Bariatric and metabolic surgery and microvascular complications of type 2<i>diabetes mellitus</i>

Cohen, Ricardo; Pechy, Fernando Nogueira Quirino; Petry, Tarissa; Correa, José Luis; Caravatto, Pedro Paulo de Paris; Tzanno-Martins, Carmen

doi:10.5935/0101-2800.20150061

Cited by 13 publications

(17 citation statements)

References 57 publications

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“…Although our findings for reduction in incident microvascular disease for postbariatric patients with type 2 diabetes are supported by the literature to date (10,11,19), the rate reported here is less pronounced (29% reduction) compared with rates reported in other studies. For example, the Swedish Obese Subjects (SOS) study found a 56% lower risk of incident microvascular disease postsurgery (19), and a much larger retrospective observational study of 2,580 bariatric patients found an 80% lower risk of incident microvascular disease (11).…”

Section: Discussionsupporting

confidence: 69%

“…A recent review of the literature published since 2011 found that in general, there was strong support for postbariatric reduction in risk for nephropathy, less so for retinopathy, and almost no evidence published for neuropathy (10). Only one study had been performed with a large patient population (>2,500 bariatric patients) representative of current clinical practices in the U.S. (11).…”

Section: Introductionmentioning

confidence: 99%

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Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

et al. 2016

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OBJECTIVETo identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSWe conducted a retrospective observational cohort study (n = 4,683; 40% racial/ethnic minority) of patients with type 2 diabetes who underwent bariatric surgery from 2001 through 2011. The primary outcome measure was incident microvascular disease defined as a composite indicator of the first occurrence of retinopathy, neuropathy, and/or nephropathy. The Cox proportional hazards framework was used to investigate the associations between type 2 diabetes remission/relapse status and time to microvascular disease.RESULTSCovariate-adjusted analyses showed that patients who experienced type 2 diabetes remission had 29% lower risk of incident microvascular disease compared with patients who never remitted (hazard ratio [HR] 0.71 [95% CI 0.60, 0.85]). Among patients who experienced a relapse after remission, the length of time spent in remission was inversely related to the risk of incident microvascular disease; for every additional year of time spent in remission prior to relapse, the risk of microvascular disease was reduced by 19% (HR 0.81 [95% CI 0.67, 0.99]) compared with patients who never remitted.CONCLUSIONSOur results indicate that remission of type 2 diabetes after bariatric surgery confers benefits for risk of incident microvascular disease even if patients eventually experience a relapse of their type 2 diabetes. This provides support for a legacy effect of bariatric surgery, where even a transient period of surgically induced type 2 diabetes remission is associated with lower long-term microvascular disease risk.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

et al. 2016

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“…Bariatric surgical procedures can cause prompt and sustained normoglycaemia in up to 80% patients with T2DM and episodes of postoperative reactive hypoglycaemia are not uncommon, making EW of DR a potential concern in this group . Retrospective studies have demonstrated variable effects of bariatric surgery on DR with worsening reported in between 1% and 45% of subjects 1 year after surgery .…”

Section: Discussionmentioning

confidence: 99%

“…Bariatric surgical procedures can cause prompt and sustained normoglycaemia in up to 80% patients with T2DM 51,52 and episodes of postoperative reactive hypoglycaemia are not uncommon, making EW of DR a potential concern in this group. 53 Retrospective studies have demonstrated variable effects of bariatric surgery on DR with worsening reported in between 1% and 45% of subjects 1 year after surgery. 11,[54][55][56][57] In a prospective observational study, 13% of patients exhibited progression of DR in the first 12 months post-operatively, but only 5% of those persisted at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Early worsening of diabetic retinopathy due to intensive glycaemic control

Lim

Wijngaarden

Harper

et al. 2018

Clinical Exper Ophthalmology

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The prevalence of diabetes and diabetic retinopathy is increasing around the world. Glycaemic control is important in reducing the long‐term risk of complications of diabetes, however intensive glycaemic control, particularly in patients with longstanding and poorly controlled diabetes, is associated with the risk of early worsening of diabetic retinopathy and vision loss. We present two clinical cases to illustrate the presentation of early worsening and to highlight a role for intravitreal anti‐vascular endothelial growth factor therapies in ameliorating this phenomenon, as well as a review of the current understanding of this phenomenon. We emphasise the importance of identifying individuals at risk of early worsening of diabetic retinopathy and recommend regular ophthalmological review during the period of intensive glycaemic control to ensure optimal visual outcomes.

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“…Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with alterations in carbohydrate and fat metabolism and is strongly associated with major health complications, increasing overall morbidity and mortality with enormous economic costs . Although the exact etiology of T2DM remains unclear, hyperglycemia has been identified as a hallmark for T2DM and has been linked to increase the risk of major health complications . Therefore, glycemic management has been primarily suggested as a therapeutic approach for T2DM.…”

Section: Introductionmentioning

confidence: 99%

Antidiabetic effect of chitosan oligosaccharide (GO2KA1) is mediated via inhibition of intestinal alpha‐glucosidase and glucose transporters and PPARγ expression

Kwon

Lee

et al. 2016

BioFactors

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We have previously reported that administration of low molecular weight chitosan oligosaccharide (GO2KA1) significantly suppressed postprandial blood glucose rise with increased plasma adiponectin and HbA1c levels in animals and humans. However, the cellular mechanisms whereby GO2KA1 exerts antihyperglycemic effects still remain to be determined. Using intestinal Caco-2 cells and 3T3-L1 cells, here we show that GO2KA1 has dual modes of antidiabetic action by (1) inhibiting intestinal α-glucosidase as well as glucose transporters SGLT1 and GLUT2 that were distinct from the acarbose effect; (2) enhancing adipocyte differentiation, PPARγ expression and its target genes, such as FABP4, adiponectin, and GLUT4, whereas the effects were abolished by co-treatment with BADGE, a PPARγ antagonist. Moreover, GO2KA1 significantly increased glucose uptake, which was reduced in the presence of BADGE. Our data show that GO2KA1 may prevent hyperglycemia by inhibiting intestinal glucose digestion and transport and also enhance glucose uptake, at least in part, by upregulating adiponectin expression through PPARγ in adipocytes. These findings may provide potential molecular modes of action for the antidiabetic effects of chitosan oligosaccharide observed in clinical and animal studies. © 2016 BioFactors, 43(1):90-99, 2017.

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Bariatric and metabolic surgery and microvascular complications of type 2diabetes mellitus

Abstract: Overall, although data so far is exciting, there is a pressing need for prospective randomized controlled trials examining long-term microvascular outcomes following bariatric/metabolic surgery in patients with T2DM.

Cited by 13 publications

References 57 publications

Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

Early worsening of diabetic retinopathy due to intensive glycaemic control

Antidiabetic effect of chitosan oligosaccharide (GO2KA1) is mediated via inhibition of intestinal alpha‐glucosidase and glucose transporters and PPARγ expression

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