Bariatric surgery in patients with Type 2 diabetes: benefits, risks, indications and perspectives

Scheen, André; Flines, Jenny De; Roover, Arnaud De; Paquot, Nicolas

doi:10.1016/s1262-3636(09)73463-9

Cited by 22 publications

(16 citation statements)

References 48 publications

(72 reference statements)

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“…RYGB postoperative glucose was reduced earlier than weight loss, indicating that weight loss and reducing the food intake may not be the real cause of RYGB improving glucose levels. However, the exact mechanism involved remains unclear (15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Gastric bypass surgery alters the mechanisms of insulin resistance in the adipose tissue of GK rats

Wang

Zhou

et al. 2012

Molecular Medicine Reports

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Abstract. Roux-en-Y gastric bypass (RYGB) has become an effective treatment for type 2 diabetes mellitus (T2DM). However, the blood glucose mechanism involved remains unclear. In this study, 60 male Goto-Kakizaki (GK) rats were randomly divided into 6 groups (each with 10 rats): the GB1/2 group (treated with gastric bypass surgery), the SO1/2 group (treated with sham operation) and the CO1/2 group (with normal water consumption only). We tested expression levels of tumor necrosis factor α (TNFα) mRNA, glucose transporter 4 (GLUT4), peroxisome proliferator-activated receptor γ2 (PPARγ2) and phosphatidylinositol-3-kinase subunit p85α (PI3Kp85α) in the adipose tissues. We found that the weight, fasting blood glucose and postprandial blood glucose decreased in the GB group compared with the CO group. A total of 20 and 30 days after surgery, PPARγ2, PI3Kp85α and GLUT4 increased in the fat tissue in the GB group compared with the CO group. However, 20 days after surgery, TNFα mRNA decreased in fat tissue by 0.51 times in the GB group compared with the CO group, and serum TNFα levels showed no statistically significant difference. Fasting blood glucose and GLUT4 membrane protein were negatively correlated. In conclusion, RYGB may improve insulin resistance and treat T2DM through upregulation of the PPARγ2 protein, downregulation of TNFα mRNA transcription, through the autocrine pathway, upregulation of PI3Kp85α expression, upregulation of GLUT4 mRNA transcripts and by inducing translocation of GLUT4 in adipose tissue. IntroductionIt has been reported that the incidence of diabetes has increased to up to 9.7% of the population over the age of 20 in China (almost 92.4 million in total) (1). Globally, China has become the country with the fastest growth in diabetes incidence, overtaking India. Type 2 diabetes mellitus (T2DM) patients account for 90% of all patients with diabetes, and the number of diabetes patients overall has increased primarily due to the increase in T2DM patients. Over the years, the clinical treatment of T2DM has involved using traditional conservative therapy, including drugs to stimulate insulin secretion and insulin replacement therapy. However, according to a recent study, drug therapy and insulin replacement therapy cannot delay the complications in high-risk T2DM patients and cannot improve the prognosis (2). A weight-loss surgeon discovered coincidentally that the blood glucose in obese Roux-en-Y gastric bypass (RYGB) patients with T2DM decreased to normal levels postoperatively and was maintained in the long-term (3). Currently, as the medical treatment of T2DM and control of complications is generally ineffective, this discovery will undoubtedly bring a glimmer of hope for the majority of T2DM patients.The main clinical manifestations of T2DM include damaged islet cell function and progressive increases of insulin resistance (4). In the pathogenesis of T2DM, insulin resistance is an important link, which is mainly caused by decreasing the glucose uptake and use of the peripheral tissues. In ...

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Section: Discussionmentioning

confidence: 99%

Gastric bypass surgery alters the mechanisms of insulin resistance in the adipose tissue of GK rats

Wang

Zhou

et al. 2012

Molecular Medicine Reports

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“…[101] Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. [102] Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity, including patients with body mass index 30.0-34.9 kg/m² if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. [103] …”

Section: Anti-obesity Agents and Bariatric/metabolic Surgerymentioning

confidence: 99%

Pharmacological management of type 2 diabetes: what’s new in 2017?

Scheen

2017

Expert Review of Clinical Pharmacology

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IntroductionNovelties in the management of type 2 diabetes are dominated by the commercialisation of new glucose-lowering agents, which offer alternatives to older antidiabetic medications, and by the publication of several prospective placebo-controlled outcome trials, which demonstrated not only cardiovascular safety but also cardiovascular and renal protection with some new medications. Areas coveredUpdates regarding the use of glucose-lowering agents are discussed from a clinical point of view. Some new viewpoints concern older antidiabetic agents such as metformin, sulfonylureas and glitazones whose benefit-risk balance has been revisited, especially in high risk patients. The recent data regarding DPP-4 inhibitors (gliptins) focused on the safety profile of this pharmacological class, including in patients with impaired renal function. The highlight concerns the cardiovascular (and renal) protection by some GLP-1 receptor agonists (liraglutide, semaglutide) and SGLT2 inhibitors (empagliflozin, canagliflozin) in patients with high cardiovascular risk. Finally, efficacy and safety of new combinations and advances in insulin therapy will be briefly discussed. Expert Opinion/commentaryThe recent data from randomized controlled trials, meta-analyses and observational real-life studies should trigger a revision of the algorithm for the treatment of hyperglycemia in type 2 diabetes, especially in patients with high cardiovascular and/or renal risk.

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“…Classiquement, la chirurgie est réservée aux patients avec un indice de masse corporelle (IMC) supérieur à 40 kg/m² ou supérieur à 35 kg/m² si cette obésité est accompagnée de complications secondaires à la surcharge pondérale [4,5], dont le diabète de type 2 (DT2) occupe une place importante [6]. Pendant longtemps, la perte pondérale induite par la chirurgie bariatrique a été uniquement expliquée par la balance énergétique négative résultant d'un apport calorique limité mécaniquement par les techniques dites restrictives et/ou d'une déperdition calorique fécale imposée par les techniques dites malabsorptives.…”

Section: Introductionunclassified

Le tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique

Scheen

Flines

Roover

et al. 2011

Médecine des Maladies Métaboliques

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Mots clés : Chirurgie bariatrique -Chirurgie métabolique -Dérivation gastro-intestinaleDiabète de type 2 -Hormones digestives -Incrétine -Obésité SUMMARYBariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission of diabetes occurs very early, before any significant weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. These hormonal changes result from partial stomach amputation (leading to reduced ghrelin secretion), from bypass of duodenal-jejunal foregut (leading to reduced secretion of still unknown factors that may counteract insulin secretion and/or action) and from an earlier contact of food with hindgut (leading to enhanced secretion of incretin hormones such as glucagon-like peptide-1 -GLP-1 -by the ileal L cells, neuropeptide YY and oxyntomodulin). The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery.

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Bariatric surgery in patients with Type 2 diabetes: benefits, risks, indications and perspectives

Cited by 22 publications

References 48 publications

Gastric bypass surgery alters the mechanisms of insulin resistance in the adipose tissue of GK rats

Gastric bypass surgery alters the mechanisms of insulin resistance in the adipose tissue of GK rats

Pharmacological management of type 2 diabetes: what’s new in 2017?

Le tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique

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