest predstavlja poremećaj metabolizma ugljenih hidrata koji se u kasnijem toku karakteriše razvojem brojnih komplikacija i pogoršanjem kvaliteta života. Remisija šećerne bolesti tipa 2 (DM2) se definiše kao održavanje glikoregulacije ispod nivoa koji se koristi za postavljanje dijagnoze: glikozilirani hemoglobin (HbA1c) manji od 6% (<42 mmol/mol) i glikemija našte manja od 5.6 mmol/L, tokom godine dana, a bez korišćenja antidijabetesnih lekova. Ključ remisije šećerne bolesti tipa 2 (DM2) je redukcija telesne mase, što može biti rezultat pridržavanja hipokalorijskih dijeta i/ili rezultat hirurškog lečenja-barijatrijskom hirurgijom. Za postizanje remisije šećerne bolesti tipa 2 kod gojaznih pacijenata, koji čine većinu obolelih, savetuje se gubitak minimum 15 kg ili prosečno oko 15% telesne mase. Barijatrijska hirurgija dovodi do značajnog i održivog gubitka telesne mase i remisije šećerne bolesti i do 5 godina nakon intervencije. Faktori koji utiču na postizanje remisije nakon barijatrijske hirurgije su: preoperativna glikemijska kontrola, trajanje bolesti, komplijansa pacijenta, izgubljena telesna masa, tip šećerne bolesti i početne količine visceralnog masnog tkiva. SOS studija je pokazala da su operisani pacijenti imali značajno veći procenat remisije bolesti nego grupa pacijenata koja je tretirana klasičnom modifikacijom životnog stila. Za remisiju bolesti je bila značajnija redukcija težine nego početni BMI. Look AHEAD studija nije uspela da dokaže redukciju kardiovaskularnih događaja promenom životnih navika, ali je jasno pokazala da intenzivna modifikacija životnih navika dovodi do značajnije redukcije telesne mase i bolje kontrole DM2. DiRECT studija je pokazala da je 45,6% pacijenata koji su oboleli od šećerne bolesti tipa 2, a koji su bili na niskokalorijskoj dijeti, ušlo u remisiju DM2 nakon 12 meseci. Ova studija je pokazala da je 64% pacijenata koji su izgubili više od 10kg bila u remisiji DM2 i nakon dve godine. S obzirom na to da je barijatrijska hirurgija skupa metoda, povezana sa komplikacijama i rizicima, potrebno je usmeriti istraživanja na manje agresivne intervencije

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“…The restriction in calorie intake achieved directly by surgical procedures and indirectly by self-adaptation to restrict post-prandial dumping syndrome, alterations in satiety by postprandial neuro-humoral signals and incretin effects, mal-absorption of nutrients, increase in beta cell mass and improvement in insulin production, and changes in the gut microbiome are some of the mechanisms that play important roles in control and remission of T2DM in patients undergoing bariatric surgical procedures. 48 – 50 …”

Section: Bariatric Surgerymentioning

confidence: 99%

Non-pharmacological Treatment Options in the Management of Diabetes Mellitus

Raveendran

Chacko

Pappachan

2018

European Endocrinology

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The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.

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Metabolic surgery: A paradigm shift in type 2 diabetes management

Cited by 10 publications

References 52 publications

Non-alcoholic fatty liver disease and diabetes

Non-alcoholic fatty liver disease and diabetes

Remisija diabetes mellitusa tipa 2 kod gojaznih pacijenata

Non-pharmacological Treatment Options in the Management of Diabetes Mellitus

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